Osteoarthritis: Part I

October 1, 2013 by

I’ve been an Associate Editor for CJSM now for six months, and so some of you in the blog world may already know a little bit of my background as it has come out over time in my various posts.

For those of you who may be new readers of this blog, I thought for today’s post it was important for me to let you know that I work at Nationwide Children’s Hospital, the pediatric hospital affiliate of Ohio State University, and my specialty is pediatric sports medicine.

So……I don’t manage a lot of osteoarthritis (OA) in my current practice.

ocd of knee jpeg

Adult OCD of the knee,
unstable lesion: destined for osteoarthritis?

However, I didn’t narrow my clinical scope of practice to the younger crowd until 2010, and I have managed my fair share of OA in my career, injecting plenty of knees with hyaluronic acid derivatives, encouraging weight management and low impact exercise…….Now, I suppose I’m more on the end of the spectrum of primary prevention of the disease: if I manage my young patients’ knee osteochondritis dissecans properly, perhaps I can spare them from degenerative joint disease later in life.

I’m not telling anyone reading this something they don’t know already when I write that career paths are varied in modern medicine.  There’ s no telling if I’ll be taking care of kids exclusively in 10 years.  We all have mandates from Certification Boards requiring us to stay abreast of the current medical literature; we’re tested on it every few years now, as Maintenance of Certification is a phenomenon here to stay.  Forces like these make it incumbent that I read and ‘stay on top of’ developments in the world of OA diagnosis and management, even if I am not seeing much of this disease in my current practice.

After all, OA is the leading cause of chronic disability among older adults in the United States.  That’s a disease worth knowing about.

I thought, therefore, that I would share with you a couple of interesting studies that have come out recently on major issues in the world of osteoarthritis.  Both studies were just published within the last month:  the first, “Shared Decision Making in Patients with Osteoarthritis of the Hip and Knee,”  published in the Journal of Bone and Joint Surgery (JBJS), I will discuss in my next blog post.  And the second, “Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults with Knee Osteoarthritis,” published in the Journal of the American Medical Association (JAMA), I will review now.   They are both large, high quality evidence (Level 1) studies which focus on low tech, low cost interventions that have the potential of having major clinical impact.  They are both studies primary care sports/MSK clinicians like myself might be expected to be aware of. Read more of this post

Filed under Basic Sciences in SEM, Evidence-based Medicine in SEM, General Interest, Patient Education, Patient Outcome Measures, Physical activity interventions, Public Health in Sports and Exercise Medicine Tagged with

Computerized Neurocognitive Testing in the Management of Concussions, Part 2

August 25, 2013 by

Leather_football_helmet_(circa_1930's)

Concussion management for football,
c. 1930

I woke up this morning to my usual Sunday routine:  the New York Times Sports page and coffee.

Today’s sports section–and I don’t think the Times is alone in this regard–is devoted to the subject of the forthcoming American college football season.  The first games of the season will take place this Thursday, August 29.  As the Times puts it, “The nation’s annual rite of mayhem and pageantry known as the college football season begins this week…..”

When I’m not doing work with the Clinical Journal of Sports Medicine, I’m taking care of youth, high school and college athletes; for my colleagues and me, the football season has already begun, with the various teams we cover already having had weeks of steady, increasingly intense practices and scrimmages.  And we’re seeing the injury results of the sport, including an increase in volume of concussions.

I’ve mentioned this in my blog posts for this month, where the theme has been ‘concussions.’  Last week I wrote about the special set of CJSM concussion research articles we have made freely available for a limited time.  At the beginning of the month, I authored a post on the subject of computerized neurocognitive testing (e.g. ANAM4, CNS-Vital Signs, AxonSports,  ImPACT, etc.) and their use in managing concussions.  I want to return to that subject in today’s post.

axon sport macdonald

The author’s baseline AxonSport report

A recent article from the Archives of Clinical Neuropscyhology was especially interesting, I thought. The authors looked at a military population while evaluating the test-retest reliability of four computerized neurocognitive assessment tools (NCATs):  Automated Neuropsychological Assessment Metrics 4 (ANAM4), CNS-Vital Signs, CogState (available now in the U.S. as ‘Axon Sports’), and ImPACT).  I’m familiar with these products, but most especially ‘know’ CogState, as this is the NCAT we use in our clinic.

The authors correctly assert that test-retest reliability is one of the “…fundamental psychometric characteristics that should be established in each NCAT,” and that “….reliability should be established before making conclusions about a test’s validity,” which is the psychometric construct that can indicate whether a test measures what one is truly trying to measure (for instance, ‘reaction time,’ or ‘memory’).  Reliability, is the “…extent to which the test produces consistent results across multiple administrations to the same individual.”

In this study of 215 individuals (mean age 34, range 19 to 59), Read more of this post

Filed under Concussion in Sport, Evidence-based Medicine in SEM, Patient Outcome Measures, Preparticipation Evaluation and Screening, Psychology in Sport, Safeguarding in Sport, Technology in Sports Medicine

Risk Factors for Injury in Elite Youth Ice Hockey

May 14, 2013 by 1 Comment

I had planned today on writing a sequel to my weekend post on spondylolysis, and I will definitely do so later this week.  But I have hockey on my mind this morning.

Our local team, the Columbus Blue Jackets, fought valiantly this shortened NHL season, and came within a whisker of the playoffs.  The team I grew up with, the Detroit Red Wings, have moved on to the Conference semi-finals, and so if I have any skin left in the game, it is with the Wings.

But I was captivated last night, as I’m sure some of the blog’s readership was, with an extraordinary Game 7 between the Toronto Maple Leafs and the Boston Bruins which brought to mind Jim McKay’s famous line from the “Wide World of Sports”:  “the thrill of victory, and the agony of defeat.”

Patrice_Bergeron

Patrice Bergeron scored the goals at end of regulation and in OT to send Bruins to victory

800px-Toronto_Maple_Leafs_bild

The Maple Leafs: deflated at the end of a heartbreaking game.

Somehow, the Maple Leafs went from leading 4-1 to losing 5-4 in overtime, as the Bruins, playing at home in Boston, achieved one of the more memorable comebacks in NHL playoff history.

As this was happening, my Twitter feed exploded with #bruins and #leafs posts, as two cities were collectively either shouting with joy or gnashing their teeth.  If you’ve never ‘watched’ a sporting event via Twitter, I commend the experience to you: it’s a bit like tapping into the collective consciousness of whatever group your following. Read more of this post

Filed under Elite sport, Epidemiology, Evidence-based Medicine in SEM, General Interest, Patient Outcome Measures, Psychology in Sport, Youth Sport Tagged with , ,

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