Research Spotlight

Driver, S. and A. Woolsey (2016). “Evaluation of a physical activity behavior change program for individuals with a brain injury.” Arch Phys Med Rehabil 97(9 Suppl): S194-200.

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OBJECTIVE: To investigate the effectiveness of a physical activity intervention for use within a comprehensive outpatient rehabilitation program for individuals with brain injury. DESIGN: Quasi-experimental comparison group design with 3-month follow-up. SETTING: Comprehensive outpatient rehabilitation clinic that is a transitional setting between acute inpatient rehabilitation and community dwelling. PARTICIPANTS: Individuals (N=47) with a brain injury were enrolled into either the intervention (n=22; 8 women, 14 men; mean age, 48.68y) or control group (n=25; 9 women, 16 men; mean age, 46.23y). INTERVENTION: Consisted of an 8-week informational and social/behavioral program that focused on enabling individuals to become independently active. The control group completed the standard of care typically available to patients in comprehensive outpatient rehabilitation. MAIN OUTCOME MEASURES: Behavioral Risk Factor Surveillance Survey self-report physical activity items, Exercise Self-Efficacy Scale, and Mayo-Portland Adaptability Inventory-4. RESULTS: The intervention group reported significantly (P<.001) greater weekly activity, self-efficacy, and rehabilitation outcomes at the completion of the program as well as at the 3-month follow-up when compared with the control group. Significantly, individuals in the experimental group reported increasing their weekly activity from 45 minutes preprogram to 72 minutes postprogram (d=2.12; 95% confidence interval, 1.78-2.52), and 67 minutes at 3-month follow-up. CONCLUSIONS: Findings suggest that the intervention may be effective in increasing the physical activity behaviors of individuals engaged in a comprehensive outpatient rehabilitation program after brain injury.

Emmett, M. and A. Mehta (2016). “Gastrointestinal potassium binding-more than just lowering serum [k(+)]: Patiromer, potassium balance, and the renin angiotensin aldosterone axis.” Kidney Int 90(3): 484-486.

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Hyperkalemia limits the use of renin-angiotensin-aldosterone axis (RAAS) blockers in patients with renal insufficiency. This can be managed by efforts to increase kaliuresis and by gastrointestinal potassium binding with sodium polystyrene sulfonate, a relatively ineffective agent. Now with the availability of patiromer, RAAS blockers can be used more liberally. In addition, potassium reduction decreases aldosterone, which may be beneficial. Adverse nonepithelial aldosterone effects such as endothelial dysfunction and cardiac fibrosis may be ameliorated.

Cedars, A. and A. R. Opotowsky (2016). “Sustaining happiness in adult congenital heart disease.” World J Pediatr Congenit Heart Surg 7(5): 635-637.

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Patients with ACHD appear to have a distinct psychological adaptation to their lifelong heart disease. Although there is some inconsistency in the results of published studies, most data indicate that QOL among patients with ACHD is similar to the healthy general population, with the exception of the physical functioning domain.3 Furthermore, despite marked variability in objectively measured physical capacity between lesions,4 QOL in ACHD is not clearly related to lesion severity or complexity.3,5 This phenomenon appears to be consistent between countries with dramatically different health-care systems.6 The present study by Steele et al in a group of patients with CHD of high complexity provides further evidence for this observation. The apparent mental resilience among patients with ACHD is in stark contrast to adults with acquired heart failure (HF) in whom QOL is notably impaired compared to healthy controls.7 Although the reasons for preserved QOL in ACHD remain unknown, it has been proposed that patients with ACHD have a unique ‘‘sense of coherence.’’8 This concept, first introduced by Aaron Antonovsky as a metric of individual optimism and sense of control, may insulate patients with ACHD against health-related stressors.9

Garofalo, R., B. Flanagin, A. Castagna, V. Calvisi and S. G. Krishnan (2016). “Massive irreparable rotator cuff tear and associated deltoid tear. Does the reverse shoulder arthroplasty and deltoid repair be a possible option of treatment?” J Orthop Sci: 2016 Aug [Epub ahead of print].

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BACKGROUND AND PURPOSE: Rupture of the anterior and middle deltoid muscle associated with rotator cuff tear arthropathy (RCA) could result in a definitive loss of shoulder function. The purpose of this study was to evaluate clinical outcomes after a concomitant reverse shoulder arthroplasty (RSA) and deltoid repair under these circumstances. MATERIALS AND METHODS: Between 2006 and 2012, 18 consecutive patients with a mean age of 69.7 years, affected by massive irreparable rotator cuff tear and associated dehiscence or rupture of anterior and middle deltoid muscle underwent this operation through a modified anterosuperior approach. Four patients referred a previous shoulder surgery and deltoid tear was iatrogenic. The other 14 cases had an attritional deltoid tears. The average follow-up was 64 months (range 25-121 months). RESULTS: The mean active anterior elevation passed from a preoperative mean of 53 +/- 9.1 (range 45-70) to 132.7 +/- 11.6 degrees (85-155 degrees ), active external rotation passed from a preoperative mean value of 22.4 +/- 3.6 degrees (range 18-26) to an average of 33.7 +/- 4.7 degrees (range 30-40 degrees ). Mean Constant score increased from 42 +/- 6.1 (range 31-51) pre-operatively to 72.3 +/- 8.2 (range 57-82) post-operatively. At final review, deltoid contour subjectively was satisfactory to all patients with no palpable defects. CONCLUSION: RSA associated with a repair of deltoid tear could be a viable surgical option in cases of tear involving the anterior and middle deltoid associated with a RCA. Patient with a preoperative chronic axillary nerve neuropathy associated with a deltoid muscle tear should be cautioned about the possibility of lower functional outcomes.

Gensous, N., N. Schmitt, C. Richez, H. Ueno and P. Blanco (2016). “T follicular helper cells, interleukin-21 and systemic lupus erythematosus.” Rheumatology (Oxford): 2016 Aug [Epub ahead of print].

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SLE is a chronic systemic autoimmune disease characterized by a breakdown of tolerance to nuclear antigens and generation of high-affinity pathogenic autoantibodies. These autoantibodies form, with autoantigens, immune complexes that are involved in organ and tissue damages. Understanding how the production of these pathogenic autoantibodies arises is of prime importance. T follicular helper cells (Tfh) and IL-21 have emerged as central players in this process. This article reviews the pathogenic role of Tfh cells and IL-21 in SLE.