Littérature scientifique sur le sujet « Oxford Grading Scale »

ABSTRACT Objectives The objectives of the study are to: (i) Assess the perineal muscle strength of postnatal mothers after vaginal delivery in the experimental and control groups before and after the intervention. (ii) Evaluate the effectiveness of Kegel's exercise on perineal laxity in the experimental group compared to control group. Methods This single blinded randomized controlled trial at a 1000 bedded tertiary care teaching hospital in India, enrolled 290 postnatal mothers between 20 and 40 years who had vaginal delivery with < 2 on modified Oxford grading scale as measured by per vaginal digital examination. The subjects were randomized into experimental and control groups. The experimental group received instructions to perform Kegel's exercises along with routine postnatal care while the control group received advice on routine postnatal care. Two follow-up assessments were done at 6 and 10 weeks. The primary outcome measure was increase in Oxford grading score. Results Major findings of the study were: The mean perineal muscle strength assessment scores noted before the intervention and during first and second postintervention assessments were 1.5 ± 0.52, 3.58 ± 0.51 and 4.28 ± 0.57 respectively for the experimental group and 1.56 ± 0.55, 2.41 ± 0.52 and 3 ± 0.51 respectively for the control group. Comparison of these scores between the groups by unpaired t-test yielded p-value of < 0.0001 suggesting high significant difference in favor of the experimental group. However, no additional benefit was observed after Kegel's exercise in the mothers who had episiotomy during vaginal delivery. Conclusion The Kegel's exercise is effective to reduce perineal laxity and hence should be included as a part of routine postnatal care.

Summary Introduction: Digital palpation and manometry are methods that can provide information regarding maximum voluntary contraction (MVC) and endurance of the pelvic floor muscles (PFM), and a strong correlation between these variables can be expected. Objective: To investigate the correlation between MVC and endurance, measured by digital palpation and manometry. Method: Forty-two women, with mean age of 58.1 years (±10.2), and predominant symptoms of stress urinary incontinence (SUI), were included. Examination was firstly conducted by digital palpation and subsequently using a Peritron manometer. MVC was measured using a 0-5 score, based on the Oxford Grading Scale. Endurance was assessed based on the PERFECT scheme. Results: We found a significant positive correlation between the MVC measured by digital palpation and the peak manometric pressure (r=0.579, p<0.001), and between the measurements of the endurance by Peritron manometer and the PERFECT assessment scheme (r=0.559, P<0.001). Conclusion: Our results revealed a positive and significant correlation between the capacity and maintenance of PFM contraction using digital and manometer evaluations in women with predominant symptoms of SUI.

Background: Knee Osteoarthritis is the most common joint disorder and one of the leading causes of disability. The main symptoms associated with osteoarthritis are pain, discomfort, limitation of activity and reduced participation. Physiotherapy management is evidence-based treatment approach that have short-term and long-term effect on reducing pain, improve muscle strength and function. Aim: The aim of this study was to find out evidence-based physiotherapy in patient with knee osteoarthritis through three tract reasoning on reducing pain, improve muscle strength and function. Method: A case-based study was conducted. The three tract reasoning: procedural, interactive and conditional were used during diagnosis and in management of knee osteoarthritis. Results: The patient respond well in physiotherapy treatment. The swelling was 100% reduced, reduced pain in VAS from 8/10 to 1/10, improved muscle strength by oxford muscle grading scale by grade V, weight bearing is more (90%) and only 25% remain limitation in functionally from 69%. Conclusion: Knee osteoarthritis is frequent musculoskeletal condition that affect person’s activities and restricted the participation. Using clinical reasoning physiotherapist diagnosed and managed the symptoms. After receiving physiotherapy treatment improved the patient’s status of health.

Purpose This study aimed to analyze the association of tear matrix metalloproteinase 9 (MMP-9) immunoassay with the severity of dry eye (DE) signs and symptoms through qualitative, semiquantitative, and quantitative evaluations of immunoassay band. Materials and methods This cross-sectional study enrolled 320 eyes of 320 patients. The clinical signs of DE were assessed using the Ocular Surface Disorder Index (OSDI) score, visual analogue scale (VAS), tear breakup time (tBUT), tear volume evaluation by tear meniscometry, and staining scores of the cornea and conjunctiva by the Oxford grading scheme. The tear MMP-9 immunoassay results were interpreted using qualitative (positive or negative), semi-quantitative (reagent band density on a four-point scale: 0 = negative; 1 = weakly positive; 2 = moderately positive; 3 = strongly positive), and quantitative (ratio of reagent band density to control band density) indicators. Results Positive MMP-9 immunoassay results were significantly related to shorter tBUT, tBUT ≤3 seconds, higher corneal staining score, corneal staining score ≥2, and conjunctival staining score ≥2. The semi-quantitative results of the MMP-9 immunoassay were positively correlated with higher corneal staining score (r = 0.122, p = 0.029) and negatively correlated with tBUT (r = -0.125, p = 0.025). However, in the quantitative analysis, none of the DE signs or symptoms were correlated to the band density of the MMP-9 immunoassay. Conclusions The positive MMP-9 immunoassay results were related to the severity of ocular signs of DE. However, using quantitative measures of the MMP-9 immunoassay to assess the clinical severity of DE requires further investigation.

Now a day’s abnormal uterine bleeding in premenopausal women is the most common indication of hysterectomy which usually results from myomas and adenomyosis. In this case study, a 38-year-old female, with a complaint of abnormally heavy bleeding with menstrual cycle irregularity and discomfort for 15 days each month with dysmenorrhoea. She was diagnosed for large fibroid deposition at the posterior wall of the uterus and extroverted in the position. So, she was prescribed for vaginal Hysterectomy by a gynecologist further investigation, she underwent a vaginal hysterectomy, post-operatively patient was complaining about lower abdominal pain and difficulty in bed mobility activities. There was weakness in pelvic floor muscles after the surgery, due to which she had worried about overweight, physical health, and her quality of life. So she approached the physiotherapist, where she had trained for pelvic floor muscle training two-three sessions per day for two weeks with abdominal, back, and hip strengthening exercises with a home exercise program. VAS scale, Oxford grading system, PFIQ, QOL questionnaire was taken as outcome measure prior and after the intervention. The present case report emphasizes the effect of the combination of different exercises for pelvic floor muscles encasing the comprehensive rehabilitation plan including a home exercise regimen allowing the patient to recover early and return to daily activities.

Introduction: Frequent and regular exercises in the first six months of stroke may cause return of a significant portion of sensory and motor function of patients. This study aimed to examine the effects of passive range of motion exercise in the acute phase after stroke on motor function of the patients. Methods: A randomized controlled trial study was conducted. The patients with first ischemic stroke were randomly allocated to either experimental (n=33) or control (n=19) group. Passive range of motion exercises was performed in the experimental group during the first 48 hours of admission as 6 to 8 times of 30 minute exercise. Before intervention, and one and three months after intervention, motor function were measured by muscle strength grading scale (Oxford scale) and compared. SPSS version 13.0 for Windows was used for statistical analysis. Frequency distribution was used to describe the data. For comparisons, paired t-test, independent t-test was used, and repeated measures test was used. Results: In acute phase, the intervention in the experimental group led to significant improvement of motor function between the first and third month in both the upper and lower extremities. In control group, improvement was observed only in the muscle strength of upper extremity in the first and third month compared to pre-intervention measurement. The greatest improvement was observed in the interval from base to one month in the upper extremity, and base to the first month and the first to the third month in the lower extremity. Conclusion: It is recommended to use early passive range of motion exercise as part of care for people with stroke during the acute phase of the disease.

Background: Various techniques have been described for surgical treatment of recalcitrant medial epicondylitis (ME). No single technique has yet to be proven the most effective. Purpose: To evaluate the clinical outcomes of a double-row repair for ME. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed on 31 consecutive patients (33 elbows) treated surgically for ME with a minimum clinical follow-up of 2 years. All patients were initially managed nonoperatively with anti-inflammatories, steroid injections, topical creams, and physical therapy. Outcome measures at final follow-up included visual analog scale (VAS) scores (scale, 0-10), time to completely pain-free state, time to full range of motion (FROM), Mayo Elbow Performance Scores (MEPS), and Oxford Elbow Scores (OES). Patients were contacted by telephone to determine current functional outcomes, pain, activity, functional limitations, and MEPS/OES. Successful and unsuccessful outcomes were determined by the Nirschl grading system. Results: The mean clinical and telephone follow-up periods were 2.3 and 3.6 years, respectively, and 31 of 33 (94%) elbows were found to have a successful outcome. The mean VAS improvement was 4.9 points, from 5.8 preoperatively to 0.9 postoperatively ( P < .001). The mean MEPS and OES at final follow-up were 95.1 and 45.3, respectively. The mean time to pain-free state and time to FROM were 87.4 and 96 days, respectively. Unlike prior studies, no difference in outcome was found between those with and without ulnar neuritis preoperatively ( P = .67). Conclusion: A double-row repair is effective in decreasing pain and improving the overall function for recalcitrant ME. Uniquely, the presence of preoperative ulnar neuritis was associated with higher patient-reported preoperative pain scores but not with poor outcomes using this protocol.

Background: The prognostic factors for patients with full-thickness rotator cuff tears (RCTs) include tear size, muscle atrophy and fatty infiltration. However, the influence of early coexisting degenerative changes on RCT outcomes is unappreciated. The purpose of this study was to calculate the impact that pre-existing partial glenohumeral cartilaginous changes have on patients undergoing arthroscopic RCT repair.Methods: A study of 54 patients undergoing arthroscopic RCT repair was undertaken. The presence of co-existing patches of glenohumeral degenerative cartilaginous changes and RCT size was recorded at surgery. Pre- and postoperative outcomes were assessed using traditional (Oxford Shoulder Score [OSS], 5-level EuroQol-5D [EQ-5D-5L] questionnaire and EuroQol visual analog scale [EQ-VAS]) and patient-centric re-formatted prisms. Outcomes were assessed as an entire dataset, and sub-group analysis was performed according to the grade of co-existing arthritis and tear size.Results: Significant improvements (p<0.05) in clinical outcomes were recognized when assessed using either the traditional or reformatted prisms (average % improvements in OSS, EQ-5D-5L and EQ-VAS were 47%, 33% and 43%, respectively; average improvements in pain, function, and psychological well-being were 48%, 33% and, 29%, respectively). Positive gain was noted in all sub-groups of arthritic grading and tear size.Conclusions: Good clinical outcomes can be achieved following RCT repair even in the presence of local partial degenerative cartilage changes and advancing tear size. These benefits are patient-centered but require RCT repairability.

Il glaucoma è una patologia neurodegenerativa sostenuta dalla morte per apoptosi delle CGR. Rappresenta la principale causa di cecità irreversibile al mondo. Non sono ancora stati compresi a fondo tutti i meccanismi che causano la degenerazione neuronale nel glaucoma (tanto che sussistono delle forme di glaucoma a PIO normale). Un ruolo importante nel meccanismo patogenetico glaucomatoso viene riconosciuto oggi ad una condizione di infiammazione cronica a livello retinico determinata da alterazioni dei livelli di PIO. Lo scopo del presente progetto di dottorato è stato un approccio multidisciplinare al glaucoma, di tipo clinico e biochimico-molecolare. In primo luogo, è stato implementato un prototipo di perimetro (Compass, Centervue, Padova, Italia), attuando dapprima un database normativo di soggetti sani al fine di integrare le caratteristiche demografiche per il test perimetrico 30-2. Successivamente, è stata valutata l’affidabilità test-retest dell’apparecchio, eseguendo il campo visivo “New Grid” per sei volte consecutive in un gruppo di pazienti clusterizzati secondo l’MD, ottenendo una bassa variabilità intra-test. È stato altresì calcolato l’agreement tra tre diversi revisori, i quali hanno esaminato indipendentemente le perimetrie e le foto fundus Compass, stabilendo un peggioramento o meno della patologia glaucomatosa, nonché la concordanza tra l’analisi da remoto dei campi visivi e immagini Compass, e la visita clinica standard dei pazienti affetti da glaucoma. I risultati hanno messo in evidenza un’ottima concordanza tra i Reviewers e tra gli esami da remoto e la visita clinica. Ai fini di stabilire la precisione punto per punto del perimetro, è stata eseguita un’analisi del Compass 10-2 in pazienti affetti da atrofia geografica, trovando una corrispondenza punto per punto della perimetria con l’immagine retinica sottostante. In ultimo, è stata effettuata un’analisi dell’osmolarità lacrimale e di tutti i parametri clinici del film lacrimale in pazienti affetti da glaucoma asimmetrico. Per quanto riguarda l’indagine biochimico-molecolare, è stata effettuata una analisi preliminare nell’umore acqueo della proteina di gap-junction Connessina 43 in un piccolo gruppo di soggetti sani e glaucomatosi, che ha posto in evidenza un aumento quasi doppio della dell’espressione della molecola nei soggetti glaucomatosi, anche se la ridotta numerosità del campione non ha prodotto un risultato statisticamente significativo. È stato inoltre utilizzato in questo progetto di dottorato un metodo innovativo di analisi: la metabolomica, ramo scientifico che si occupa di analizzare i metaboliti <1,5 kDa che derivano da specifici processi chimici cellulari in campioni biologici umani. Utilizzando la Spettroscopia di Risonanza Magnetica Nucleare 1H, sono stati analizzati campioni di vitreo di pazienti sottoposti a vitrectomia, identificando un aumento di acetone e metanolo negli occhi glaucomatosi.
Glaucoma is a neurodegenerative disease caused by ganglion cells death by apoptosis. It represents the leading cause of irreversible blindness in the world. Although the mechanisms triggering the neuronal degeneration in glaucoma have not yet been fully understood, a chronic inflammatory condition at the retinal level, sustained by abnormal IOP, is considered today a main factor in glaucoma pathogenesis. The aim of this PhD project was a multidisciplinary approach to glaucoma investigation, both clinical and bio-molecular. Firstly, a prototype of visual field analyzer (Compass, Centervue, Padua, Italy) was implemented, primarily by developing a demographic database of healthy subjects for 30-2 perimetric test. Subsequently, the test-retest reliability of the device was assessed by performing the "New Grid" visual field six straight times in a group of patients clustered according to the MD, resulting in a good inter-test reliability. The agreement between three different reviewers was also calculated: they independently examined Compass visual fields and the fundus photos, establishing whether or not the glaucomatous pathology worsened, as well as the agreement between the remote analysis and the standard clinical visit of glaucoma patients. The results highlighted an excellent agreement among the Reviewers and between remote analysis and the clinical examination. In order to establish the Compass’ point-by-point accuracy, a 10-2 visual field was performed in patients affected by geographic atrophy, finding an accurate correspondence of the perimetric scores with the underlying retinal image. Ultimately, the osmometry and all the clinical parameters of the tear film were analyzed in patients suffering from asymmetric glaucoma. Afterwards, for the biochemical and molecular approach, the analysis of gap-junction protein connexin 43 in the aqueous humor of affected and unaffected glaucoma patients was performed: a nearly double expression of the protein was found in glaucomatous subjects, even if there were no statistically significant differences, probably due to the small number of samples. An innovative method of biochemical analysis was introduced in this doctorate thesis: the metabolomics, a scientific branch that deals with the analysis of <1.5 kDa metabolites deriving from specific cellular processes in human samples. Vitreous samples of patients operated by vitrectomy were analyzed by 1H-NMR Nuclear Magnetic Resonance Spectroscopy, and an increase in acetone and methanol was observed in glaucomatous eyes.

An advanced technique for establishing pressure boundary conditions in annular sector cascade experiments has been developed. This novel technique represents an improvement over previous methods, and provides the first means by which annular sector boundary conditions that are representative of those which develop in an annular cascade can be established with a high degree of satisfaction. The technique will enable cascade designers to exploit the obvious advantages of annular sector cascade testing: the reduced cost of both facility manufacture and facility operation, and the use of engine parts in place of two-dimensional counterparts. By employing an annular sector of deswirl vanes downstream of the annular sector of test vanes, the radial pressure gradient established in the swirling flow downstream of the test vanes is not disturbed. The deswirl vane exit-flow — which has zero swirl velocity — can be exhausted without unsteadiness, and without the risk of separation, into a plenum at constant pressure. The pressure ratio across the annular sector of test vanes can be tuned by adjusting the throat area at the deswirl vane exit plane. Flow conditioning systems which utilise the Oxford deswirl vane technology have previouly been used to set pressure boundary conditions downstream of fully annular cascades in both model and engine-scale (the Isentropic Light Piston Facility at Farnborough) experimental research facilities (Povey et al. [1, 2]). The deswirl vane is particularly suited to the control of highly whirling transonic flows. It has been demonstrated by direct comparison of aerodynamic measurements from fully annualr and annular sector experiments that the use of a deswirl vane sector for flow conditioning at the exit of an annular sector cascade represents an attractive novel solution to the boundary condition problem. The annular sector technique is now described.