• The effectiveness of a stratified group intervention using the STarTBack screening tool in patients with LBP - a non randomised controlled trial

      Murphy, Susan E; Blake, Catherine; Power, Camillus K; Fullen, Brona M (2013-12-05)
      Abstract Background Low back pain (LBP) is costly to society and improving patient outcomes is a priority. Stratifying LBP patients into more homogenous groups is advocated to improve patient outcome. The STarT Back tool, a prognostic screening tool has demonstrated efficacy and greater cost effectiveness in physiotherapy settings. The management of LBP patients in groups is common but to date the utility of the STarT Back tool in group settings has not been explored. The aim of this study is to determine if the implementation of ‘stratified care’ when delivered in a group setting will lead to significantly better physical and psychological outcomes and greater cost effectiveness in LBP patients compared to a bestcare historical control group. Methods/Design This study is a non randomised controlled trial. Low back pain patients recruited from the Waterford Primary Care area (population = 47,000) will be stratified into low, medium or high risk of persisting symptoms using the STarT Back Tool. Low risk patients will be offered a single one off education/exercise class offering positive messages on LBP management in line with recommended guidelines. Medium risk patients will be offered a 12 week group exercise/education intervention addressing their dominant physical obstacles to recovery. A 12 week group cognitive behavioural approach will be delivered to the high risk patients, characterised by the presence of high levels of psychosocial prognostic factors. These patients will be compared with a historical control group where therapists were blinded as to the risk stratification of patients and a generic group intervention was delivered to all patients, irrespective of their initial risk stratification. The primary outcome measure will be disability (Roland Morris Disability Questionnaire). Secondary outcomes will include back pain intensity (Visual Analogue Scale), distress (Distress and Risk Assessment Method), back beliefs (Back Beliefs Questionnaire), health status (Euroqol), global benefit (7 point likert scale), satisfaction (7 point likert scale), cost effectiveness and functional status. Outcome will be measured at baseline, 12 weeks and 6 months. Discussion This paper details the rationale, design, methods, planned analysis and operational aspects of a study examining the utility of the STarT Back Tool as a ‘stratification tool for targeted treatment’ in a group intervention. Trial registration Current controlled trials: ACTRN12613000431729.
    • Hungry bone syndrome and normalisation of renal phosphorus threshold after total parathyroidectomy for tertiary hyperparathyroidism in X-linked hypophosphataemia: a case report

      Crowley, Rachel K; Kilbane, Mark; King, Thomas FJ; Morrin, Michelle; O’Keane, Myra; McKenna, Malachi J (2014-03-04)
      Abstract Introduction This is the first report of which the authors are aware to describe this c.2166delinsGG mutation in X-linked hypophosphataemia and to describe normalisation of renal threshold for phosphate excretion after parathyroidectomy for tertiary hyperparathyroidism in X-linked hypophosphataemia. Case presentation We present the case of a 34-year-old Caucasian woman with X-linked hypophosphataemia. She developed tertiary hyperparathyroidism with markedly high bone turnover requiring total parathyroidectomy and had prolonged requirement for intravenous calcium infusion after surgery. She had a novel mutation in her phosphate-regulating gene with homologies to endopeptidases on the X-chromosome and had an unusual degree of dependence on phosphate supplementation. Prior to operative intervention she had a trial of cinacalcet that improved bone turnover markers when used in isolation but which led to a paradoxical rise in parathyroid hormone levels when given with phosphate supplementation. After correction of hungry bone syndrome, the renal phosphorus threshold normalised as a manifestation of hypoparathyroid state despite marked elevation in level of fibroblast growth factor 23. Conclusions This case illustrates the risk of tertiary hyperparathyroidism as a complication of treatment for hypophosphataemia; it highlights the morbidity associated with hungry bone syndrome and provides novel insight into renal handling of phosphorus.
    • Idiopathic toe walking: a gait laboratory review

      O’Sullivan, R; O'Brien, T (Irish Medical Journal, 2015-07)
    • Musculoskeletal modelling of muscle activation and applied external forces for the correction of scoliosis

      Curtin, Maurice; Lowery, Madeleine M (2014-04-07)
      Abstract Background This study uses biomechanical modelling and computational optimization to investigate muscle activation in combination with applied external forces as a treatment for scoliosis. Bracing, which incorporates applied external forces, is the most popular non surgical treatment for scoliosis. Non surgical treatments which make use of muscle activation include electrical stimulation, postural control, and therapeutic exercises. Electrical stimulation has been largely dismissed as a viable treatment for scoliosis, although previous studies have suggested that it can potentially deliver similarly effective corrective forces to the spine as bracing. Methods The potential of muscle activation for scoliosis correction was investigated over different curvatures both with and without the addition of externally applied forces. The five King’s classifications of scoliosis were investigated over a range of Cobb angles. A biomechanical model of the spine was used to represent various scoliotic curvatures. Optimization was applied to the model to reduce the curves using combinations of both deep and superficial muscle activation and applied external forces. Results Simulating applied external forces in combination with muscle activation at low Cobb angles (< 20 degrees) over the 5 King’s classifications, it was possible to reduce the magnitude of the curve by up to 85% for classification 4, 75% for classifications 3 and 5, 65% for classification 2, and 60% for classification 1. The reduction in curvature was less at larger Cobb angles. For King’s classifications 1 and 2, the serratus, latissimus dorsi, and trapezius muscles were consistently recruited by the optimization algorithm for activation across all Cobb angles. When muscle activation and external forces were applied in combination, lower levels of muscle activation or less external force was required to reduce the curvature of the spine, when compared with either muscle activation or external force applied in isolation. Conclusions The results of this study suggest that activation of superficial and deep muscles may be effective in reducing spinal curvature at low Cobb angles when muscle groups are selected for activation based on the curve type. The findings further suggest the potential for a hybrid treatment involving combined muscle activation and applied external forces at larger Cobb angles.
    • Physical activity guidelines: is the message getting through to adults with rheumatic conditions?

      O'Dwyer, T.; Rafferty, T.; O'Shea, F.; Gissane, C.; Wilson, F. (Rheumatology, 2014-05)
    • Treatment of hip dysplasia in patients with mucopolysaccharidosis type I after hematopoietic stem cell transplantation: results of an international consensus procedure

      Langereis, Eveline J; Borgo, Andrea; Crushell, Ellen; Harmatz, Paul R; van Hasselt, Peter M; Jones, Simon A; Kelly, Paula M; Lampe, Christina; van der Lee, Johanna H; Odent, Thierry; et al. (2013-10-03)
      Abstract Background Mucopolysaccharidosis type I (MPS-I) is a lysosomal storage disorder characterized by progressive multi-organ disease. The standard of care for patients with the severe phenotype (Hurler syndrome, MPS I-H) is early hematopoietic stem cell transplantation (HSCT). However, skeletal disease, including hip dysplasia, is almost invariably present in MPS I-H, and appears to be particularly unresponsive to HSCT. Hip dysplasia may lead to pain and loss of ambulation, at least in a subset of patients, if left untreated. However, there is a lack of evidence to guide the development of clinical guidelines for the follow-up and treatment of hip dysplasia in patients with MPS I-H. Therefore, an international Delphi consensus procedure was initiated to construct consensus-based clinical practice guidelines in the absence of available evidence. Methods A literature review was conducted, and publications were graded according to their level of evidence. For the development of consensus guidelines, eight metabolic pediatricians and nine orthopedic surgeons with experience in the care of MPS I patients were invited to participate. Eleven case histories were assessed in two written rounds. For each case, the experts were asked if they would perform surgery, and they were asked to provide information on the aspects deemed essential or complicating in the decision-making process. In a subsequent face-to-face meeting, the results were presented and discussed. Draft consensus statements were discussed and adjusted until consensus was reached. Results Consensus was reached on seven statements. The panel concluded that early corrective surgery for MPS I-H patients with hip dysplasia should be considered. However, there was no full consensus as to whether such a procedure should be offered to all patients with hip dysplasia to prevent complications or whether a more conservative approach with surgical intervention only in those patients who develop clinically relevant symptoms due to the hip dysplasia is warranted. Conclusions This international consensus procedure led to the construction of clinical practice guidelines for hip dysplasia in transplanted MPS I-H patients. Early corrective surgery should be considered, but further research is needed to establish its efficacy and role in the treatment of hip dysplasia as seen in MPS I.