Search results
Found 22796 matches for
Professor Peter Rothwell says more must be done to raise awareness of the need to take rapid action after a mini-stroke in order to reduce the number of major strokes.
Exploring standard and low luminance visual acuity and the Moorfields Acuity Chart as outcome measures in inherited retinal disease
AbstractIntroductionStandard visual acuity (VA) is often insensitive to subtle changes in vision that result from inherited retinal disease. Low luminance VA (LLVA) has grown in popularity as an alternative acuity measure. A new test, the Moorfields Acuity Chart (MAC) has been designed as a more sensitive and repeatable test for use in patients with age‐related macular degeneration. The study explores the utility and repeatability of standard VA, LLVA and the MAC in a mixed cohort of patients with inherited retinal disease.MethodsParticipants were recruited as part of the visual function in retinal degeneration study (Ethics Reference 20/WM/0283). Standard VA was obtained using the Early Treatment of Diabetic Retinopathy study (ETDRS) chart placed at 4 m. LLVA was obtained using the same ETDRS chart with the addition of a 2.0‐log unit neutral density filter. MAC VA was obtained using standard clinic room lighting. All participants completed repeated testing.ResultsThirty‐five patient participants and 36 healthy controls, with logMAR 1.00 (6/60) or better, completed testing. Both LLVA and MAC VA were reduced compared to standard VA in patient participants and healthy controls (linear mixed model: p < 0.001). All three acuity tests show comparable sensitivity, specificity and repeatability. A subset of participants (patient participants n = 34, healthy controls n = 35) completed microperimetry. Post hoc analysis of microperimetry volume sensitivity correlated significantly with all of the acuity tests and showed no significant difference in the gradient of the slopes. This suggests that VA, LLVA and MAC VA decline at a consistent rate with disease progression.ConclusionAll three acuity tests could be considered viable outcome measures for clinical trials. For patients with early to moderate inherited retinal disease (logMAR 1.00 (6/60) or better), no single acuity chart appeared significantly beneficial.
Decoding dynamic brain networks in Parkinson's disease with temporal attention.
Detecting brief, clinically meaningful changes in brain activity is crucial for understanding neurological disorders. Conventional imaging analyses often overlook these subtle events due to computational demands. IMPACT (Integrative Multimodal Pipeline for Advanced Connectivity and Time-series) addresses this challenge by converting 3D/4D fMRI scans into time-series signals using a standardized brain atlas. This approach integrates regional signals, network patterns, and dynamic connectivity, and employs machine learning to detect subtle fluctuations. In Parkinson's disease diagnosis across two independent cohorts (n=43 and n=40), it achieves high accuracy (area under the curve = 0.97-0.98), outperforming conventional methods. Analyses reveal transient connectivity disruptions that align with dopaminergic mechanisms, while interpretability highlights the critical time windows and regions driving classification. This reproducible, standardized pipeline is readily adaptable to other conditions where short-lived brain changes serve as key diagnostic markers.
Does Your Bedside Neurological Examination for Suspected Peripheral Neuropathies Measure Up?
SYNOPSIS: Neurological testing is essential for screening and diagnosing suspected peripheral neuropathies. Detecting changes in somatosensory and motor nerve function can also have direct implications for management decisions. Nevertheless, there is considerable variation in what is included in a bedside neurological examination and how it is performed. Neurological examinations are often used as screening tools to detect neurological deficits but not used to their full potential for monitoring progress or deterioration. Here, we advocate for better use of the neurological examination within a clinical reasoning framework. Constrained by the lack of research in this field, our Viewpoint is based on neuroscientific principles. We highlight 6 challenges for clinicians when conducting neurological examinations and propose ways to overcome these challenges in clinical practice. We challenge widely held ideas about how the results of neurological examinations for peripheral neuropathies are interpreted and how the examinations are performed in practice. J Orthop Sports Phys Ther 2023;53(3):107-112. Epub: 28 October 2022. doi:10.2519/jospt.2022.11281.
How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis
Abstract Purpose Physiotherapy interventions are prescribed as first-line treatment for people with sciatica; however, their effectiveness remains controversial. The purpose of this systematic review was to establish the short-, medium- and long-term effectiveness of physiotherapy interventions compared to control interventions for people with clinically diagnosed sciatica. Methods This systematic review was registered on PROSPERO CRD42018103900. Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), Embase, PEDro, PubMed, Scopus and grey literature were searched from inception to January 2021 without language restrictions. Inclusion criteria were randomised controlled trials evaluating physiotherapy interventions compared to a control intervention in people with clinical or imaging diagnosis of sciatica. Primary outcome measures were pain and disability. Study selection and data extraction were performed by two independent reviewers with consensus reached by discussion or third-party arbitration if required. Risk of bias was assessed independently by two reviewers using the Cochrane Risk of Bias tool with third-party consensus if required. Meta-analyses and sensitivity analyses were performed with random effects models using Revman v5.4. Subgroup analyses were undertaken to examine the effectiveness of physiotherapy interventions compared to minimal (e.g. advice only) or substantial control interventions (e.g. surgery). Results Three thousand nine hundred and fifty eight records were identified, of which 18 trials were included, with a total number of 2699 participants. All trials had a high or unclear risk of bias. Meta-analysis of trials for the outcome of pain showed no difference in the short (SMD − 0.34 [95%CI − 1.05, 0.37] p = 0.34, I2 = 98%), medium (SMD 0.15 [95%CI − 0.09, 0.38], p = 0.22, I2 = 80%) or long term (SMD 0.09 [95%CI − 0.18, 0.36], p = 0.51, I2 = 82%). For disability there was no difference in the short (SMD − 0.00 [95%CI − 0.36, 0.35], p = 0.98, I2 = 92%, medium (SMD 0.25 [95%CI − 0.04, 0.55] p = 0.09, I2 = 87%), or long term (SMD 0.26 [95%CI − 0.16, 0.68] p = 0.22, I2 = 92%) between physiotherapy and control interventions. Subgroup analysis of studies comparing physiotherapy with minimal intervention favoured physiotherapy for pain at the long-term time points. Large confidence intervals and high heterogeneity indicate substantial uncertainly surrounding these estimates. Many trials evaluating physiotherapy intervention compared to substantial intervention did not use contemporary physiotherapy interventions. Conclusion Based on currently available, mostly high risk of bias and highly heterogeneous data, there is inadequate evidence to make clinical recommendations on the effectiveness of physiotherapy interventions for people with clinically diagnosed sciatica. Future studies should aim to reduce clinical heterogeneity and to use contemporary physiotherapy interventions.
Collaborative care model versus usual care for people with musculoskeletal conditions and co-existing anxiety and depression: protocol for a feasibility mixed-methods randomised controlled trial.
BACKGROUND: In the UK 17.8 million people have musculoskeletal pathophysiology, which becomes universal with age. Levels of discomfort and incapability correlate with symptoms of anxiety and depression. People with sufficient symptoms who seek care can benefit from collaborative diagnosis and treatment of mental and physical health organised by a case manager. This paper presents the protocol for a feasibility trial of collaborative care in an orthopaedic setting. AIMS: To determine the feasibility and acceptability of providing collaborative care for patients with musculoskeletal conditions and co-existing symptoms of anxiety and depression identified on a screening tool in a physical and occupational therapy out-patient setting. METHOD: A two-arm parallel-group randomised controlled trial will recruit 40 adult out-patients with at least moderate anxiety and depression, who have been referred for physiotherapy and occupational therapy. Participants will be allocated on a 1:1 ratio to collaborative care or to usual care. Co-primary outcomes will be key feasibility indicators collected at baseline and at 6 months. A qualitative study will be conducted post-intervention to explore the acceptability and potential improvements to the collaborative care model. RESULTS: This study will investigate the use of the collaborative care model for patients with musculoskeletal and co-existing moderate or severe levels of anxiety or depression. CONCLUSIONS: The results will provide important evidence to determine a future trial.
The prevalence of musculoskeletal pain and therapy needs in adults with Osteogenesis Imperfecta (OI) a cross-sectional analysis.
BACKGROUND: Osteogenesis Imperfecta affects approximately 1 in every 10,000 people. Musculoskeletal disorders and pain are common in adults with Osteogenesis Imperfecta, but specific knowledge of the problems people have is lacking. Access to therapy services for adults with Osteogenesis Imperfecta is variable. We designed this analysis to better understand the musculoskeletal disorders and consequent therapy needs for adults with Osteogenesis Imperfecta. METHODS: This study was a cross-sectional analysis of outpatients with Osteogenesis Imperfecta. Adults attending a newly established multidisciplinary clinic at a tertiary centre in 2019 were included. A highly specialist physiotherapist worked within the clinic to offer therapy input if required and to refer patients to appropriate therapy as needed. People over the age of 18 were included if they had a diagnosis of Osteogenesis Imperfecta. Data were collected over a five month period using routinely collected clinical information and patient reported outcomes. RESULTS: Over five months 50 patients attended the clinic. Musculoskeletal pain was a significant feature reported by 84% of patients. Over 50% of patients reported persistent pain for longer than one year duration and the most common site of pain was in the spine (46%). No difference in pain between types of OI and age. Forty five per cent (n = 19) of patients reported moderate to severe problems with mobility on the EQ-5D with over half reporting problems with self-care and ability to carry out usual activities. Over 50% of patients in clinic also reported anxiety (EQ-5D). During the consultation 70% of patients received therapy input which was either advice in clinic or an onward referral to the appropriate service. The referral rate to specialist out-patient rehabilitation services at a tertiary centre was 30%. CONCLUSIONS: This analysis highlights the high prevalence of MSK pain in adults with OI and the effect on physical function and emotional wellbeing. This study demonstrates the diverse needs of the adult Osteogenesis Imperfecta population and the need for suitable multidisciplinary therapy services.
Early surgery for sciatica.
Does new evidence challenge a stepped care approach for all patients?
Early neurological deterioration in patients with minor stroke: A single-center study conducted in Vietnam
A minor ischemic stroke is associated with a higher likelihood of poor clinical outcomes at 90 days when there is early neurological deterioration (END). The objective of this case-control study conducted in a comprehensive stroke facility in Vietnam is to examine the frequency, forecast, and outcomes of patients with END in minor strokes. The study employs a descriptive observational design, longitudinally tracking patients with minor strokes admitted to Bach Mai Hospital’s Stroke Center between December 1, 2023, and August 31, 2024. Hospitalized within 24 hours of symptom onset, minor stroke patients with National Institutes of Health Stroke Scale (NIHSS) scores ≤ 5 and items 1a, 1b, and 1c on the NIHSS scale, each equal to 0, were included in the study. The primary measure of interest is the END rate, defined as a rise of 2 or more points in the NIHSS score during the first 72 hours after admission. We conduct a logistic regression analysis to identify forecasting factors for END. Out of 839 patients, 88 (10.5%) had END. In the END group, we found that most patients had complications within the first 24 hours of stroke, accounting for 43.2%; the 24 – 48-hour window accounted for 35.2%, and the 48 – 72-hour window accounted for 21.6%. END was associated with a higher likelihood of poor outcomes (mRS 2 – 6) at discharge (OR = 22.76; 95% CI 11.22 – 46.20; p < 0.01), 30 days post-stroke(OR = 24.38; 95% CI 14.40 – 41.29; p < 0.01), and 90 days post-stroke (OR = 21.74; 95% CI 12.63 – 37.43; p < 0.01). Some of the prognostic factors for END were admission NIHSS score (OR = 1.24; 95% CI 1.03 – 1.49; p = 0.02), admission systolic blood pressure greater than 150mmHg (OR = 1.70; 95% CI 1.03 – 2.81; p = 0.04), admission blood glucose (OR = 1.07; 95% CI 1.01 – 1.14; p = 0.02), reperfusion therapy (OR = 3.35; 95% CI 1.50 – 7.49; p < 0.01), use of antiplatelet monotherapy (OR = 3.69; 95% CI 2.24 – 6.08; p < 0.01), internal capsule infarction (OR = 2.54; 95% CI 1.37 – 4.71; p < 0.01), hemorrhagic transformation (OR = 5.72; 95% CI 1.07 – 30.45; p = 0.04), corresponding extracranial carotid artery occlusion (OR = 4.84; 95% CI 1.26 – 18.65; p = 0.02), and middle cerebral artery occlusion OR = 3.06; 95% CI 1.29 – 7.30; p = 0.01). END in minor stroke patients accounts for 10.5% and is a risk factor for poor neurological outcomes. Admission NIHSS score, higher systolic blood pressure, admission blood glucose, reperfusion therapy, use of antiplatelet monotherapy, internal capsule infarction, hemorrhagic transformation, corresponding extracranial carotid artery occlusion, and middle cerebral artery occlusion were some of the prognostic factors for END in our observational study.
Stacking models of brain dynamics to improve prediction of subject traits in fMRI.
Beyond structural and time-averaged functional connectivity brain measures, modelling the way brain activity dynamically unfolds can add important information to our understanding and characterisation of individual cognitive traits. One approach to leveraging this information is to extract features from models of brain network dynamics to predict individual traits. However, these predictions are susceptible to variability due to factors such as variation in model estimation induced by the choice of hyperparameters. We suggest that, rather than merely being statistical noise, this variability may be useful in providing complementary information that can be leveraged to improve prediction accuracy. To leverage this variability, we propose the use of stacking, a prediction-driven approach for model selection. Specifically, we combine predictions developed from multiple hidden Markov models-a probabilistic generative model of network dynamics that identifies recurring patterns of brain activity-to demonstrate that stacking can slightly improve the accuracy and robustness of cognitive trait predictions. By comparing analysis from the Human Connectome Project and UK Biobank datasets, we show that stacking is relatively effective at improving prediction accuracy and robustness when there are enough subjects, and that the effectiveness of combining predictions from static and dynamic functional connectivity approaches depends on the length of scan per subject. We also show that the effectiveness of stacking predictions is driven by the accuracy and diversity in the underlying model estimations.
Neural correlates of cognitive ability and visuo-motor speed: Validation of IDoCT on UK Biobank Data
Automated online and App-based cognitive assessment tasks are becoming increasingly popular in large-scale cohorts and biobanks due to advantages in affordability, scalability, and repeatability. However, the summary scores that such tasks generate typically conflate the cognitive processes that are the intended focus of assessment with basic visuo-motor speeds, testing device latencies, and speed-accuracy tradeoffs. This lack of precision presents a fundamental limitation when studying brain-behaviour associations. Previously, we developed a novel modelling approach that leverages continuous performance recordings from large-cohort studies to achieve an iterative decomposition of cognitive tasks (IDoCT), which outputs data-driven estimates of cognitive abilities, and device and visuo-motor latencies, whilst recalibrating trial-difficulty scales. Here, we further validate the IDoCT approach with UK BioBank imaging data. First, we examine whether IDoCT can improve ability distributions and trial-difficulty scales from an adaptive picture-vocabulary task (PVT). Then, we confirm that the resultant visuo-motor and cognitive estimates associate more robustly with age and education than the original PVT scores. Finally, we conduct a multimodal brain-wide association study with free-text analysis to test whether the brain regions that predict the IDoCT estimates have the expected differential relationships with visuo-motor versus language and memory labels within the broader imaging literature. Our results support the view that the rich performance timecourses recorded during computerised cognitive assessments can be leveraged with modelling frameworks like IDoCT to provide estimates of human cognitive abilities that have superior distributions, re-test reliabilities, and brain-wide associations.
Automated Assessment of Pain (AAP) and Multimodal Sensing Grand Challenge for Next-Gen Pain Assessment (AI4Pain)
Pain communication varies, with some individuals being highly expressive regarding their pain and others exhibiting stoic forbearance and minimal verbal account of discomfort. Considerable progress has been made in defining behavioral indices of pain [1]-[3]. An abundant literature shows that a limited subset of facial movements, in several non-human species, encode pain intensity across the lifespan [2]. To advance reliable pain monitoring, automated assessment of pain is emerging as a powerful mean to realize that goal. Though progress has been made, this field remains in its infancy. The workshop aims to promote current research and support growth of interdisciplinary collaborations to advance this groundbreaking research.
The AI4Pain Grand Challenge 2024: Advancing Pain Assessment with Multimodal fNIRS and Facial Video Analysis
The Multimodal Sensing Grand Challenge for NextGen Pain Assessment (AI4PAIN) is the first international competition focused on automating the recognition of acute pain using multimodal sensing technologies. Participants are tasked with classifying pain intensity into three categories: No Pain, Low Pain, and High Pain, utilising functional near-infrared spectroscopy (fNIRS) and facial video recordings. This paper presents the baseline results of our approach, examining both individual and combined modalities. Notably, this challenge represents a pioneering effort to advance pain recognition by integrating neurological information (fNIRS) with behavioural data (facial video). The AI4Pain Grand Challenge aims to generate a novel multimodal sensing dataset, facilitating benchmarking and serving as a valuable resource for future research in autonomous pain assessment. The results show that individual fNIRS data achieved the highest accuracy, with 43.2% for the validation set and 43.3% for the test set, while facial data yielded the lowest accuracy, with 40.0% for the validation set and 40.1% for the test set. The combined multimodal approach produced accuracies of 40.2% for the validation set and 41.7% for the test set. This challenge provides the research community with a significant opportunity to enhance the understanding of pain, ultimately aiming to improve the quality of life for many pain sufferers through advanced, automated pain assessment methods.
Research assistants’ experiences recruiting patients with psychosis into clinical trials: a qualitative study
Abstract Objectives Treatments for patients diagnosed with psychosis need to be improved. Clinical trials are an important way of assessing the efficacy of new treatments. However, recruiting patients into trials is challenging. This study sought to better understand the reasons for this from the perspective of research assistants. Design A qualitative study underpinned by a critical realist ontology and contextualist epistemology. Methods Research assistants who had recruited patients with psychosis into trials, primarily of psychological interventions, were interviewed. Reflexive thematic analysis was used to identify themes. Results Overarching themes representing four types of factors influencing recruitment of patients with psychosis into clinical trials were generated: patient, clinical team, research team, and NHS infrastructure. Patients largely wished to take part in trials but needed time to build trust with research assistants. Clinical teams held the power in suggesting patients for trials; therefore, it was essential for research teams to build strong relationships with clinical staff. Research teams recruiting into trials benefited from lived experience expertise, support systems, and institutional knowledge. A key NHS infrastructure factor was that mental health staff had limited time to consider trials for their patients. Conclusions Trial participation needs to be made more accessible to patients with psychosis, who often want to take part but lack opportunities. Methods of increasing accessibility could include identifying and addressing barriers to referral from clinical teams, employing multiple recruitment strategies, and flexible appointment formats. Qualitative research with clinical teams and patients will also help in developing the understanding of barriers to recruitment.
Long-Term Outcome of Covered Stent Implantation for Management of Iliofemoral Vascular Complications in Patients Undergoing Transcatheter Aortic Valve Replacement
Background: Covered stent implantation has become a common approach for management of iliofemoral vascular complications in patients undergoing transcatheter aortic valve replacement (TAVR), but the long-term outcomes associated with this approach are unknown. The aims of the study were 1) to evaluate the incidence and indication for covered stent placement in patients undergoing TAVR, 2) to assess long-term clinical outcomes after covered stent placement, and 3) to describe the performance of covered stents over long-term follow-up as assessed by Doppler ultrasonography. Methods: Retrospective cohort study of patients undergoing iliofemoral covered stent implantation at the time of TAVR in a single high-volume UK center. Results: 1277 patients underwent transfemoral TAVR between January 1, 2019, and December 31, 2022. Of these, a total of 54 patients (4.2%) underwent iliofemoral covered stent implantation. Indications for covered stent placement were hemorrhage (39/54, 72.2%), dissection (11/54, 20.4%), and other causes (4/54, 7.4%). Overall, the median follow-up time was 22 ± 2.3 months during which no patient required vascular reintervention on the stented limb. Doppler ultrasonography was performed on 27 (71%) of surviving patients at a median of 34 ± 2.6 months post-TAVR. There were no cases of stent fracture or complete occlusion. Two patients (7.4%) had evidence of asymptomatic moderate restenosis. Conclusion: Iliofemoral covered stent placement is a safe and effective means of managing significant vascular complications. Over long-term follow-up, we found no evidence of clinical stent failure requiring reintervention, and a low incidence of subclinical in-stent restenosis.
Acute Febrile Encephalopathy with Rigidity.
Febrile encephalopathy with rigidity can be the presenting feature of several life-threatening neurological emergencies such as neuroleptic malignant syndrome (NMS) and serotonin syndrome. Although the pathogenesis of these conditions is poorly understood, we review advances in our understanding of underlying genetic and other biological mechanisms. We also discuss the complex and expanding differential diagnoses which include other drug-induced hyperpyrexia or rigidity syndromes (eg malignant hyperthermia, parkinsonism-hyperpyrexia syndrome, malignant catatonia) as well as autoimmune syndromes. Finally, we consider potential predictive and preventative approaches along with best practice management strategies.
Epilepsy Research Institute UK Sudden Unexpected Death in Epilepsy (SUDEP) workshop: Identifying the pre-clinical and clinical priorities for SUDEP research.
The Epilepsy Research Institute's Mortality, Morbidity and Risk Theme workshop on Sudden Unexpected Death in Epilepsy (SUDEP) brought together a diverse group of stakeholders, including basic science researchers, clinicians and clinical researchers, charity partners, bereaved individuals and people with epilepsy to identify important gaps in pre-clinical and clinical SUDEP research. Collectively, the SUDEP workshop highlighted recommendations for future research to address several identified gaps and the need to develop infrastructures that utilise data-driven approaches to reduce SUDEP risk. National and global cross-institution collaborations will be fundamental in driving these research efforts forward.