Schulthess-Klinik

Spinal cord injury (SCI) incidence is rising among the elderly, yet the relationship between age and recovery remains controversial. The aim of this study was to evaluate the relationship between age and neurologic and functional outcomes and to identify an age cutoff associated with a decline in recovery. We conducted a prospective cohort study using data from patients with traumatic and ischemic SCI enrolled in the European Multicenter Study about Spinal Cord Injury between 2001 and 2022. Linear regression models assessed the relationship between age and changes from baseline to 1 year after SCI in the total motor score (TMS) of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and in the Spinal Cord Independence Measure (SCIM) total score. Additional analyses examined the relationship between age and the evolution of ISNCSCI light-touch and pinprick scores, as well as ambulation parameters (6-minute walking test, 10-meter walking test, and Walking Index for Spinal Cord Injury). Models were adjusted for baseline scores, sex, year of injury, American Spinal Injury Association Impairment Scale (AIS) grade, and level of injury. The age cutoff was determined using a change-point model. A total of 2,171 patients (median age 47 years, 77.9% male, 51.9% injured at the cervical level, and 50.0% with a motor complete injury [AIS-A and AIS-B]) were included in the analysis. Increased age was not associated with changes in TMS (p = 0.896) but was significantly associated with reduced SCIM improvement (p < 0.001), with an estimated decline of 4.3 SCIM points per decade of age. Sensory outcomes were not significantly affected by age (Δlight-touch: p = 0.273; Δpinprick: p = 0.520) while ambulation recovery declined with increasing age (all outcomes p < 0.01). A noticeable reduction in functional recovery was observed in patients older than 70 years. Older age does not seem to affect neurologic recovery but is linked to poorer functional and ambulation outcomes. These findings, including the identified age cutoff, should inform future clinical trial design and guide tailored care strategies for older adults with SCI. ClinicalTrials.gov Identifier NCT01571531.

Athletes frequently experience sleep disturbances due to training intensity, competitive pressure, and travel. While sexual activity, particularly achieving orgasm, is linked with improved sleep through hormonal mechanisms in general populations, this relationship remains unexplored in athletes, whose sleep and recovery needs are unique. This cross-sectional study primarily aimed to examine competitive athletes' perceptions regarding how sexual activity (partnered intercourse and masturbation, with or without orgasm) influences sleep quality, latency, and sport performance and explore differences by sex and sport discipline (individual vs team). In this cross-sectional descriptive study, 164 competitive athletes (males = 115, females = 49; age 18-40y) from Italian sport federations completed a structured survey assessing sexual behavior, orgasm frequency, sleep parameters, and perceived athletic impact. Statistical analysis included chi-square, Fisher exact, and t tests with significance at P < .05. A majority reported that orgasmic sexual activity significantly improved sleep quality (partnered sex: 67.7%, masturbation: 49.1%) and latency (partnered sex: 58.4%, masturbation: 46.9%). Partnered sex appeared slightly more beneficial, but the difference was not statistically significant (quality: P = .810, latency: P = .996). Significant sex differences emerged in orgasm consistency during partnered sex (men: 77.8%, women: 30.0%; P < .001) and masturbation (men: 99.1%, women: 83.3%; P < .001). No sex or sport-discipline differences were identified regarding perceived sleep benefits or performance impact; most athletes (≥50%) perceived no negative effects on training or competition. Competitive athletes perceive sexual activity with orgasm as beneficial for sleep and neutral regarding athletic performance, challenging conventional abstinence recommendations. Practitioners should adopt individualized, evidence-based strategies when advising athletes on sexual behavior in relation to sleep and performance.

Existing classification systems for lateral clavicle fractures have low interobserver reliability and provide limited information for treatment decisions. The aim of this study was to introduce a new classification system and to evaluate its comprehensiveness, inter- and intraobserver reliability, and concordance of associated treatment strategy for lateral clavicle fractures compared with existing classifications. Four raters, all experienced in shoulder surgery, independently assessed routine radiographs of 100 patients with lateral clavicle fractures. They were asked to classify the fractures according to the Neer and Jäger/Breitner classification systems, as well as a new classification system, and to determine appropriate treatment for each case based on the new classification system. The assessment was performed at 2 different time points 6 weeks apart. The new classification divides the fractures into 3 zones according to the attachment of the coracoclavicular (CC) ligaments, as well as displacement (1: lateral to the CC ligament attachment; 2: at the attachment of the CC ligaments; 3: medial to the CC ligament attachment; a: nondisplaced, b: displaced). Furthermore, 30 orthopedic surgeons were surveyed about their knowledge regarding the Neer and Jäger/Breitner classification systems. Inter-rater reliability was moderate for the Neer classification (κ = 0.565), substantial for the Jäger/Breitner classification (κ = 0.781) and for the new classification system (κ = 0.798). Although 28 cases with the Neer classification and 28 cases with the Jäger/Breitner classification could not be classified by at least 1 of the raters, 99% of the cases could be classified with the new classification. Intrarater reliability was moderate for the Neer classification (κ = 0.693) and for the Jäger/Breitner classification (κ = 0.660) and substantial for the new classification system (κ = 0.762). The inter- and intrarater reliability of treatment choice was regarded as substantial (κ = 0.659, κ = 0.738, respectively). Although the raters would treat 94%-99% of all cases classified as subgroup b surgically, only 0%-26% of cases classified as subgroup a were classified as requiring surgery. The knowledge of Jäger/Breitner and Neer classification among the surgeons surveyed was relatively poor: None of the 30 surgeons was able to describe the fracture types of Neer classification, while 2 of 30 surgeons could detail all types of Jäger/Breitner classification. Our study demonstrated a high inter- and intrarater reliability of the new classification system and the associated treatment choices. Furthermore, the new classification system appears capable of categorizing the vast majority of lateral clavicle fractures.

Over the span of 25 years, the International Federation of Sports Physical Therapy (IFSPT) has grown from its founding in 2000 in the city of Utrecht in the Netherlands to a Federation of more than 40 member organizations. The IFSPT was officially recognized as a member organization of the World Confederation for Physical Therapy in 2003. Since then, it has partnered with the International Journal of Sports Physical Therapy (in 2010), defined the core competencies for sports physiotherapists, launched the pathway to become a Registered International Sports Physical Therapist, and inaugurated its own World Congress in 2015, with the sixth congress planned for December 2026. This perspective reviews these milestones, notes remaining global disparities, and outlines priorities in equity, digital health, and sustainabilityLevel of Evidence5