Physio support in COVID-19 recovery

New physiotherapy guidelines are targeting COVID-19 patient recovery for respiratory management, exercise and mobilization in acute hospital wards and Intensive Care Units. The new guidelines published in the Australian Journal of Physiotherapy aim to prevent complications of the respiratory system and muscle deconditioning, speed up recovery from mechanical ventilation, and improve long-term physical function and recovery. It also provides physiotherapists with workforce planning and preparation in a pandemic, PPE (personal protective equipment) requirements and how to safely deliver treatments, how to determine who physiotherapists should treat, and how to protect health care workers and resources. Physiotherapists are an essential professional group who will be required to limit the severity of ICU-acquired weakness in patients and provide longer term rehabilitation and interventions to survivors of COVID-19 to allow them to function upon returning home and regain their life roles, the researchers say. The clinical practice guidelines were developed by a group of international experts in cardiorespiratory physiotherapy. The authors have extensive clinical experience in ICUs and on the wards, as well as academic physiotherapists who have experience in a range of research methods including clinical practice guidelines. The physiotherapy guidelines were prepared with reference to existing medical guidelines, relevant literature and a process to determine consensus agreement within the expert group. Flinders University Caring Futures Institute researcher Claire Baldwin, a co-author of the clinical practice guide, said key points of difference in these guidelines compared to medical guidelines relate to the specific respiratory care that physiotherapists can provide. "The common presentation of COVID-19 does not appear to be characterized by a cough with phlegm. However, some people may develop phlegm that they are unable to clear from their lungs, or, have added challenges because they have difficulty with coughing up phlegm even under normal circumstances. This is where respiratory physiotherapy treatments may be needed. Because cough generates aerosols, it is important that respiratory physiotherapy techniques are recognized as an aerosol generating exposure and physiotherapists can be protected with the correct PPE.”

Co-delivery of IL-10 and NT-3 to enhance spinal cord injury repair

Spinal cord injury (SCI) creates a complex microenvironment that is not conducive to repair; growth factors are in short supply, whereas factors that inhibit regeneration are plentiful. In a new report, researchers have developed a structural bridge material that simultaneously stimulates IL-10 and NT-3 expression using a single bi-cistronic vector to alter the microenvironment and enhance repair. The article, published April 17, 2020, is reported in Tissue Engineering. In "Polycistronic Delivery of IL-10 and NT-3 Promotes Oligodendrocyte Myelination and Functional Recovery in a Mouse Spinal Cord Injury Model," Lonnie Shea, University of Michigan, and coauthors report the development of a new poly(lactide-co-glycolide) (PLG) bridge with an incorporated polycistronic IL-3/NT-3 lentiviral construct. This material was used to stimulate repair in a mouse SCI model. IL-10 was included to successfully stimulate a regenerative phenotype in recruited macrophages, while NT-3 was used to promote axonal survival and elongation. The combined expression was successful; axonal density and myelination were increased, and locomotor functional recovery in mice was improved.

European countries face a costly 23% increase in fragility fractures by 2030

A new International Osteoporosis foundation (IOF)-led study examining the burden and management of fragility fractures in six European countries revealed an alarming treatment gap, with fracture-related costs projected to increase to €47.4 billion (US$51.87 billion) by 2030. The new study provides an overview and comparison of the burden and management of fragility fractures due to osteoporosis in the five largest countries in Europe (France, Germany, Italy, Spain, and the U.K.) as well as Sweden. The publication 'Fragility fractures in Europe: burden, management and opportunities' has been authored by an IOF steering committee in cooperation with experts from national societies. The authors found that in 2017 an estimated 2.7 million fragility fractures in the six countries resulted in an associated annual cost of €37.5 billion. By 2030, the number of annual fragility fractures is expected to increase by 23%, to 3.3 million, with projected costs of approximately €47.4 billion. The burden of fragility fractures exceeds those of many other chronic diseases. An estimated 1.02 million quality-adjusted life years (QALYSs) were lost in 2017 due to fracture. The current disability-adjusted life years (DALYs) per 1000 individuals age 50 years or more is estimated at 21 years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. As well as quantifying the heavy burden of fragility fractures on patients, their families, and national health care systems, the study also identifies a massive treatment gap in all countries, based on the percentage of eligible individuals not receiving medication. The smallest treatment gap is in the U.K. (64% in women and 43% in men) and the highest treatment gap in Germany, with only 20% of eligible men and 22% of women receiving a pharmacological intervention to prevent future fractures. Lead author, John Kanis, IOF honorary president, noted that with timely identification and treatment of the underlying condition, “fragility fractures in individuals at high risk are largely preventable. However, we have found that the percentage of eligible individuals not receiving osteoporosis medication is unacceptably high and estimated to be, on average, 73% for women and 63% for men. Of further concern, the treatment gap has seen a marked increase in the past decade, increasing by approximately 17% since 2010." Given that a first fracture is a warning sign of future fractures, post-fracture care to treat osteoporosis is of critical importance and the key to preventing a cycle of recurring fractures, pain and long-term disability.

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