Hässleholms Sjukhus

BackgroundWrist splinting is a common treatment for carpal tunnel syndrome (CTS), but there is little evidence supporting its efficacy.MethodsIn this parallel-group clinical trial, patients with primary idiopathic CTS with symptoms for at least 1 month and no previous treatment were randomly assigned to wear either a rigid wrist splint or placebo soft bandage (allowed full wrist motion) for 6 weeks. If symptoms persisted after 6 weeks, treatment was continued for 4 more weeks. If symptoms persisted after 12 weeks, surgery was considered. Co-primary outcomes were change in the six-item CTS symptoms score (range 1–5, higher score indicates worse symptoms, minimal clinically important difference, 0.9) from baseline to 12 weeks and proportion of patients undergoing surgery at 1 year. Adverse events were assessed at 6 weeks and 1 year.ResultsSeventy patients were randomly assigned to the rigid splint group and 72 patients to the placebo bandage group. The mean CTS symptoms scores were as follows: rigid splint: baseline, 2.81 and 12 weeks, 2.45 (unadjusted mean difference, −0.36 [95% confidence interval (CI), −0.51 to −0.21]) and placebo bandage: baseline, 2.80 and 12 weeks, 2.52 (unadjusted mean difference, −0.28 [95% CI, −0.45 to −0.11]). The adjusted mean difference in the 12-week change in scores between the two groups was 0.08 (95% CI, −0.15 to 0.31; P=0.478). At 1 year, 40 (57.1%) patients in the rigid splint group and 37 (51.4%) patients in the placebo bandage group had surgery (adjusted relative risk, 1.10 [95% CI, 0.81–1.48]). Minor local adverse events were reported by 12 patients in each group. There were no serious adverse events.ConclusionsAmong patients with CTS randomly assigned to treatment with a rigid wrist splint versus placebo soft bandage, the change of symptom scores after 12 weeks was not significantly different and the proportion undergoing surgery within 1 year was similar between the two groups. (Funded by a Southern Healthcare Region Research and Development Grant, Swedish Governmental Funding for Clinical Research [ALF], and Lions Foundation Skåne; ISRCTN number, ISRCTN81836603.)

Abstract BackgroundBehavioural and psychological symptoms (BPSD) are common in major cognitive disorders and an important driver of suffering and high care needs. The Swedish BPSD registry was founded in 2010 to develop an evidence base for quality improvement in the care of patients with BPSD. Here we describe the process of establishing and operating the registry, the patient population included, and data collected since the start of the registry in 2010.MethodsThe Swedish BPSD registry provides a framework for documenting the occurrence of behavioural disturbances, formulating individual caring and treatment plans and following up the patients and capturing health outcomes. Symptoms are recorded by the neuropsychiatric inventory ‐ nursing home (NPI‐NH) scale, and data is entered by trained staff, mainly at institutional care facilities. Triggering factors for BPSD are also recorded, as well as care objectives and targeted symptoms.ResultsBetween 2010 and 2023, 324,900 registrations were made in 110,684 persons. The number of patients active in the registry each year is 20‐25,000. Alzheimer’s disease was the most common diagnosis, 33%, followed by vascular dementia 17%, mixed 8%, DLB/PDD in 3% and FTD in 1,5%. Pain was the most cited trigger factor in all symptoms, except for night‐time and appetite/eating disturbances. The most frequently used care objective was affirmation/security, especially to manage agitation/aggression. Median survival was 24.0 months for men, 30.5 months for women.ConclusionsThe Swedish BPSD registry provides a unique view of the final stages in the disease course of dementia, with specific focus on the role of behavioural disturbances and their management. The scale, data completeness, long duration and possibility of linkage to other health registries is to our knowledge unparalleled and a great potential as a resource for data‐driven research.

Mild traumatic brain injury, such as concussion, was once considered self-resolving. However, over the past decade, increased understanding of the short- and long-term impact has led to new guidelines for active management. In this review, we summarise recent findings, covering diagnostic criteria, and management for early and persistent symptoms. Many of the postconcussive symptoms can be treated and an individualised approach from a biopsychosocial perspective is recommended. Overall, the new knowledge will significantly impact patient care and future research.

Background and purposeDifferent marker-selection methods are applied to represent implant and tibial segments in radiostereometric analysis (RSA) studies of total knee arthroplasty (TKA). Either a consistent set of markers throughout subsequent RSA examinations (“consistent-marker method”) is used or all available markers at each follow-up (“all-marker method”). The aim of this secondary analysis was to compare marker-selection methods on individual and group level TKA migration results.MethodsData from a randomized RSA study with 72 patients was included. Tibial baseplate migration was evaluated at 3 months, 1, 2, and 5 years postoperatively with both marker-selection methods. Additionally, migration was calculated using 5 fictive points, either plotted based on the consistent set of markers or all available markers.ResultsMigration could be calculated with both marker-selection methods for 248 examinations. The same prosthesis and bone markers (n = 136), different prosthesis markers (n = 71), different bone markers (n = 21), or different prosthesis and bone markers (n = 20) were used. The mean difference in maximum total point motion (MTPM) between all examinations was 0.02 mm, 95% confidence interval –0.26 to 0.31 mm. 5 implants were classified as continuously migrating with the consistent-marker method versus 6 implants (same 5 plus one additional implant) with the all-marker method. Using fictive points, fewer implants were classified as continuously migrating in both marker-selection methods. Differences between TKA groups in mean MTPM were comparable with both marker-selection methods, also when fictive points were used.ConclusionEstimated group differences in mean MTPM were similar between marker-selection methods, but individual migration results differed. The latter has implications when classifying implants for estimated risk of future loosening.

BackgroundVascular adverse events after collagenase injection for Dupuytren disease are absent in large trials and systematic reviews. The aim of this study is to present a case series of delayed vascular complications after collagenase treatment.MethodsA prospective evaluation of 1181 consecutively treated patients at one orthopedic department identified three patients reporting symptoms of possible vascular complication. Baseline demographics and description of symptoms were collected, with a physical examination documenting extension deficit and neurovascular status. All patients completed the Cold Intolerance Symptom Severity (CISS) scale (range 4-100, lower is better) and underwent Doppler sonography examination of the digital arteries.ResultsAll patients were treated in the small finger and two had an isolated proximal interphalangeal joint contracture. All patients had a delayed presentation of a few months, with episodes of white discoloration of the treated finger relieved within 30 min and associated with variable pain, paresthesia, stiffness and weakness. Two of the patients reported cold exposure as an episode trigger and had a pathological CISS score (40 and 36, respectively). Doppler sonography identified a nonpatent ulnar digital artery in one patient.ConclusionsDelayed vascular complication after collagenase treatment is rare, but surgeons and patients should be aware of the risk, especially when treating the small finger.

This chapter presents a clinical scenario of a 59-year-old healthy woman who had injures in her dominant wrist after a fall at home. Her wrist radiographs show a displaced extra-articular distal radius fracture with a dorsal angulation of 15° (from 0°) and an ulnar variance of 3 mm. The treating surgeon has a discussion with the patient about surgical and nonsurgical treatment options and the expected outcomes in case the fracture heals with malunion or in a near anatomical position. They also discuss which treatment method would be most effective in restoring near normal anatomy. Treatment of displaced distal radius fractures has shifted toward increasing use of open reduction and fixation with volar locking-plate. Distal radius osteotomy (sometimes combined with ulnar osteotomy) is a major surgical procedure that requires substantial postoperative rehabilitation.

The Assessment of Learning Powered mobility use (ALP) tool including the ALP instrument and facilitating strategies, was developed for Driving to Learn. This therapeutic intervention aims to provide children and adults who have profound cognitive disabilities with opportunities to learn tool use through powered mobility practise. To allow for longer intervention periods, a partnership was developed between professionals supervising Driving to Learn and persons accompanying children or adults to their practice sessions. Accompanying persons (relatives or assistants) gradually took on shared responsibility for applying the intervention and conducting assessments with the ALP-instrument. The aim of this study was to test the inter-rater reliability of the ALP-instrument version 2.0 as applied in this novel partnership in assessment and intervention. A psychometric analysis compared pair-wise assessments with the ALP-instrument version 2.0, made independently by professional supervisors and accompanying persons following each Driving to Learn session. Weighted kappa statistic was used to compare the matched pair ordinal data. Eight professional supervisors and 22 accompanying persons independently completed assessments with the ALP-instrument after 55 sessions with six children and five adults, who each participated in five Driving to Learn sessions. When the scores from the 55 pairs of assessments were compared, a weighted kappa value of 0.85 was obtained, indicating very good inter-rater reliability between the two rater groups. The resulting inter-rater reliability suggests that it is reliable to implement the ALP-instrument as part of partnership in intervention between supervisors and accompanying persons. Provision of longer periods of Driving to Learn is possible when those who accompany the child or adult are able to gradually assume responsibility for practice and assessment under the supervision of a professional. This partnership approach enables children and adults with multiple and complex disabilities to practise and learn in accordance with their conditions and needs.

ObjectiveTo study whether an injury prevention exercise programme would reduce the number of injuries in youth floorball players.Methods 81 youth community level floorball teams (48 clusters=clubs) with female and male players (12–17 years) were cluster-randomised into an intervention or control group. Intervention group coaches were instructed to use the Swedish Knee Control programme and a standard running warm-up before every training session, and the running warm-up before every match, during the season. Control teams continued usual training. Teams were followed during the 2017/2018 competitive season (26 weeks). Player exposure to floorball and occurrence of acute and overuse injuries were reported weekly via a web-based player survey using the Oslo Sports Trauma Research Centre Questionnaire.Results 17 clusters (301 players) in the intervention group and 12 clusters (170 players) in the control group were included for analyses. There were 349 unique injuries in 222 players. The intervention group had a 35% lower incidence of injuries overall than the control group (adjusted incidence rate ratio (IRR) 0.65, 95% CI 0.52 to 0.81). The absolute risk reduction was 6.6% (95% CI 3.2 to 10.0), and the number needed to treat was 152 hours of floorball exposure (95% CI 100 to 316). Intervention group teams had a 45% lower incidence of acute injuries (adjusted IRR 0.55, 95% CI 0.37 to 0.83). There was no difference in the prevalence of overuse injuries (adjusted prevalence rate ratio 0.96, 95% CI 0.73 to 1.26).Conclusion The Knee Control injury prevention programme reduced acute injuries in youth floorball players; there was no effect on overuse injuries.Trial registration numberClinical Trials NCT03309904.