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Wound infection following implant removal of foot, ankle, lower leg or patella; a protocol for a multicenter randomized controlled trial investigating the (cost-)effectiveness of 2 g of prophylactic cefazolin compared to placebo (WIFI-2 trial)

Background: Elective implant removal (IR) after fracture fixation is one of the most common procedures within (orthopedic) trauma surgery. The rate of surgical site infections (SSIs) in this procedure is quite high, especially below the level of the knee. Antibiotic prophylaxis is not routinely prescribed, even though it has proved to lower SSI rates in other (orthopedic) trauma surgical procedures. The primary objective is to study the effectiveness of a single intravenous dose of 2 g of cefazolin on SSIs after IR following fixation of foot, ankle and/or lower leg fractures. Methods: This is a multicenter, double-blind placebo controlled trial with a superiority design, including adult patients undergoing elective implant removal after fixation of a fracture of foot, ankle, lower leg or patella. Exclusion criteria are: an active infection, current antibiotic treatment, or a medical condition contraindicating prophylaxis with cefazolin including allergy. Patients are randomized to receive a single preoperative intravenous dose of either 2 g of cefazolin or a placebo (NaCl). The primary analysis will be an intention-to-treat comparison of the proportion of patients with a SSI at 90 days after IR in both groups. Discussion: If 2 g of prophylactic cefazolin proves to be both effective and cost-effective in preventing SSI, this would have implications for current guidelines. Combined with the high infection rate of IR which previous studies have shown, it would be sufficiently substantiated for guidelines to suggest protocolled use of prophylactic antibiotics in IR of foot, ankle, lower leg or patella. Trial registration Nederlands Trial Register (NTR): NL8284, registered on 9th of January 2020, https://www.trialregister.nl/trial/8284

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Wound infection following implant removal of foot, ankle, lower leg or patella; a protocol for a multicenter randomized controlled trial investigating the (cost-)effectiveness of 2 g of prophylactic cefazolin compared to placebo (WIFI-2 trial)

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COVID 19 Conspiracy Thinking Across the World

Presentatie van het manuscript 'COVID 19 Conspiracy Thinking Across the World ' door Annemarie Walter en Hugo Drochon bij REPRESENT, Research Centre for the Study of Parties and Democracy van de Universiteit van Nottingham, op 24 maart 2021.

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The relation of asymmetry in power and balance in the lower extremities

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Lower limb orthoses

Background: Osteoarthritis (OA) is the most common rheumatic disease of the musculoskeletal system, with the knee as the most affected joint. The number of people with OA of the knee is likely to increase due to the ageing society and the obesity epidemic. The predominant clinical symptom of knee OA is pain, which is described as worsening by activity and relieving by rest. Knee instability has been recognized as an important clinical feature in persons with knee OA. Pain and knee instability are associated with limitations in performing daily activities. Non-pharmacological options in the management of knee OA consist of education, weight loss, exercise, braces and physical therapy. Knee bracing has been recommended by the Osteoarthritis Research Society International (OARSI). Valgus knee braces designed to decrease loads on the medial compartment of the knee for patients with varus alignment are the most common. It has been shown however, that valgus bracing may have little or no effect on pain and physical functioning, and adherence to this treatment in patients with knee OA is low.Because of ease of use and access, lack of complications and low cost, soft knee braces are commonly used in persons with knee OA. However, the evidence for efficacy of soft knee bracing on pain and activity limitations in knee OA is limited. Therefore, it is important to strengthen the evidence of using a soft brace to reduce pain and activity limitations as well as to evaluate the efficacy of soft knee bracing on knee instability in persons with knee OA. There is also debate about the effectiveness of soft braces in other affected joints of the lower extremity and in conditions other than OA such as rheumatoid arthritis.Objectives: The aim of the study will be to evaluate the effect of wearing a soft brace on dynamic knee instability in patients with OA of the knee.Methods: Persons with knee OA and self-reported knee instability from the Amsterdam Osteoarthritis cohort participated in a single-session lab-experimental study. A within-subject design was used, comparing no brace versus brace, and comparing a non-tight versus a tight brace (standard fit). The primary outcome measure was dynamic knee instability, expressed by the Perturbation Response (PR), i.e., a biomechanics based measure reflecting deviation in the mean knee varus-valgus angle after a controlled mechanical perturbation, standardized to the mean (SD) varus-valgus angle during level walking. Linear mixed-effect model analysis was used to evaluate the effect of a brace on dynamic knee instability.Results: The wearing of a soft brace reduced the knee instability significantly during perturbed walking. Results will also be presented from the literature search and from the lab-experimental study.Conclusion: Wearing a soft brace reduces dynamic knee instability in patients with knee OA. However, longitudinal studies are needed to evaluate the clinical implications of wearing a soft brace.

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Jump landing characteristics predicts lower extremity injuries in indoor team sports

The aim of this study is to investigate the predictivevalue of landing stability and technique togain insight into risk factors for ankle and kneeinjuries in indoor team sport players. Seventyfivemale and female basketball, volleyball orkorfball players were screened by measuringlanding stability after a single-leg jump landingand landing technique during a repeated countermovement jump by detailed 3-dimensional kinematicsand kinetics. During the season 11 acuteankle injuries were reported along with 6 acuteand 7 overuse knee injuries by the teams’ physicaltherapist. Logistic regression analysis showedless landing stability in the forward and diagonaljump direction (OR 1.01–1.10, p ≤ 0.05) in playerswho sustained an acute ankle injury. Furthermorelanding technique with a greater ankle dorsiflexionmoment increased the risk for acuteankle injury (OR 2.16, p ≤ 0.05). A smaller kneeflexion moment and greater vertical groundreaction force increased the risk of an overuseknee injury (OR 0.29 and 1.13 respectively,p ≤ 0.05). Less one-legged landing stability andsuboptimal landing technique were shown inplayers sustaining an acute ankle and overuseknee injury compared to healthy players. Determiningboth landing stability and technique mayfurther guide injury prevention programs.

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Effects of reduced relative implicit and explicit feedback on lower extremity jump-landing mechanics: a preliminary analysis

Implicit (IF) and explicit (EF) feedback are two motor learning strategies that have been demonstrated to alter biomechanical movement patterns. While both strategies have been utilized for injury prevention, it remains unclear which strategy may be more effective. PURPOSE: To examine the effects of reduced relative IF and EF feedback on lower extremity landing mechanics. METHODS: Seventeen participants (23.5±0.9 years, 1.72±0.1m, 67.7±11.5kg) were randomly assigned to three groups: IF (n=6), EF (n=5), and Control (CG) (n=6). A box-drop jump task was performed three times a week for six weeks. Testing occurred before and after 6 weeks of intervention. IF and EF were provided by ? video feedback with instructions, while CG received no feedback. IF were instructed to focus their attention outside their body, while EF were instructed to focus their attention to their lower extremities. Intervention sessions were partitioned into 100% feedback, 33% feedback, and 16.6% feedback frequency phases. Participants viewed video recordings of their task to analyze their jump-landing mechanics from both a sagittal and frontal plane cameras. Participants viewed 2 video recordings per camera, once in real-time and once in slow motion. Multivariate analysis of variance was conducted to compare differences between groups and time for hip abduction angle (HA), knee abduction moment (KAM), and knee flexion angle (KF). RESULTS: No statistically significant difference (p>0.05) was found for: HA (CG:pre=-9.85±5.3, post=-7.36±8.65; IF:pre=-4.17±2.67, post=-7.52±5.27; EF:pre=-5.68±6.12, post=-5.98±5.43), KAM (CG:pre=-0.5±0.3, post=-0.34±0.13; IF:pre=-0.5±0.21, post=-0.48±0.13; EF:pre=-0.48±0.12, post=-0.46±0.26), and KF (CG:pre=-92.26±9.12, post=-100.33±15.2; IF:pre=-106.37±16.34, post=-103.45±19.97; EF:pre=-100.32±11.4, post=-112.4±18.22). CONCLUSION: We did not find statistically significant differences for any dependent measures between groups from pre to post-test. It should be noted that IF HA slightly decreased from pre to post-test whereas it increased for CG. For KAM, CG was lower on post-test comparing to IF and EF. EF and CG trended to decrease from pre to post-test, while IF slightly increased KF. Our preliminary findings partially support that implicit and explicit feedback alters lower body mechanics while jumping.

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Effectiveness and cost-effectiveness of an optimized process of providing assistive technology for impaired upper extremity function

Background: Impaired upper extremity function due to muscle paresis or paralysis has a major impact on independent living and quality of life (QoL). Assistive technology (AT) for upper extremity function (i.e. dynamic arm supports and robotic arms) can increase a client’s independence. Previous studies revealed that clients often use AT not to their full potential, due to suboptimal provision of these devices in usual care. Objective: To optimize the process of providing AT for impaired upper extremity function and to evaluate its (cost-)effectiveness compared with care as usual. Methods: Development of a protocol to guide the AT provision process in an optimized way according to generic Dutch guidelines; a quasi-experimental study with non-randomized, consecutive inclusion of a control group (n = 48) receiving care as usual and of an intervention group (optimized provision process) (n = 48); and a cost-effectiveness and cost-utility analysis from societal perspective will be performed. The primary outcome is clients’ satisfaction with the AT and related services, measured with the Quebec User Evaluation of Satisfaction with AT (Dutch version; D-QUEST). Secondary outcomes comprise complaints of the upper extremity, restrictions in activities, QoL, medical consumption and societal cost. Measurements are taken at baseline and at 3, 6 and 9 months follow-up.

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Effectiveness and cost-effectiveness of an optimized process of providing assistive technology for impaired upper extremity function

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Monitoring perceived stress, recovery and non-traumatic lower extremity injuries in competitive runners

Runners often sustain lower extremity injuries (19-79%) (van Gent et al, 2007). In a theoretical model it has been described that a disturbance in perceived stress and recovery can increase the risk of sustaining an injury (Williams & Andersen, 1998). Therefore, the purpose of this study was to investigate changes in perceived stress and recovery preceding an injury of competitive runners.Methods: Twenty-four competitive runners were monitored over one full training season (46 weeks). Every week, the runners filled an on-line RESTQ-sport (Nederhof et al, 2008). Furthermore, runners and their coaches kept a log with injuries and physical complaints. A non-traumatic injury was defined as any pain, soreness or injury that was not caused by trauma and resulted from training and led to a decrease in training duration or training intensity for at least one week (Jacobsson et al, 2013). Because baseline levels of perception of stress and recovery vary largely between runners, the 19 scales of the RESTQ-Sport were normalized to Z-scores based on the runner’s individual average and standard deviation of the whole season (excl. injured periods). The normalized scores of 1, 2 and 3 weeks before the first sustained injury were compared to 0, which is the average normalized score, by repeated measures ANOVA’s.Results: Twenty-two runners sustained a non-traumatic lower extremity injury. Eight of these runners filled out the RESTQ-Sport all 3 weeks preceding the injury and their data was used for further analysis. The injuries sustained were non-traumatic injuries of the knee, Achilles tendon, ankle, foot and shin. It was shown that 1 week preceding the injury, runners scored lower than the average normalized score on “Success” (Z-score: -0.68±0.62) and 2 weeks preceding the injury runners scored higher than their average on “Fitness/Injuries” (Z-score: 1.04±1.12).Discussion: A decrease in perceived success may be a marker to predict a non-traumatic lower extremity injury. Also an increase in the perception of muscle ache, soreness, pain and vulnerability to injury (“Fitness/Injury”) preceded injuries. Thereby, monitoring changes in individual stress and recovery may help to prevent non-traumatic injuries.

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Risk factors for lower-extremity injuries among contemporary dance students

OBJECTIVE: To determine whether student characteristics, lower-extremity kinematics, and strength are risk factors for sustaining lower-extremity injuries in preprofessional contemporary dancers.DESIGN: Prospective cohort study.SETTING: Codarts University of the Arts.PATIENTS: Forty-five first-year students of Bachelor Dance and Bachelor Dance Teacher.ASSESSMENT OF RISK FACTORS: At the beginning of the academic year, the injury history (only lower-extremity) and student characteristics (age, sex, educational program) were assessed using a questionnaire. Besides, lower-extremity kinematics [single-leg squat (SLS)], strength (countermovement jump) and height and weight (body mass index) were measured during a physical performance test.MAIN OUTCOME MEASURES: Substantial lower-extremity injuries during the academic year were defined as any problems leading to moderate or severe reductions in training volume or in performance, or complete inability to participate in dance at least once during follow-up as measured with the Oslo Sports Trauma Research Center (OSTRC) Questionnaire on Health Problems. Injuries were recorded on a monthly basis using a questionnaire. Analyses on leg-level were performed using generalized estimating equations to test the associations between substantial lower-extremity injuries and potential risk factors.RESULTS: The 1-year incidence of lower-extremity injuries was 82.2%. Of these, 51.4% was a substantial lower-extremity injury. Multivariate analyses identified that ankle dorsiflexion during the SLS (OR 1.25; 95% confidence interval, 1.03-1.52) was a risk factor for a substantial lower-extremity injury.CONCLUSIONS: The findings indicate that contemporary dance students are at high risk for lower-extremity injuries. Therefore, the identified risk factor (ankle dorsiflexion) should be considered for prevention purposes.

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Producten 842

Wound infection following implant removal of foot, ankle, lower leg or patella; a protocol for a multicenter randomized controlled trial investigating the (cost-)effectiveness of 2 g of prophylactic cefazolin compared to placebo (WIFI-2 trial)

COVID 19 Conspiracy Thinking Across the World

The relation of asymmetry in power and balance in the lower extremities

Lower limb orthoses

Jump landing characteristics predicts lower extremity injuries in indoor team sports

Effects of reduced relative implicit and explicit feedback on lower extremity jump-landing mechanics: a preliminary analysis

Effectiveness and cost-effectiveness of an optimized process of providing assistive technology for impaired upper extremity function

Monitoring perceived stress, recovery and non-traumatic lower extremity injuries in competitive runners

Risk factors for lower-extremity injuries among contemporary dance students

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FIT TO PERFORM: Onderzoek naar de fysieke en mentale gezondheid van dansers

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Producten 842

Wound infection following implant removal of foot, ankle, lower leg or patella; a protocol for a multicenter randomized controlled trial investigating the (cost-)effectiveness of 2 g of prophylactic cefazolin compared to placebo (WIFI-2 trial)

COVID 19 Conspiracy Thinking Across the World

The relation of asymmetry in power and balance in the lower extremities

Lower limb orthoses

Jump landing characteristics predicts lower extremity injuries in indoor team sports

Effects of reduced relative implicit and explicit feedback on lower extremity jump-landing mechanics: a preliminary analysis

Effectiveness and cost-effectiveness of an optimized process of providing assistive technology for impaired upper extremity function

Monitoring perceived stress, recovery and non-traumatic lower extremity injuries in competitive runners

Risk factors for lower-extremity injuries among contemporary dance students

Projecten 1

FIT TO PERFORM: Onderzoek naar de fysieke en mentale gezondheid van dansers