Today’s Top Story
Study: Corticosteroid may offer faster pain relief and improvement than oral NSAIDs for adhesive capsulitis.
Data from a study published online in the February issue of The American Journal of Sports Medicine (AJSM) suggest that a single corticosteroid injection may provide faster pain relief and earlier improvement compared to oral NSAIDs for patients with adhesive capsulitis. The authors conducted a randomized, controlled trial of 74 patients with primary adhesive capsulitis in the freezing stage who received either intra-articular injection with betamethasone or oral NSAIDs. During the first 8 weeks after treatment, they found that patients treated with corticosteroid injection achieved faster pain relief compared with control patients. However, no significant difference in pain was observed among the groups at 12-week follow-up. Shoulder function and motion improved significantly in both groups at all follow-up points. However, function scores and most motion parameters improved faster in the injection group up to week 8, with no significant differences in function or motion noted at final 12 weeks. Read the abstract…

Other News

Studies look at effects and risks of falling in older adults.
Two recent studies examine the effects and risks of falling in older patients. In the first, published online in the journal The BMJ, the research team conducted a multicenter, single-blind, randomized trial of 1,635 sedentary adults aged 70-89 years with functional limitations, but who were able to walk 400 meters, who were randomized to a structured, moderate intensity physical activity program (n=818) including aerobic, strength, flexibility, and balance training activities, or to a health education program. At 2.6-year follow-up, they found that 75 participants (9.2 percent) in the physical activity group and 84 participants (10.3 percent) in the health education group had experienced a serious fall injury—results that were consistent across several subgroups, including sex. Read more…
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     In the second study, published online in the journal Arthritis Care & Research, the authors surveyed 1,842 participants in the Multicenter Osteoarthritis Study and found that, at 60 months, 16.8 percent reported knee buckling and at 84 months, 14.1 percent had recurrent falls. Those with knee buckling at 60 months had a 1.6 to 2.5-fold greater odds of recurrent falls, fear of falling, and poor balance confidence at 84 months. Study participants who fell when a knee buckled had 4.5-fold, 2-fold and 3-fold increased odds 2 years later of recurrent falls, significant fall injuries, and fall injuries that limited activity, respectively, and were 4 times more likely to have poor balance confidence. Read more…
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Study: Resorbable scaffold may help prevent joint degeneration after total meniscectomy.
Findings from a sheep study published online in AJSM suggest that use of a resorbable, fiber-reinforced meniscus scaffold may help prevent joint degeneration after total meniscectomy. The researchers conducted a controlled laboratory study of seven skeletally mature ewes implanted with a fiber-reinforced scaffold after total meniscectomy, and two additional animals with untreated total meniscectomies. At 52 weeks, they found that all explants remained fully intact and incorporated into the bone tunnels, and exhibited functional tensile loads, tensile stiffness, and compressive moduli. The researchers noted fibrocartilagenous repair with both types 1 and 2 collagen, with areas of matrix organization and biochemical content similar to native tissue. In addition, Mankin scores showed less cartilage damage in the explant group compared to the meniscectomy group. Read the abstract…

Study: Chemotherapy linked to significant bone loss during first month of leukemia treatment.
According to a study published online in the journal Bone, significant bone loss may occur during the first month of chemotherapy for acute lymphoblastic leukemia (ALL). The researchers conducted a prospective cohort study of 38 pre-adolescent and adolescent patients aged 10–21 years who were newly diagnosed with ALL. Using quantitative computerized tomography, they found that pre-chemotherapy bone properties were similar to age- and sex-matched controls. However, over the 1-month induction period, they noted that cancellous volumetric bone mineral density (vBMD) decreased markedly with sparing of cortical vBMD. The researchers state that the tibia underwent significant cortical thinning, with the femur less affected. Areal BMD concurrently measured by dual-energy X-ray absorptiometry underestimated changes from baseline as compared to vBMD. The researchers argue that significant alterations to cancellous and cortical bone develop during the first month of treatment of ALL therapy—far earlier than previously considered. Read more…
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Study: Hip fracture may serve as indicator for increased likelihood of Parkinson disease.
Data from a study conducted in Sweden and published online in the journal PLOS Medicine suggest that an increased risk of falling and hip fracture may serve as markers for later development of Parkinson disease (PD). The research team compiled two nested case–control cohorts. In the first, they matched 24,412 patients aged 50 years or older diagnosed with PD and 243,363 controls. They found that PD was associated with increased risks of injurious fall up to 10 years before diagnosis, and hip fracture 15 years or more prior to diagnosis. In the second cohort, the research team matched 622,333 individuals who had an injurious fall in need of emergency care against a single control. They found that 0.7 percent of individuals with an injurious fall and 0.5 percent of controls were diagnosed with PD at up to 10-year follow-up. Read the abstract…

Study: Is body mass index a reliable indicator of health?
A study published online in the International Journal of Obesity suggests that many individuals considered to be overweight may be cardiometabolically healthy, while others considered to be in the “normal” weight range are cardiometabolically unhealthy. The authors reviewed data on 40,420 individuals aged 18 years or older from the National Health and Nutrition Examination Survey. Based on blood pressure, triglyceride, cholesterol, glucose, insulin resistance, and C-reactive protein data, they found that nearly half of overweight individuals, 29 percent of obese individuals, and 16 percent of obesity type II/III individuals were metabolically healthy, while over 30 percent of normal weight individuals were cardiometabolically unhealthy. The authors argue that researchers should seek to improve diagnostic tools related to weight and cardiometabolic health. Read more…
Read the abstract…

Study: P4P initiative linked to modest improvements at pediatric ACO.
A study published online in the journal JAMA Pediatrics suggests that pay for performance (P4P) may be linked to modest changes in physician performance in a pediatric accountable care organization (ACO). The researchers conducted a retrospective cohort study of 2,966 physicians: 203 incentivized physicians, 2,590 nonincentivized physicians, and 173 nonincentivized hospital physicians. They looked at 21 quality measures, 14 of which were subject to P4P incentives. The researchers found that incentivized community physicians displayed greater improvements in performance than nonincentivized community physicians on two of two well visits, three of 10 immunization-incentivized measures, and two nonincentivized measures. The employed physician group at the hospital showed greater improvements in performance than incentivized community physicians on eight of 14 incentivized measures and one of seven nonincentivized measures. Read more…
Read the abstract…

Last call: AHRQ Quality Indicators Standing Work Group.
AAOS seeks to nominate members to a U.S. Agency for Healthcare Research and Quality (AHRQ) Standing Work Group (SWG) to be convened by an AHRQ contractor. The workgroup will initially focus on the AHRQ Patient Safety Indicators, issues related to the International Classification of Diseases Clinical Modification (ICD-9-CM and ICD-10-CM) code set conversion, and AHRQ Inpatient Quality Indicators. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application; a current curriculum vitae; a 100-word biosketch; a letter of interest highlighting their expertise in the subject area; and a description of any financial interest, recent conduct, or current or planned commercial, non-commercial, institutional, intellectual, public service, or other activities pertinent to the potential scope of the workgroup that could be perceived as influencing the workgroup’s process or recommendations. All supporting materials must be submitted by Feb. 14, 2016 at 11:59 p.m. CT, to Kyle Shah at: shah@aaos.org
Learn more and submit your application…(member login required)