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Physical therapy is routinely delivered to patients after discharge from the hospital following knee arthroplasty (KA). Posthospitalization physical therapy is thought to be beneficial, particularly for those patients most at risk for poor outcome, the subgroup with persistent function-limiting pain despite an apparently successful surgery. Research teams have undertaken 3 large-scale multicenter Phase III randomized clinical trials designed specifically for patients at risk for poor outcome following KA. All 3 trials screened for poor outcome risk using different methods and investigated different physical therapist interventions delivered in different ways. Despite the variety of types of physical therapy and mode of delivery, all trials found no effects of the enhanced treatment as compared with usual care. In all cases, usual care required a lower dosage of physical therapy as compared with the enhanced interventions. This Perspective compares and contrasts the 3 trials, speculates on factors that may explain the no-effect findings, and proposes areas for future study designed to benefit the poor outcome phenotype.

To investigate the influence of diabetes duration and glycemic control, assessed by glycated hemoglobin (HbA1c) levels, on risk of incident dementia.

The present study is a prospective study of 461,563 participants from the UK Biobank. The age at diabetes diagnosis was determined by self-report. Diabetes duration was calculated as baseline age minus age at diagnosis. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidential intervals (CIs).

During a median follow-up of 8.1 y, 2,233 dementia cases were recorded. As compared with normoglycemic individuals, individuals with diabetes had higher risk of all-cause dementia, and the risk increased with increasing duration of diabetes; compared with participants with diabetes duration of <5 y, the multivariable-adjusted HRs (95% CIs) were 1.49 (1.12-1.97), 1.71 (1.21-2.41), and 2.15 (1.60-2.90) for those with diabetes durations ≥5 to < 10, ≥10 to <15, and ≥ 15 y, respectively (P for trend < 0.001). Among participants with diabetes, those with both longer diabetes duration (diabetes duration ≥10 y) and poor glycemic control (HbA1c ≥8%) had the highest risk of All-cause dementia (multivariable-adjusted HR =2.07, 95% CI 1.45, 2.94), compared with patients with shorter duration of diabetes and better glycemic control (diabetes duration <10 y and HbA1c <8%).

Diabetes duration appeared to be associated with the risk of incident dementia due to factors beyond glycemic control. Clinicians should consider not only glycemic control but also diabetes duration in dementia risk assessments for patients with diabetes.

Diabetes duration appeared to be associated with the risk of incident dementia due to factors beyond glycemic control. Clinicians should consider not only glycemic control but also diabetes duration in dementia risk assessments for patients with diabetes.

Cerebral autoregulation (CAR) systems maintain blood flow to the brain across a wide range of blood pressures. Deficits in CAR have been linked to gait speed but previous studies had small sample sizes and used specialised equipment which impede clinical translation. The purpose of this work was to assess the association between gait speed and orthostatic cerebral oxygenation in a large, community-dwelling sample of older adults.

Data for this study came from the Irish Longitudinal Study on Ageing. A near infrared spectroscopy (NIRS) device attached to the forehead of each participant (n=2708) was used to track tissue saturation index (TSI; the ratio of oxygenated to total haemoglobin) during standing. Gait speed (GS) was assessed using a portable walkway.

Recovery was impaired in slower GS participants with a TSI value at 20 seconds (after standing) of -0.55% (95% CI -0.67, -0.42) below baseline in the slowest GS quartile versus -0.14% (95% CI -0.25, -0.04) in the fastest quartile. Slower GS predicted a lower TSI throughout the 3-minute monitoring period. Results were not substantially altered by adjusting for orthostatic hypotension. Adjustment for clinical and demographic covariates attenuated the association between but differences remained between GS quartiles from 20 seconds to 3 minutes after standing.

This study reported evidence for impaired recovery of orthostatic cerebral oxygenation depending on gait speed in community-dwelling older adults. Future work assessing NIRS as a clinical tool for monitoring the relationship between gait speed and cerebral regulation is warranted.

This study reported evidence for impaired recovery of orthostatic cerebral oxygenation depending on gait speed in community-dwelling older adults. Future work assessing NIRS as a clinical tool for monitoring the relationship between gait speed and cerebral regulation is warranted.

Current guidelines recommend management of musculoskeletal pain conditions from a biopsychosocial approach, however biopsychosocial interventions delivered by physical therapists vary considerably in effectiveness. It is unknown whether the differences are explained by the intervention itself, the training and/or competency of physical therapists delivering the intervention, or fidelity of the intervention. The aim was to investigate and map the training, competency assessments and fidelity checking of individualized biopsychosocial interventions delivered by physical therapists to treat musculoskeletal pain conditions.

A scoping review methodology was employed, using Arksey and O'Malley's framework. Seven electronic databases were searched between January to March 2019, with a bridge search completed in January 2020. Full text peer-reviewed papers, with an individualized biopsychosocial intervention were considered, and thirty-two studies were included.

Reporting overall was sparse and highly variable.nt in future interventions. These findings can help inform future research and facilitate more widespread implementation of physical therapist delivered biopsychosocial interventions for people with musculoskeletal pain and thereby improve their quality of life.

This study highlighted problematic reporting, training, assessment of competency and fidelity checking of physical therapist delivered individualized biopsychosocial interventions. Findings here highlight why previous interventions may have shown small effect sizes and areas for improvement in future interventions. These findings can help inform future research and facilitate more widespread implementation of physical therapist delivered biopsychosocial interventions for people with musculoskeletal pain and thereby improve their quality of life.The amino acid proline has been known for many years to be a component of proteins as well as an osmolyte. Many recent studies have demonstrated that proline has other roles such as regulating redox balance and energy status. In animals and plants, the well-described proline cycle is concomitantly responsible for the preferential accumulation of proline and shuttling of redox equivalents from the cytosol to mitochondria. The impact of the proline cycle goes beyond regulating proline levels. In this review, we focus on recent evidence of how the proline cycle regulates redox status in relation to other redox shuttles. We discuss how the interconversion of proline to glutamate shuttles reducing power between cellular compartments. Spatial aspects of the proline cycle in the entire plant are considered in terms of proline transport between organs with different metabolic regimes (photosynthesis versus respiration). Furthermore, we highlight the importance of this shuttle in the regulation of energy and redox power in plants, through a particularly intricate coordination notably between mitochondria and cytosol.

Plurality of treatment choice is often observed, as in many instances people choose to use both conventional and complementary and alternative medicine (CAM). The existing models of healthcare utilization or healthcare behavior do not specifically address this medical pluralism. Hence, to understand an individual's pluralistic choice of treatment, major studies describing this have been systematically reviewed in this study in order to extract the principal factors driving such choice. Also, applicability of current healthcare models is qualitatively analyzed in order to identify whether they properly explain the factors driving such pluralistic choices.

A systemic literature review was performed of 20 studies including 6 National Surveys. The major variables included were prevalence of integrative medicine in the last 12 months, nature of pluralism, major factors driving plurality of choice and the underlying model describing such choices.

Mean usage of plurality was 44.48% (95% CI, 44.12-44.84%). The em, personality trait was observed to be an important but neglected component of existing models. From the existing studies, no single pluralism-driven integral model could be established, satisfying all the important conditions of pluralistic choice.

Low back pain (LBP) is a painful pathology causing pain and disability despite treatment with the best evidence-based therapies. Osteopathic manual therapy (OMT) and Kaltenborn-Evjenth orthopedic manual therapy (KEOMT) are alternative treatments for LBP.

The study intended to evaluate the efficacy of OMT compared to that of KEOMT for patients with chronic LBP.

The research team designed a randomized study.

The study was held at the Medita Health Center in Warsaw, Poland.

The study included 68 participants of both genders, aged 30 to 60, with chronic LBP.

Participants were randomly assigned to one of two parallel groups, each with 34 members. The OMT group received, as a direct technique, a high-velocity/low-amplitude (HVLA) impulse, and as indirect techniques, strain counterstrain (SCS), myofascial release (MFR), and visceral mobilization therapy (VMT). The KEOMT group received lumbar segmental traction and lumbar segmental mobilization-flexion and gliding therapy grade 3. The participants in both groups received 10 treatments, two per week for five weeks.

The primary outcome was pain severity, using a numeric pain rating scale (NPRS). The secondary outcome was measurement of functional disability, using the Oswestry Disability Index (ODI).

The OMT and KEOMT both decreased pain and disability; however, the changes on the NPRS and ODI postintervention were statistically greater for the OMT group compared to the KEOMT group (P < .05).

OMT was better at reducing pain and improving quality of life. It reduced functional disability more than KEOMT in patients with chronic LBP.

OMT was better at reducing pain and improving quality of life. YC-1 clinical trial It reduced functional disability more than KEOMT in patients with chronic LBP.This study is a comparative analysis of the effects of intuitive eating and correlations with quality of life and wellbeing in Yoga practitioners, physical activity practitioners and sedentary individuals. The study involved 204 participants, comprising 66 Yoga practitioners, 74 physical activity practitioners and 64 sedentary individuals, between the ages of 20 and 59, who were resident in Brazil at the time of the study. Quantitative research was conducted through Facebook and the application questionnaires via Google Forms to measure intuitive eating, food consumption, quality of life, stress level, satisfaction with body image and level of mindfulness. The study found that while intuitive eating did not differ between Yoga practitioners and physical activity practitioners, both showed greater adoption of intuitive eating as compared to inactive individuals. Still, Yoga practitioners had better confidence in their physiological signs of hunger and satiety, as well as better eating behavior, quality of life, satisfaction with body image, healthy body weight, and stress-related emotional regulation, as compared to the other groups.