This observational study aimed to identify predictors of kinesiophobia and examine its correlation with early functional outcomes in TKA recipients. On the first and fifth postoperative days (POD1 and POD5), we evaluated pain using the International Pain Outcomes Questionnaire (IPO-Q) and created multidimensional pain composite scores (PCSs). The Total Pain Composite Score (PCStotal) assesses the overall impact of pain, taking into account outcomes of pain intensity, pain-related interference with function, and emotions and side effects. Functional status on POD 5 was determined by the Barthel index, 6 min walking test, and knee range of motion. Kinesiophobia was assessed on POD5 using the Tampa Scale for Kinesiophobia (TSK). Among 75 TKA patients, 27% exhibited kinesiophobia. The final regression model highlighted PCStotal on POD5 (OR = 6.2, CI = 1.9–19.9), PCStotal (OR = 2.1, CI = 1.2–3.8) on POD1, and the intensity of chronic pain before surgery (OR = 1.4, CI = 1.1–2.1) as significant kinesiophobia predictors. On POD5, those with kinesiophobia showed increased dependency, slower gait, and poorer knee extension recovery. This study emphasizes the need to identify and address kinesiophobia in TKA patients for better functional outcomes and recovery. Additionally, it is vital to assess different domains of pain, not just pain intensity, as it can lead to kinesiophobia development.

Background: Cisplatin-induced peripheral neuropathy is a common complication of cisplatin therapy, which develops in most patients with lung cancer. There are no effective preventive measures and once it occurs there is no effective therapy, except symptomatic. In this study, we aimed to assess the effect of transcutaneous electrical nerve stimulation (TENS) therapy on the pain intensity and the quality of life of patients with cisplatin-induced neuropathy. Material and Methods: A prospective cohort study was performed from 2013 to 2018, at the Clinical Center of Serbia. After the initial evaluation of 106 newly diagnosed patients with lung cancer, 68 patients did not have peripheral neuropathy. These 68 patients continued in the study and started the cisplatin chemotherapy. Forty of these patients developed cisplatin-induced neuropathy, which was manifested by neuropathic symptoms and proven by ENG examination. All patients with cisplatin-induced neuropathy were treated with TENS therapy. Their neuropathic pain and quality of life were evaluated using the following questionnaires at diagnosis, after cisplatin therapy and after four weeks of TENS use: DN4, VAS scale, EORTC QLQ-C30 and FACT-L. Results: Two thirds (68%) of the patients with cisplatin-induced neuropathy were male and the majority were smokers (70%). Adenocarcinoma was the most common (38%), followed by squamous (33%) and small-cell carcinoma (28%). The application of TENS therapy had a positive effect on reducing the neuropathic pain and increasing the quality of life for patients with painful cisplatin-induced neuropathy. The VAS and DN4 scores significantly decreased after TENS therapy, in comparison to its values after cisplatin therapy (p < 0.001). After TENS therapy, patients had significantly higher values in most of the domains of EORTC QLQ-C30 and FACT- L, in comparison with the values after cisplatin therapy (p < 0.001). Conclusion: The application of TENS therapy has a positive effect on reducing neuropathic pain and increasing the quality of life for patients with lung cancer and cisplatin-induced neuropathy.

Introduction: A minority of patients with hip fractures sustain concomitant wrist fractures. Little is known about the rehabilitation outcome in this group of patients. Aim of study: Prospective investigation of functional outcome and survival in patients with combined hip and wrist fractures compared with patients who sustain an isolated hip fracture. Methods: 341 patients who presented with an acute hip fracture during a 12 month period were included in the study. Outcome at discharge and 4 months follow-up was compared between patients with isolated hip fractures and those patients who sustained simultaneous distal wrist fractures. Results: The actual incidence of concurrent hip and wrist fractures in our cohort was 4.7%. Patients who sustained a concurrent hip and wrist fracture showed no differences regarding short- and long-term functional outcome and survival. Conclusion: Our results imply that patients with simultaneous hip and wrist fractures have no difference in rehabilitative outcome. Future studies should further investigate the distinctive characteristics of this patient subgroup.

Decreased muscle strength is not only a risk factor for hip fracture in elderly patients, but plays a role in recovery of physical function. Our aim was to assess the role of grip strength measured early after hip fracture, and classified according to the EWGSOP2 criteria in predicting short- and long-term functional recovery. One hundred ninety-one patients with acute hip fracture consecutively admitted to an orthopaedic hospital have been selected. A multidimensional geriatric assessment evaluating sociodemographic variables, cognitive status, functional status and quality of life prior to fracture, as well as perioperative variables were performed. Follow-ups at 3 and 6 months after surgery were carried out to evaluate functional recovery. Multivariate regression models were used to assess the predictive role of handgrip strength. The mean age of the participants was 80.3 ±6.8 years. Thirty-five percent of our patients with clinically relevant hand grip strength weakness were significantly older, more often female, had a lower BMI, and were of worse physical health. They also had a lower cognitive level, lower Barthel index, and lower EQ5D scores before fracture. Multivariate regression analysis adjusted for age and gender revealed that hand grip weakness was an independent predictor of worse functional outcome at 3 and 6 months after hip fracture for both genders and in all age populations. Our study supports the prognostic role of hand grip strength assessed at hospital admission in patients with hip fracture. Thus, clinicians should be encouraged to include hand grip assessment in their evaluation of hip fracture patients in the acute setting in order to optimize treatment of high-risk individuals.

Skeletal muscles, renowned for their remarkable adaptability, undergo significant mass reduction under catabolic conditions, a phenomenon notably observed during critical illness. Aging, exacerbated by reduced physical activity, accelerates this process, leading to a cascade of health consequences. The term "sarcopenia" has emerged to encapsulate these multifaceted aspects, encompassing diminished muscle strength, mass, and functional capacity. This comprehensive review explores the evolution of the concept of sarcopenia. Irwin Rosenberg's pioneering work 1989 introduced the term, defining it as the age-related loss of muscle mass. Subsequently, Baumgartner in 1998 refined the definition by quantifying sarcopenia as a reduction in appendicular skeletal muscle mass, precisely defined by statistical parameters. The European Working Group on Sarcopenia in the Elderly, in 2018, further advanced our understanding by including muscle strength as a diagnostic criterion. It also underscored the significance of reduced muscle mass in confirming the diagnosis. Severe sarcopenia is marked by the fusion of existing muscle damage and functional impairment, presenting a critical pathological condition. Sarcopenia has garnered official recognition in numerous countries as a distinct muscle disorder, classified under the diagnostic code ICD-10-MC. This review explores the pathophysiological underpinnings of sarcopenia, which can manifest either chronically, often accompanying the aging process, or acutely during hospitalization or prolonged bed rest. A key facet of age-related sarcopenia is the deterioration of type II fast-twitch muscle fibers, crucial for muscle strength and overall performance. Sarcopenia emerges as a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. It is inexorably linked with physical disability, diminished quality of life, and, notably, increased mortality rates. Observational studies have indicated a substantial prevalence of sarcopenia among critically ill patients, affecting up to 60% of individuals admitted to intensive care units, especially those requiring mechanical ventilation. In light of these findings, this review aims to provide insights into the epidemiological, pathophysiological, and clinical facets of sarcopenia. We underscore its particular relevance in the context of critically ill patients in intensive care units, examining the profound impact on mortality. Furthermore, we delve into contemporary diagnostic methods for identification and available treatment modalities, aiming to shed light on the complexities of this pervasive and underrecognized condition.

The aim of this study was to determine the outcome for patients who sustain a second hip fracture compared with those who sustain a first fracture, and to define the optimal measure to evaluate functional outcome after second hip fracture. Methods: 343 patients with acute hip fractures who presented during a 12 month period were included in the study. Patients with a first (318 patients, 78.10 +/− 7.53 years) and second (25 patients, 78.96 +/− 6.02) hip fracture were compared regarding all baseline variables. Regression analysis was also performed to assess the independent relationship between the presence of a second hip fracture and observed outcome variables at discharge (physical disability, complications, length of stay, and mortality) and one-year after surgery (physical disability and mortality). Results: Disability when performing instrumentalized activities of daily living (IADL) at one-year follow-up is independently related to the presence of a second hip fracture. There were no other statistically significant relationships between the presence of a second hip fracture and other observed outcome variables. Conclusions: Patients with a second hip fracture showed worse functional outcome at one-year follow-up when measured with the IADL scale. No increased short-nor long-term mortality rates were found in patients with a secondary hip fracture. IADL is a good tool to assess disability after a second hip fracture and could be thus a more reliable outcome measure when investigating differences in functional recovery in patients with a second hip fracture compared to conventionally used ADL scales.