Nickel sulfate most common allergen in patients with eyelid dermatitis, claims study

Nickel sulfate most common allergen in patients with eyelid dermatitis, claims study published in the Journal of Dermatology.

Allergic contact dermatitis has been established as the most frequent cause of eyelid dermatitis, but it is often misdiagnosed. The purpose of this study was to evaluate the characteristics of patients with eyelid dermatitis who were referred for patch testing. The patients were divided into three subgroups in this retrospective study: patients with only eyelid involvement, patients with involvement of eyelids and other areas, and patients without eyelid involvement. Data was collected on diagnoses, medical history, personal care products and make-up use, occupational dermatitis, and positive allergens.

An independent t-test, one-way ANOVA, and chi-squared test were used to analyze the data. A total of 427 patients who referred for patch tests were included in the study. Of these, 139 patients had eyelid dermatitis. Allergic contact dermatitis (ACD) was the most common diagnosis in all three groups referred for patch tests. Use of shaving cream and hair conditioner was significantly higher in patients with only eyelid involvement and nickel sulfate was the most common allergen among them. Patch testing is the gold standard tool in the evaluation of eyelid contact dermatitis, and it is a necessity in the treatment of eyelid dermatitis, for the accurate identification of responsible allergens.Reference:

Yazdanparast T, Nassiri Kashani M, Shamsipour M, Izadi Heidari F, Amiri F, Firooz A. Contact allergens responsible for eyelid dermatitis in adults. J Dermatol. 2024; 51: 691–695. https://doi.org/10.1111/1346-8138.17140

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Matcha mouthwash inhibits bacteria that causes periodontitis, suggests study

Periodontitis is an inflammatory gum disease driven by bacterial infection and left untreated it can lead to complications including tooth loss. The disease also been associated with diabetes mellitus, preterm birth, cardiovascular disease, rheumatoid arthritis and cancer. One of the chief bacterial culprits behind periodontitis is Porphyromonas gingivalis, which colonizes biofilms on tooth surfaces and proliferates in deep periodontal pockets.

Matcha, a finely ground green tea powder, may help keep P. gingivalis at bay. This week in Microbiology Spectrum, an open-access ASM journal, researchers in Japan report that matcha inhibited the growth of P. gingivalis in lab experiments. In addition, in a clinical study involving 45 people with periodontitis, people who used matcha mouthwash showed significantly lower levels of P. gingivalis in saliva samples than at the start of the study. “Matcha may have clinical applicability for prevention and treatment of periodontitis,” the authors noted in the paper.

Camellia sinensis is a green tea plant that has long been studied for its potential antimicrobial effects against bacteria, fungi and viruses. A previous study on mice found that green tea extract can inhibit the growth of pathogens, including Escherichia coli. Other research has found that the extract can inhibit the growth of P. gingivalis and reduce its adherence to oral epithelial cells. In addition, observational studies have associated green tea consumption with better health.

Matcha, which is used in traditional ceremonies and for flavoring in beverages and sweets, is made from raw leaves of C. sinensis. For the new study, researchers from the Nihon University School of Dentistry at Matsudo, the National Institute of Infectious Disease in Tokyo and other institutions carried out a series of in vitro experiments to test the efficacy of a matcha solution against 16 oral bacterial species, including 3 strains of P. gingivalis. The matcha mouthwash showed little activity against strains of commensal oral bacteria.

Within 2 hours, nearly all the cultured P. gingivalis cells had been killed by the matcha extract, and after 4 hours of exposure, all the cells were dead. Those findings suggested a bactericidal activity against the pathogen.

The researchers then recruited 45 people diagnosed with chronic periodontitis at the Nihon University Hospital School of Dentistry at Matsudo for a follow up clinical study. The patients were randomly assigned to 3 groups: One group received barley tea mouthwash, the second received the mouthwash made from matcha extract, and the third received mouthwash that included sodium azulene sulfonate hydrate, which is used to treat inflammation. Saliva samples were collected before and after the intervention and analyzed using PCR, and participants were instructed to rinse twice daily.

The analysis revealed that patients in the group that used matcha mouthwash showed a significant reduction in the level of P. gingivalis. Patients in the other 2 groups did not show that same significant reduction.

While the new study isn’t the first to probe the antimicrobial effects of tea-derived compounds on P. Gingivalis, the researchers note that it does support the potential benefits of matcha as part of a treatment plan for people with periodontal disease.

Reference:

Ryoma Nakao, Ayami Takatsuka, Kengo Mandokoro, Naoki Narisawa, Tsuyoshi Ikeda, Hideki Takai, Multimodal inhibitory effect of matcha on Porphyromonas gingivalis, Microbiology Spectrum,  https://doi.org/10.1128/spectrum.03426-23.

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Ketogenic Diet Could Improve Mental Health in Healthy Individuals, finds study

A new study published in the Nutrition journal suggests that a ketogenic diet, known for its popularity in weight loss circles, could offer significant mental health benefits for the general population. While the diet has already been recognized for its positive impact on the individuals with neurodegenerative and neurodevelopmental disorders, its effects on the mental well-being of healthy individuals had not been extensively explored so far.

This cross-sectional study with multiple cohorts by Sarah Garner and team focused to fill this gap by investigating the association between a ketogenic diet and various aspects of mental health in a non-clinical sample. This research focused on metrics like calmness, contentedness, alertness, cognitive and emotional stress, depression, anxiety and loneliness.

The study utilized two online surveys to collect data where the first cohort comprised a total of 147 participants and employed the Bond-Lader visual analog scales and the Perceived Stress Scale to gauge their mental health. The second cohort included 276 participants and used the Depression Anxiety Stress Scale and the revised UCLA Loneliness Scale. The results were compared between individuals adhering to a ketogenic diet and the individuals following a non-specific diet.

The findings from the study indicated that individuals on a ketogenic diet reported higher levels of mental and emotional well-being when compared to their non-ketogenic counterparts. Also, they experienced greater calmness, contentedness and alertness, along with lower levels of cognitive and emotional stress, depression, anxiety and loneliness.

The study highlighted the significance of these findings which indicates the benefits of a ketogenic diet that extended beyond physical health, impacting psychological well-being positively. This could be a potential trend for many looking to improve their mental health through dietary changes.

The results of this study add to the growing body of evidence that support the holistic benefits of ketogenic diets. Traditionally, the focus has been on the ability of this diet to promote weight loss and improve physical health metrics such as blood sugar levels and cholesterol. However, these new findings suggest that the impact of diet on mental health could be equally substantial.

Despite these promising results, the  study emphasized the need for further research to fully understand the long-term psychological effects of a ketogenic diet on the general population. While our study provides valuable insights, more longitudinal studies are required to establish causation and understand the underlying mechanisms at play. Overall, this research illuminates the importance of looking at dietary interventions from a physiological perspective and also in terms of mental health by paving the way for more comprehensive health and wellness strategies.

Reference:

Garner, S., Davies, E., Barkus, E., & Kraeuter, A.-K. (2024). Ketogenic diet has a positive association with mental and emotional well-being in the general population. In Nutrition (Vol. 124, p. 112420). Elsevier BV. https://doi.org/10.1016/j.nut.2024.112420

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Adaptive Behavioral effetive Intervention for Weight Loss Management, reveals study

USA: In a groundbreaking development in healthcare, a recent randomized clinical trial has unveiled promising results regarding an adaptive behavioral intervention for weight loss management. This innovative approach offers new hope for individuals struggling with weight-related health issues, providing a tailored and dynamic strategy to support their journey towards healthier lifestyles.

The adaptive, noninferiority randomized clinical trial of 400 adults with obesity or overweight showed that a wireless system that provided daily feedback on progress in weight loss and lifestyle change is not noninferior to the same system with human coaching.

“In the study, the mean 6-month weight change was −2.8 kg with the wireless system alone and −4.8 kg with the wireless system with coaching (difference in weight change, −2.0 kg),” the researchers reported in the Journal of the American Medical Association (JAMA).

In clinical practice, lifestyle interventions for weight loss are difficult to implement. Self-managed mobile health implementations with or without added support after unsuccessful weight loss attempts could offer effective population-level obesity management. Considering this, Bonnie Spring, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and colleagues aimed to test whether a wireless feedback system (WFS) provides noninferior weight loss versus WFS plus telephone coaching. They also tested whether participants who do not respond to initial treatment achieve greater weight loss with more versus less vigorous step-up interventions.

The noninferiority randomized trial included 400 adults aged 18 to 60 years, with a body mass index (BMI) of 27 to 45. They were randomized in a 1:1 ratio to undergo three months of treatment initially with WFS or WFS plus coaching at a US academic medical center between 2017 and 2021. Those who attained suboptimal weight loss were rerandomized to undergo modest or vigorous step-up intervention.

The WFS comprised a Wi-Fi activity tracker and scale transmitting data to a smartphone app that provided daily feedback on progress in weight loss and lifestyle changes, and WFS plus coaching added 12 weekly 10- to 15-minute supportive coaching calls delivered by bachelor’s degree–level health promotionists viewing self-monitoring data of the participants on a dashboard; step-up interventions included supportive messaging via mobile device screen notifications with or without powdered meal replacement or coaching.

Staff and participants were unblinded, and outcome assessors were blinded to treatment randomization.

The primary outcome was the between-group difference in 6-month weight change. Noninferiority margin was defined as a difference in weight change of −2.5 kg. Secondary outcomes comprised between-group differences for all participants in weight change at 3 and 12 months and between-group 6-month weight change differences among nonresponders exposed to modest vs vigorous step-up interventions.

The study led to the following findings:

  • Among 400 participants (mean age, 40.5 years; 76.3% women; mean BMI, 34.4) randomized to undergo WFS (n = 199) versus WFS plus coaching (n = 201), outcome data were available for 85.5% of participants at six months.
  • Six-month weight loss was −2.8 kg for the WFS group and −4.8 kg for participants in the WFS plus coaching group (difference in weight change, −2.0 kgs); the 90% CI included the noninferiority margin of −2.5 kg.
  • Weight change differences were comparable at 3 and 12 months and, among nonresponders, at six months, with no difference by step-up therapy.

“The findings showed that a wireless feedback system (Wi-Fi activity tracker and scale with a smartphone app to provide daily feedback) was not noninferior to the same system with added coaching,” the researchers wrote.

“There is a need for continued efforts to identify strategies for weight loss management and to accurately select interventions for different individuals to achieve weight loss goals,” they concluded.

Reference:

Spring B, Pfammatter AF, Scanlan L, et al. An Adaptive Behavioral Intervention for Weight Loss Management: A Randomized Clinical Trial. JAMA. Published online May 14, 2024. doi:10.1001/jama.2024.0821

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Epidural linked to reduction in serious complications after childbirth: Study

Having an epidural during labour is associated with a marked reduction in serious complications in the first few weeks after giving birth, finds a study published by The BMJ today.

Doctors refer to these complications as severe maternal morbidity (SMM), which can include heart attack, heart failure, sepsis, and hysterectomy.

Epidural analgesia is recommended for women with known risk factors for SMM, such as obesity, certain underlying conditions, or having more than one baby. These women are said to have a ‘medical indication’ for epidural analgesia in labour. Women delivering prematurely also carry a higher risk of SMM.

Some research suggests that epidural analgesia in labour may reduce the risk of SMM, though evidence is limited.

To address this, a team from the University of Glasgow in collaboration with the University of Bristol set out to determine the effect of labour epidural on SMM and explore whether this was greater in women with a medical indication for epidural in labour, or those in preterm labour.

Their findings are based on Scottish National Health Service data for 567,216 mothers in labour (average age 29, 93% white) delivering vaginally or via unplanned caesarean section in Scotland between 2007 and 2019.

Medical records were used to identify any of the 21 conditions defined as SMM by the US Centers for Disease Control and Prevention or a critical care admission occurring at any point from date of delivery to 42 days after giving birth.

Factors such as mother’s age, ethnicity, weight, smoking history and pre-existing conditions, as well as birth location and gestational age at birth were also taken into account.

Of the 567,216 women, 125,024 (22%) had an epidural in labour and SMM occurred in 4.3 per 1000 births.

Having an epidural was associated with a 35% relative risk reduction in SMM in all women in the study. Greater reductions were seen among women with a medical indication for epidural (50% risk reduction) compared to those without (33% risk reduction) and in women delivering preterm (47% risk reduction) compared to term or post-term (no evidence of reduced risk).

Notably, among the 77,439 women in the study who were at higher risk of severe maternal morbidity, only 19,061 (24.6%) received an epidural.

Possible explanations for these findings include closer monitoring of both mother and baby during labour, blunting of physiological stress responses to labour, and faster escalation to obstetric interventions if needed, note the authors.

The relatively low use of epidural, particularly in those with clinical indications may reflect women not fully understanding the potential benefits, as it is a woman’s choice that determines whether or not she has an epidural.

This is an observational study so no firm conclusions can be drawn about cause and effect, and the authors acknowledge several limitations that may have influenced their results. The study also involved predominantly white women delivering in Scotland, which may limit generalisability to ethnically diverse populations or different healthcare settings, they add.

However, this was a large, well-designed study that reflects contemporary obstetric and anaesthetic practices, and results were similar after further analyses, supporting the robustness of the findings.

As such, the authors conclude: “These findings substantiate the current practice of recommending epidural analgesia during labour to women with known risk factors, underscores the importance of ensuring equitable access to such treatment, and highlights the importance of supporting women from diverse backgrounds to be able to make informed decisions relating to epidural analgesia during labour.”

These findings suggest that epidural analgesia may be a viable protective option for at-risk pregnancies and decision makers should consider this new benefit to improve maternal health outcomes, say researchers in a linked editorial.

They point to the importance of understanding the mechanisms behind this protective effect and recognising inequalities in uptake, with much lower rates in, for example, minority ethnic groups and socioeconomically deprived communities.

With this in mind, these findings “might serve as a catalyst for initiatives aimed at improving equitable access to epidural analgesia during labour, potentially mitigating SMM and improving maternal health outcomes across diverse socioeconomic and ethnic backgrounds,” they conclude.

Reference:

Devroe S, Rex S, Lucas N. Unlocking maternal health: labour epidurals and severe morbidity BMJ 2024; 385 :q1053 doi:10.1136/bmj.q1053.

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Video laryngoscopy increased rate of successful intubations in neonates, finds study

A recent study published in the New England Journal of Medicine highlighted a critical aspect of neonatal care in endotracheal intubation. This vital procedure is often performed in neonates in the delivery room or neonatal intensive care unit (NICU) and can be fraught with challenges in achieving successful intubation on the first attempt.

The study revealed that repeated attempts at endotracheal intubation in neonates are associated with increased adverse events. Traditionally, clinicians have relied on direct laryngoscopy which helps to visually inspect the airway using a laryngoscope. However, this approach often falls short with fewer than half of first attempts proving successful.

This calls for video laryngoscopy which is equipped with a camera at the tip of the blade that provides a real-time view of the airway on a screen. This technology showed promise in enhancing the success rates of intubation in adults and children, yet, its effectiveness in neonates remained uncertain until now.

The study was conducted at a single center and randomly assigned neonates to either the video-laryngoscopy group or the direct-laryngoscopy group. The results were stratified based on gestational age and the primary outcome measured was successful intubation on the first attempt which was determined by exhaled carbon dioxide detection.

The study analyzed data from 214 neonates in the trial and found that 74% in the video-laryngoscopy group achieved successful intubation on the first attempt when compared to the 45% in the direct-laryngoscopy group. The median number of attempts to achieve successful intubation was significantly lower in the video-laryngoscopy group.

The study also evaluated physiological parameters during intubation. Neonates in the video-laryngoscopy group experienced higher median oxygen saturations and heart rates when compared to the individuals in the direct-laryngoscopy group by indicating potential benefits in terms of patient safety and comfort.

This research underlines the advantages of video laryngoscopy in neonatal intubation procedures. This technology has the potential to revolutionize neonatal care by offering a clearer and more navigable view of the airway, this reduces the need for repeated attempts and minimizing associated risks. Further studies may be imperative to explore long-term outcomes and broader applicability which can add to the existing evidence for the integration of video laryngoscopy into neonatal intensive care units and delivery rooms worldwide.

Reference:

Geraghty, L. E., Dunne, E. A., Ní Chathasaigh, C. M., Vellinga, A., Adams, N. C., O’Currain, E. M., McCarthy, L. K., & O’Donnell, C. P. F. (2024). Video versus Direct Laryngoscopy for Urgent Intubation of Newborn Infants. In New England Journal of Medicine. Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2402785

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Optimal blood glucose significantly associated with lower mortality in critically ill patients with cardiogenic shock: Study

A recent study explored the optimal blood glucose (BG) levels that are crucial for patients suffering from cardiogenic shock. This study was published in the European Journal of Medical Research which highlights the intricate balance of BG levels and its impact on patient prognosis.

This study examined data from over 2000 patients with cardiogenic shock from the renowned Medical Information Mart for Intensive Care (MIMIC) IV database. The team led by Ce Sun identified a critical range of time-weighted average BG (TWA-BG) levels by meticulously analyzing BG records and corresponding timestamps.

The findings unveiled a clear-cut threshold, where patients fared best when their TWA-BG levels ranged between 104–138 mg/dl. Also, deviations from this range proved detrimental. The patients with TWA-BG levels lower than 104 mg/dl or above 138 mg/dl faced significantly increased risks of adverse outcomes. The outcomes of the study underlines the importance of maintaining optimal blood glucose levels in the critical care setting. It serves as an important guideline for healthcare practitioners in managing patients with cardiogenic shock.

28-day mortality was the primary outcome of the study which demonstrated a significant contrast between patients within the optimal TWA-BG range and the individuals outside it. The patients with suboptimal TWA-BG levels underwent substantially increased mortality rates within the ICU and also during hospitalization.

Further analysis including sensitivity and subgroup assessments reinforced the robustness of these findings by highlighting the significance of the identified threshold. The major suggestion of this study is to adhere to optimal BG levels that could significantly improve the patient outcomes and enhance overall ICU care.

Source:

Sun, C., Zhou, J.-H., Huang, Y.-L., Ning, Y.-L., & Xu, X.-H. (2024). The optimal blood glucose is significantly associated with lower mortality in critically ill patients with cardiogenic shock: an analysis revealed with time series blood glucose records. In European Journal of Medical Research (Vol. 29, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s40001-024-01724-8

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Study of genetics of pericarditis reveals interleukin-1 immune cytokines inhibitors as breakthrough treatment

A study of the genetics of pericarditis increases understanding of newly approved drug treatment.

Sequence variants that protect against pericarditis have been discovered at a genomic locus encoding interleukin-1 immune cytokines. A newly approved drug treatment for pericarditis inhibits these cytokines and new a study from deCODE genetics and collaborators can contribute to the further development of this treatment.

A new study called “Variants at the interleukin-1 gene locus and pericarditis” was published today in the journal JAMA Cardiology, by scientists at deCODE genetics, a subsidiary of Amgen, and their collaborators from Denmark, USA, and Iceland.

The study involves a genome-wide search for variants affecting the risk of pericarditis, a disease characterized by often painful inflammation of the fibrous sack surrounding the heart. A subset of patients experiences recurrent pericarditis that does not respond well to traditional treatment with unspecific anti-inflammatory drugs. The role of specific immune processes in pericarditis is poorly understood and the aim of the study was to use human genetics to shed light on the pathogenesis of the disease.

The scientists found common variants in the genome that protect against pericarditis. They are located in a region with genes encoding interleukin-1 inflammatory cytokines. Drugs inhibiting these cytokines have previously been used to treat other inflammatory diseases and recently they have been tested in clinical studies of recurrent pericarditis with good results. One of these drugs was approved by the US Food and Drug Administration for use in recurrent pericarditis as recently as 2021.

The results of the genetic study provide important insights. They suggest that interleukin-1 may be an important contributor to pericarditis in general, as the identified variants are common (up to approximately 50% frequency). Furthermore, the results provide the foundation for future studies, such as those aimed at understanding which interleukin-1 cytokines are most important and whether response to treatment is affected by genotype.

Reference:

Thorolfsdottir RB, Jonsdottir AB, Sveinbjornsson G, et al. Variants at the Interleukin 1 Gene Locus and Pericarditis. JAMA Cardiol. Published online December 27, 2023. doi:10.1001/jamacardio.2023.4820.

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Increasing prevalence of TB-COVID Co-infection tied to increased mortality: Study

Researchers have found that tuberculosis (TB) and COVID-19 co-infection remains a significant global health concern, with limited evidence on its epidemiology and treatment outcomes. A recent systematic review aimed to investigate the prevalence, fatality rates, and treatment outcomes of TB-COVID co-infection to address this knowledge gap. TB and COVID-19, both highly infectious diseases, present significant challenges, especially in low/middle-income countries with limited medical resources. TB-COVID co-infection poses additional complexities, impacting regions with varying TB burdens.

This study was published in the journal PLOS Neglected Tropical Diseases by Quan Wang and colleagues. The systematic review analyzed data from 17 studies across 38 countries or regions, spanning both high and low TB prevalence areas. Prevalence estimates of TB-COVID co-infection ranged from approximately 0.02% in California, USA, to 0.06% in West Cape Province, South Africa.

  • Treatment approaches for TB-COVID co-infection have seen minimal evolution since 2021, typically involving a combination of recommended TB regimens and standard COVID-19 treatment.

  • Co-infected individuals faced increased risks of hospitalization, extended recovery periods, and higher mortality rates compared to those with single COVID-19 infections.

  • The pooled fatality rate among co-infected patients was 7.1%, slightly lower than previous estimates, with in-hospital co-infected patients facing a mean fatality rate of 11.4%.

  • However, the pooled relative risk of in-hospital fatality for TB-COVID patients versus single COVID patients was 0.8, suggesting a slightly lower risk among co-infected individuals.

The predominant treatment approach for TB-COVID co-infection involves a combination of recommended TB regimens and standard COVID-19 treatment. However, this approach has seen minimal changes since 2021.

Individuals with TB-COVID co-infection are at heightened risk of adverse outcomes, including hospitalization, extended recovery periods, and accelerated mortality. Limited information exists on the post-COVID-19 condition of co-infected patients, highlighting the need for further research in this area.

Despite a gradual decrease in fatality rates, TB-COVID co-infection remains a significant global health challenge. Urgent global collaboration is needed to address the complex challenges posed by this co-infection, particularly in countries with limited medical resources.

Reference:

Wang Q, Cao Y, Liu X, Fu Y, Zhang J, Zhang Y, et al. (2024) Systematic review and meta-analysis of Tuberculosis and COVID-19 Co-infection: Prevalence, fatality, and treatment considerations. PLoS Negl Trop Dis 18(5): e0012136. https://doi.org/10.1371/journal.pntd.0012136

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No benefit of physiotherapy over general advice after dislocated shoulder, reveals study

Routinely referring patients to a tailored programme of physiotherapy after a dislocated shoulder is no better than a single session of advice, supporting materials and the option to self-refer to physiotherapy, finds a clinical trial published by The BMJ today.

The findings should help clinicians and patients have informed discussions about the best approach to non-operative rehabilitation, say the researchers.

The shoulder is the most frequently dislocated joint, with rates highest in men aged 16-20 years (805 per 100,000 person years) due to sporting injuries and in women aged 61-70 years (28 per 100,000 person years) due to falls.

Non-operative management is the most common treatment after a first dislocation. This can range from an advice sheet only to a programme of individually tailored physiotherapy over several months, but no previous trial evidence is available to inform the best approach.

To explore this further, researchers set out to assess the effects of two rehabilitation interventions in adults with a first time traumatic shoulder dislocation at 40 NHS hospitals across the UK between November 2018 and March 2022.

All participants (66% male; average age 45 years) initially had their arm supported in a sling and received a physiotherapy advice session within six weeks of their injury, which included a shoulder examination plus advice and support materials to aid self-management.

After this session, 240 participants were randomly assigned to advice only (no further treatment) and 242 were offered additional physiotherapy sessions, each lasting for up to 30 minutes over four months.

The main measure of interest was shoulder function on the Oxford shoulder instability score (a 0-48 point scale) reported by patients after six months.

No clinically relevant differences in shoulder scores were found between the two groups at six months or in other measures, including a questionnaire on physical function of the arm, shoulder and hand. Complications were also similar across the two groups

This is the largest trial on the topic to date, although the researchers acknowledge that just over a quarter of participants were lost to follow up. However, further analysis, accounting for missing data, gave similar results, providing reassurance that the conclusions are robust.

As such they say, until now, no strong evidence was available to guide rehabilitation management following an initial two weeks support in a sling. “We now know an additional programme of individually tailored physiotherapy is not superior to advice, supporting materials, and an option to self-refer to physiotherapy.”

“Knowing that an individually tailored programme of physiotherapy is not superior will enable clinicians and patients to have evidenced informed discussions about the best approach to non-operative rehabilitation,” they conclude.

This randomised clinical trial was well planned, executed, and reported, say researchers in a linked editorial.

The results show that physiotherapy-led rehabilitation, including generalised range of movement and strengthening exercises (mainly below shoulder height), plus patient advice, confers minimal advantage over advice and education alone.

However, they say caution is needed when extrapolating these results, particularly concerning younger patients wishing to return to sports, occupations, or activities with high shoulder loads. 

Reference:

Kearney R S, Ellard D R, Parsons H, Haque A, Mason J, Nwankwo H et al. Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomised controlled trial BMJ 2024; 384 :e076925 doi:10.1136/bmj-2023-076925

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