Chronic low back pain (CLBP) is a major public health problem and a leading cause of years lived with disability worldwide. Although interprofessional rehabilitation is recommended for managing CLBP, its feasibility and implementation in low-resource settings, such as Ethiopia, remain largely unexplored. This study evaluated the feasibility of conducting a future definitive hybrid type I effectiveness-implementation trial comparing the Interprofessional Rehabilitation Program for Chronic Low Back Pain (IPRehab-LBP) with usual care. A two-arm, parallel-group, open-label pilot randomized controlled trial (RCT) with an embedded mixed-methods process evaluation was conducted. Forty adults with CLBP were randomized to IPRehab-LBP (n = 20) or usual care (n = 20). The 4-week IPRehab-LBP program included physical activity and exercise, pain education, cognitive behavioural therapy and psychosocial support, and task-oriented and ergonomic interventions. Primary feasibility outcomes included recruitment, retention, outcome-measure completion, and intervention fidelity. Exploratory clinical outcomes included disability, pain intensity, self-efficacy, and health-related quality of life. Outcomes were assessed at baseline, post-intervention, and 12-week follow-up. Linear mixed-effects models and ANCOVA were used to estimate between-group differences. Post-intervention interviews were conducted with 10 participants and five healthcare providers. Recruitment was 2.5 participants per week. Retention was 92.5
Gait impairment is a major manifestation of degenerative cervical myelopathy (DCM). Most previous gait studies have focused on mean spatiotemporal parameters, whereas gait variability may provide a more sensitive indicator of gait instability and fall risk. However, the clinical significance of stride length variability in patients with DCM remains unclear. This study aimed to investigate the clinical significance of stride length variability in patients with DCM by examining its associations with objective and patient-reported clinical measures, as well as other gait parameters. Sixty-three consecutive patients with DCM who completed all assessments were included. Stride length variability was quantified using the coefficient of variation (CV) of stride length during treadmill walking using the KinemaTracer three-dimensional gait analysis system. Associations between stride length variability and objective clinical measures, gait parameters, and the domains of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) were evaluated. Receiver operating characteristic analysis was performed to determine the optimal gait speed cutoff for identifying high stride length variability (CV ≥ 4
Neer type II distal clavicle fractures are unstable injuries. Clavicular hook plates (CHP) provide fixation but can cause subacromial complications and require implant removal. We compared extra-articular all-endoscopic anchor fixation (BEA) with CHP. This single-center retrospective non-randomized cohort included 120 patients treated from July 2022 to June 2025 (BEA, 51; CHP, 69). After discussion of both procedures, patients selected treatment; both techniques were performed by the same general orthopedic team. The primary outcome was the 12-month Constant–Murley Score (CMS). Radiographic union by 6 months was the key secondary radiographic outcome; other secondary outcomes included healing status at scheduled visits, perioperative measures, pain, shoulder function, complications, cortical resorption, and secondary procedures. Because radiographs were obtained at scheduled visits, time to union was not estimated. At 12 months, before CHP removal, CMS was higher in the BEA group than in the CHP group (92.4 ± 5.6 vs. 84.8 ± 6.9; mean difference, 7.6 points; 95
Total joint arthroplasty (TJA) reduces pain in patients with end-stage osteoarthritis, but many still experience residual pain after one year. We aimed to identify preoperative prognostic factors for residual pain and describe their relative strength. We systematically searched Embase, MEDLINE, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to 12 December 2023 and screened the 200 top-ranked Google Scholar records. Eligible studies involved patients undergoing primary TJA for osteoarthritis and comprised prospective or retrospective cohort studies, case-control studies, and prognostic analyses of randomised trials developing or updating an internally or externally validated multivariable prognostic model. Associations were converted to a common correlation scale and pooled using random-effects meta-analysis. Prediction intervals, certainty of evidence, and risk of bias were assessed. Fifty-nine studies (335’921 patients) addressed hip, knee, or shoulder arthroplasty; no eligible studies addressed other prespecified joints. Across joints, poorer mental health (mean correlation coefficient − 0.11; 95
Remote thoracic spinal subdural hematoma after lumbar surgery is exceptionally rare and may be overlooked when postoperative neurological deterioration is initially attributed to the operated lumbar level. A 64-year-old woman with Grade 3 hypertension, scoliosis, and a body mass index of 24.66 kg/m² underwent conventional open posterior midline L5–S1 transforaminal lumbar interbody fusion. No dural tear or cerebrospinal-fluid leakage was documented, and estimated blood loss was 100 mL. She received enoxaparin 40 mg subcutaneously on postoperative days 1 and 2. At 00:25 on postoperative day 3, she developed new thoracic back pain, followed at 02:15 by abrupt paraplegia and sensory loss, approximately 59 hours 40 minutes after the lumbar operation ended. Urgent magnetic resonance imaging showed a posterior T7–T9 intradural hematoma with an inverted Mercedes-Benz configuration. At maximal compression, hematoma thickness was 5.81 mm within a same-axis canal diameter of 11.03 mm, corresponding to a 52.7
