Research Spotlight

Posted March 16th 2021

Plantarflexor strength, gait speed, and step length change in individuals with Parkinson’s disease.

Chad Swank, Ph.D.

Chad Swank, Ph.D.

Shearin, S.M., Medley, A., Trudelle-Jackson, E., Swank, C. and Querry, R. (2021). “Plantarflexor strength, gait speed, and step length change in individuals with Parkinson’s disease.” Int J Rehabil Res 44(1): 82-87.

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Parkinson’s disease affects the ability to walk often resulting in decreased independence and low quality of life. The purpose of this study was to examine differences in plantarflexor strength (PFS), gait speed, and step length in persons with Parkinson’s disease (PwP) and healthy peers using clinical measures. A secondary purpose was to examine the relationship between these gait components across disease severity. The study was a convenience sample of 71 PwP and 25 community healthy peers. Outcome measures included 10-Meter Walk, step length, and Calf-Raise Senior Test. PwP were separated into mild and moderate impairment groups using the Movement Disorders Society United Parkinson’s Disease Rating Scale Motor Subscale. Between group differences for gait speed (F2,93 = 24.560, P = 0.000), step length (F2,93 = 21.93, P = 0.000) and PFS (F2,93 = 19.49, P < 0.000) were observed. Post hoc testing determined a difference (P < 0.00) in gait speed, step length, and PFS testing between moderate impairment versus healthy peers and mild impairment. A difference (P = 0.045) in step length and a trend towards significance (P = 0.064) for PFS was found between healthy peers and mild impairment group. This study revealed that PwP with mild impairment also have significant changes in step length and trends toward plantarflexor weakness without a significant difference in gait speed. These early changes may warrant early assessment and intervention to prevent decline. This study may bring clinical focus onto the plantarflexor and step length for early comprehensive assessment and treatment of gait and mobility for PwP.


Posted March 16th 2021

Intensity of usual care physical therapy during inpatient rehabilitation for people with neurologic diagnoses.

Chad Swank, Ph.D.

Chad Swank, Ph.D.

DiPasquale, J., Trammell, M., Clark, K., Fowler, H., Callender, L., Bennett, M. and Swank, C. (2021). “Intensity of usual care physical therapy during inpatient rehabilitation for people with neurologic diagnoses.” Pm r Feb 18. [Epub ahead of print].

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INTRODUCTION: Early, intense rehabilitation is essential to promote recovery after stroke, spinal cord injury (SCI), and traumatic brain injury (TBI). However, intensity of usual care rehabilitation interventions during inpatient rehabilitation are poorly characterized. OBJECTIVE: We described the intensity of usual care rehabilitation interventions completed during the subacute phase of recovery from neurologic injury. DESIGN: Observational. SETTING: Inpatient Rehabilitation Facility. INTERVENTIONS: 22 usual care physical therapy interventions were grouped into 6 categories: gait (4 activities), functional (2), strengthening (4), aerobic (6), balance (4), and wheelchair (2). PATIENTS: Patients admitted to inpatient rehabilitation with a primary diagnosis of stroke, SCI or TBI within 6 months of injury. MAIN OUTCOME MEASURE(S): Cardiovascular intensity (physiological and perceived) was recorded during rehabilitation activity sessions. Physiological intensity was assessed by heart rate response (HRR) via a Polar A370 Fitness Watch and characterized as very light (<30%), light (30%-39%), moderate (40%-59%), vigorous (60%-89%), and near maximal (≥90%). Perceived intensity was assessed using the Rate of Perceived Exertion scale (RPE). RESULTS: Patients [stroke n = 16 (number of activity sessions = 388 / average session duration = 15.1 minutes); SCI n = 15 (299 / 27.3 minutes); TBI n = 15 (340 / 13.4 minutes)] participated. For patients with stroke, moderate-to-vigorous HRR was attained between 42% (aerobic exercise) to 55% (wheelchair propulsion) of activity sessions. For patients with SCI, moderate-to-vigorous HRR was attained between 29% (strength training) to 46% (gait training) of activity sessions. For patients with TBI, moderate-to-vigorous HRR was attained between 29% (balance activities) to 47% (gait training) of activity sessions. Associations between HRR and RPE were very weak across stroke (r = 0.12), SCI (r = 0.18), and TBI (r = 0.27). CONCLUSIONS: Patients with stroke, SCI, and TBI undergoing inpatient rehabilitation achieve moderate-to-vigorous intensity during some usual care activities such as gait training. Patient perception of intensity was dissimilar to physiological response.


Posted March 16th 2021

Psychological distress and line-of-duty head injuries in firefighters.

Jordan E. Strack, B.S.

Jordan E. Strack, B.S.

Strack, J.E., Torres, V.A., Pennington, M.L., Cardenas, M.N., Dupree, J., Meyer, E.C., Dolan, S., Kruse, M.I., Synett, S.J., Kimbrel, N.A. and Gulliver, S.B. (2021). “Psychological distress and line-of-duty head injuries in firefighters.” Occup Med (Lond) Feb 18;kqab013. [Epub ahead of print].

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BACKGROUND: Head injuries are common injury in the fire service; however, very little data exist on the risks this may pose to the development of post-traumatic stress disorder (PTSD) and depression in this high-risk population. AIMS: Our study aimed to compare levels of PTSD and depression symptoms in firefighters with a line-of-duty head injury, non-line-of-duty head injury and no head injury. METHODS: In this cross-sectional study, we assessed current PTSD and depression symptoms as well as retrospective head injuries. RESULTS: Seventy-six per cent of the total sample reported at least one head injury in their lifetime. Depression symptoms were significantly more severe among firefighters with a line-of-duty head injury compared to those with no head injury, but not compared to those who sustained a non-line-of-duty head injury. Depression symptoms did not differ between firefighters with a non-line-of-duty head injury and those with no head injury. PTSD symptoms were significantly more severe among firefighters with a line-of-duty head injury compared to both firefighters with no head injury and those with a non-line-of-duty head injury. CONCLUSIONS: We found that firefighters who reported at least one line-of-duty head injury had significantly higher levels of PTSD and depression symptoms than firefighters who reported no head injuries. Our findings also suggest head injuries sustained outside of fire service could have less of an impact on the firefighter’s PTSD symptom severity than head injuries that occur as a direct result of their job.


Posted March 16th 2021

Randomized Evaluation of TriGuard 3 Cerebral Embolic Protection After Transcatheter Aortic Valve Replacement: REFLECT II.

Robert C. Stoler M.D.

Robert C. Stoler M.D.

Nazif, T.M., Moses, J., Sharma, R., Dhoble, A., Rovin, J., Brown, D., Horwitz, P., Makkar, R., Stoler, R., Forrest, J., Messé, S., Dickerman, S., Brennan, J., Zivadinov, R., Dwyer, M.G. and Lansky, A.J. (2021). “Randomized Evaluation of TriGuard 3 Cerebral Embolic Protection After Transcatheter Aortic Valve Replacement: REFLECT II.” JACC Cardiovasc Interv 14(5): 515-527.

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OBJECTIVES: The REFLECT II (Randomized Evaluation of TriGuard 3 Cerebral Embolic Protection After Transcatheter Aortic Valve Implantation) trial was designed to investigate the safety and efficacy of the TriGUARD 3 (TG3) cerebral embolic protection in patients undergoing transcatheter aortic valve replacement. BACKGROUND: Cerebral embolization occurs frequently following transcatheter aortic valve replacement and procedure-related ischemic stroke occurs in 2% to 6% of patients at 30 days. Whether cerebral protection with TriGuard 3 is safe and effective in reducing procedure-related cerebral injury is not known. METHODS: This prospective, multicenter, single-blind, 2:1 randomized (TG3 vs. no TG3) study was designed to enroll up to 345 patients. The primary 30-day safety endpoint (Valve Academic Research Consortium-2 defined) was compared with a performance goal (PG). The primary hierarchical composite efficacy endpoint (including death or stroke at 30 days, National Institutes of Health Stroke Scale score worsening in hospital, and cerebral ischemic lesions on diffusion-weighted magnetic resonance imaging at 2 to 5 days) was compared using the Finkelstein-Schoenfeld method. RESULTS: REFLECT II enrolled 220 of the planned 345 patients (63.8%), including 41 roll-in and 179 randomized patients (121 TG3 and 58 control subjects) at 18 US sites. The sponsor closed the study early after the U.S. Food and Drug Administration recommended enrollment suspension for unblinded safety data review. The trial met its primary safety endpoint compared with the PG (15.9% vs. 34.4% (p < 0.0001). The primary hierarchal efficacy endpoint at 30 days was not met (mean scores [higher is better]: -8.58 TG3 vs. 8.08 control; p = 0.857). A post hoc diffusion-weighted magnetic resonance imaging analysis of per-patient total lesion volume above incremental thresholds showed numeric reductions in total lesion volume >500 mm(3) (-9.7%) and >1,000 mm(3) (-44.5%) in the TG3 group, which were more pronounced among patients with full TG3 coverage: -51.1% (>500 mm(3)) and -82.9% (>1,000 mm(3)). CONCLUSIONS: The REFLECT II trial demonstrated that the TG3 was safe compared with a historical PG but did not meet its pre-specified primary superiority efficacy endpoint.


Posted March 16th 2021

Primary Results of the EVOLVE Short DAPT Study: Evaluation of 3-Month Dual Antiplatelet Therapy in High Bleeding Risk Patients Treated With a Bioabsorbable Polymer-Coated Everolimus-Eluting Stent.

Robert C. Stoler M.D.

Robert C. Stoler M.D.

Kirtane, A.J., Stoler, R., Feldman, R., Neumann, F.J., Boutis, L., Tahirkheli, N., Toelg, R., Othman, I., Stein, B., Choi, J.W., Windecker, S., Yeh, R.W., Dauerman, H.L., Price, M.J., Underwood, P., Allocco, D., Meredith, I. and Kereiakes, D.J. (2021). “Primary Results of the EVOLVE Short DAPT Study: Evaluation of 3-Month Dual Antiplatelet Therapy in High Bleeding Risk Patients Treated With a Bioabsorbable Polymer-Coated Everolimus-Eluting Stent.” Circ Cardiovasc Interv Mar 1;CIRCINTERVENTIONS120010144. [Epub ahead of print]. Circinterventions120010144.

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BACKGROUND: Prolonged dual antiplatelet therapy (DAPT) after percutaneous coronary intervention is associated with increased bleeding, despite a reduced incidence of ischemic events. The SYNERGY everolimus-eluting stent is a thin-strut platinum-chromium stent that elutes everolimus from a thin abluminal layer of bioabsorbable polymer. These design elements may facilitate rapid endothelialization and enable shorter-duration DAPT. METHODS: EVOLVE Short DAPT prospectively evaluated the safety of 3-month DAPT in high bleeding risk patients treated with the SYNERGY everolimus-eluting stent, enrolling 2009 patients at 110 global sites. Patients with acute myocardial infarction or complex lesions were excluded. After percutaneous coronary intervention, patients were required to take DAPT (aspirin+P2Y(12) inhibitor) for 3 months, except those on chronic anticoagulation in whom aspirin was optional. Patients free of events (stroke, myocardial infarction, revascularization, and stent thrombosis) who discontinued P2Y(12) inhibitor at 3 months, but continued aspirin, and had at least 1 year of follow-up or an end point event were included in the primary analysis. Two powered coprimary end points were (1) death/myocardial infarction compared with a historical control and (2) study stent-related definite/probable stent thrombosis compared to a performance goal. RESULTS: The analysis population consisted of 1487 patients. The adjusted rate of death/myocardial infarction between 3 and 15 months was 5.6% among patients receiving 3-month DAPT versus 5.7% patients in the 12-month DAPT control (propensity adjusted difference=-0.12%; 97.5% upper bound=1.63% which was less than the prespecified margin of 2.52; P(non-inferiority)=0.0016). The rate of study stent-related stent thrombosis between 3-15 months was 0.2% in the 3-month DAPT group (97.5% upper bound=0.63%; P=0.0005 for comparison to 1% performance goal). CONCLUSIONS: Favorable rates of ischemic outcomes were observed among selected high bleeding risk patients undergoing percutaneous coronary intervention with the SYNERGY everolimus-eluting stent who tolerated 3 months of P2Y(12) inhibitor and then discontinued it, supporting the safety of abbreviated DAPT with this stent platform. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02605447.