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Rotator cuff disorders include a broad spectrum of pathological conditions including partial-thickness and full-thickness tears. Studies have shown partial-thickness rotator cuff tear (PTRCT) prevalence to be twice that of full-thickness tears. In the working population, PTRCTs are one of the most common causes of shoulder pain and often result in occupational disability due to pain, stiffness, and loss of shoulder function. Treatment of PTRCTs remains controversial. The purpose of this study was to consolidate the existing high-quality evidence on best management approaches in treating PTRCTs using both nonoperative and operative approaches. A scoping review with best evidence synthesis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. MEDLINE (OVID), EMBASE (OVID), Cochrane Library (Wiley), SCOPUS, Web of Science Core Collection, CINAHL Plus with Full Text (EBSCOhost), PubMed Central, and Science Direct were searched from 2000 to March 3, 2023. Level 1 studies, and systematic reviews and meta-analyses that included level 1 and 2 studies, were included. The search yielded 8276 articles. A total of 3930 articles were screened after removing 4346 duplicates. Application of inclusion criteria resulted in 662 articles that were selected for full-text review. Twenty-eight level 1 studies, 1 systematic review, 4 meta-analyses, and 1 network meta-analyses were included in the best evidence synthesis. Nonoperative strategies included injections (ie, platelet-rich plasma, corticosteroid, prolotherapy, sodium hyaluronate, anesthetic, and atelocollagen), exercise therapy, and physical agents. Operative interventions consisted of débridement, shaving of the tendon and footprint, transtendon repair, and traditional suture anchor repair techniques with and without tear completion. Both nonoperative and operative strategies demonstrated effectiveness at managing pain and functional outcome for PTRCTs. The evidence supports the effectiveness of surgical intervention in treating PTRCTs regardless of arthroscopic technique. The results of this scoping review do not support superiority of operative over nonoperative management and suggest that both strategies can be effective at managing pain and functional outcome for PTRCTs. Surgery, however, is the most invasive and costly approach, with the highest risk of complications such as infection. Other variables such as patient expectation, treating practitioner bias, or preference may change which modalities are offered and in what sequence. [ABSTRACT FROM AUTHOR]

Objectives: Para athletes with brain impairment are affected by hypertonia, ataxia and athetosis, which adversely affect starting, sprinting and submaximal running. The aim was to identify and synthesise evidence from studies that have compared the biomechanics of runners with brain impairments (RBI) and non-disabled runners (NDR).Design: Systematic review.Methods: Five journal databases were systematically searched from inception to March 2020. Included studies compared the biomechanics of RBI (aged>14 years) and NDR performing either block-starts, sprinting, or submaximal running.Results: Eight studies were included, analysing a total of 100 RBI (78M:22F; 18-38 years) diagnosed with either cerebral palsy (n=44) or traumatic brain injury (n=56). Studies analysed block-starts (n=3), overground sprinting (n=3) and submaximal running (n=2), and submaximal treadmill running (n=1). Horizontal velocity during starts, sprinting and self-selected submaximal speeds were lower in RBI. During sprinting and submaximal running, compared with NDR, RBI had shorter stride length, step length, and flight time, increased ground-contact time, increased cadence, and reduced ankle and hip range of motion. In submaximal running, RBI had decreased ankle-power generation at toe-off.Conclusions: There is limited research and small sample sizes in this area. However, preliminary evidence suggests that RBI had lower sprint speeds and biomechanical characteristics typical of submaximal running speeds in NDR, including increased ground-contact times and reduced stride length, step length, and flight times. Meaningful interpretation of biomechanical findings in RBI is impeded by impairment variability (type, severity and distribution), and methods which permit valid, reliable impairment stratification in larger samples are required. [ABSTRACT FROM AUTHOR]

Objectives: The International Paralympic Committee has mandated that International Sport Federations develop sport-specific classification systems that are evidence-based. This study examined the predictive and convergent validity of instrumented tapping tasks to classify motor coordination impairments in Para swimming.Design: Cross-sectional.Methods: Thirty non-disabled participants and twenty-one Para swimmers with brain injury completed several instrumented tapping tasks as an assessment of upper and lower limb motor coordination. Para swimmers also completed a maximal freestyle swim to obtain a performance measure. The predictive and convergent validity of instrumented tapping tasks was examined by establishing differences in test measures between participants with and without brain injury and defining the strength of association between test measures and maximal freestyle swim speed in Para swimmers, respectively.Results: Random forest successfully classified 96% of participants with and without brain injury using test measures derived from instrumented tapping tasks. Most test measures had moderate to high correlations (r=0.54 to 0.72; p<0.01) with maximal freestyle swim speed and collectively explained up to 72% of the variance in maximal freestyle swim performance in Para swimmers with brain injury.Conclusions: The results of this study evidence the predictive and convergent validity of instrumented tapping tasks to classify motor coordination impairments in Para swimmers with brain injury. These tests can be included in revised Para swimming classification to improve the objectivity and transparency in determining athlete eligibility and sport class for these Para athletes. [ABSTRACT FROM AUTHOR]

Objective: To describe the fitness, function, and exercise training responses of patients following reconstruction of the lower limb with a total femoral (TF), proximal femoral (PF), distal femoral (DF), or proximal tibial (PT) megaprosthesis. TYPE: Systematic review.Literature Survey: Five research databases were searched systematically for original studies published in English from 2006 to 2017 that reported fitness, functioning, or exercise training responses for one or more of the four types of lower limb megaprosthesis listed above.Methodology: Methodologic quality was assessed using a 22-item modified STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist.Synthesis: Of the 5342 articles retrieved, 28 met the inclusion criteria. Thirteen studies reported fitness outcomes, primarily in PT, with none in TF. Impaired knee extensor strength of the affected limb was reported following limb salvage with PF, DF, and PT megaprosthetics. Impaired flexibility was reported following limb salvage with DF and PT megaprosthetics. Functional outcomes were described in all studies and were most commonly reported using the Musculoskeletal Tumor Society (MSTS) system score. Results indicated no clear difference in functional outcomes between megaprosthesis locations. No studies evaluated exercise training responses.Conclusions: This review identified impairments of lower limb strength and flexibility following limb salvage with a lower limb megaprosthesis. Similarity in functional outcomes for all four reported megaprosthetic locations may indicate a lack of sensitivity in outcome measures, including the absence of items assessing higher-level functioning. Exercise interventions that aim to improve fitness and function in this population have not been evaluated but are required given increasing 5-year survival rates.Level Of Evidence: I. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the reliability of swimming-specific range of movement tests developed in order to permit evidenced-based classification in the sport of para swimming. Design Test-retest intra- and inter-examiner reliability. Setting International Swimming training camps and university exercise science departments. Participants 42 non-disabled participants (mean age 23.2 years) and 24 Para swimmers (mean age 28.5 years). Main outcome measures Intra- and inter-examiner reliability of a battery of novel active range of motion tests. Results Good to excellent intra-examiner reliability was found for the majority (32/34) of tests in non-disabled participants (ICC = 0.85–0.98). SEM values ranged from 1.18° to 6.11°. Similarly, good to excellent inter-examiner reliability was found for the majority (35/42) of tests in non-disabled participants (ICC = 0.85–0.98). SEM values range from 0.73° to 6.52°. Para swimmers exhibited significantly reduced range of motion compared to non-disabled participants. Conclusions The large majority of ROM tests included in this novel battery were reliable both within and between examiners in non-disabled participants. The tests were found to differentiate between non-disabled participants and Para swimmers with hypertonia or impaired muscle power. [ABSTRACT FROM AUTHOR]

Objectives: Classification in Paralympic Sport aims to minimize the impact of 10 eligible types of impairment on the outcome of competition. Methods for assessing the extent to which a given body structure or function has been impaired are required, but are challenging because it is not possible to directly measure an absence or loss. Rather, impairment must be inferred by measurement of extant body structures or functions.Methods: This manuscript reviews the literature concerning the assessment of strength with the aim of identifying and describing the most appropriate method for inferring strength impairment in para-athletes.Results: It is posited that the most appropriate voluntary strength assessment method for inferring strength loss in para-athletes will be multi-joint, isometric tests performed at joint angles that facilitate maximum force production.Conclusions: Evidence suggests such methods will permit development of tests that are specific to a variety of para-sports and which are reliable, ratio-scaled, and resistant to training. Future research should: develop sport-specific tests which are suitable for assessment of athletes with strength impairments of variable severity and distribution; and scientifically evaluate the extent to which such tests permit strength impairment to be validly inferred, including specific evaluation of the extent to which such measures respond to athletic training. [ABSTRACT FROM AUTHOR]

• Fatigue severity in MS linked to a range of variables including depression. • Overlap between fatigue and tiredness as depressive symptom complicates interpretation. • Network analysis of large early RRMS cohort including structural MRI of brain. • No link between fatigue severity and cognitive performance, or included MRI metrics. • Fatigue linked to individual depressive symptoms in addition to tiredness. Fatigue is common and disabling in multiple sclerosis (MS), yet its mechanisms are poorly understood. In particular, overlap in measures of fatigue and depression complicates interpretation. We applied a multivariate network approach to quantify relationships between fatigue and other variables in early MS. Data were collected from patients with newly diagnosed immunotherapy-naïve relapsing-remitting MS at baseline and month 12 follow-up in FutureMS, a Scottish nationally representative cohort. Subjective fatigue was assessed by Fatigue Severity Scale. Detailed phenotyping included measures assessing each of physical disability, affective disorders, cognitive performance, sleep quality, and structural brain imaging. Network analysis was conducted to estimate partial correlations between variables. Baseline networks were compared between those with persistent and remitted fatigue at one-year follow up. Data from 322 participants at baseline, and 323 at month 12, were included. At baseline, 154 patients (47.8%) reported clinically significant fatigue. In the network analysis, fatigue severity showed strongest connections with depression, followed by Expanded Disability Status Scale. Conversely, fatigue severity was not linked to objective cognitive performance or brain imaging variables. Even after controlling for measurement of "tiredness" in our measure of depression, four specific depressive symptoms remained linked to fatigue. Results were consistent at baseline and month 12. Overall network strength was not significantly different between groups with persistent and remitted fatigue (4.89 vs 2.90, p = 0.11). Our findings support robust links between subjective fatigue and depression in early relapsing-remitting MS. Shared mechanisms between specific depressive symptoms and fatigue could be key targets of treatment and research in MS-related fatigue. [ABSTRACT FROM AUTHOR]

Most HIV-1 replication occurs in secondary lymphoid tissues in T cells within B cell follicles. Mechanisms underlying the accumulation of HIV-1-producing cells at these sites are not understood. Antiapoptotic proteins such as Bcl-2 could promote follicular CD4+ T cell survival, contributing to sustained virus production. Tonsils obtained from subjects without known HIV infection were disaggregated and analyzed for Bcl-2 expression in follicular (CXCR5+) and extrafollicular (CXCR5−) CD3+CD4+ cells by flow cytometry. Additional tonsil cells were cultured with phytohemagglutinin (PHA) and interleukin-2 (IL-2) for 2 days, infected with either CCR5(R5) or CXCR4-tropic (X4) GFP reporter viruses, and analyzed for Bcl-2 expression. In freshly disaggregated CD3+CD4+ tonsil cells, mean florescence intensity (MFI) for Bcl-2 was higher in CXCR5+ (median, 292) compared to CXCR5− cells (median, 194; p=0.001). Following in vitro stimulation with PHA and IL-2, Bcl-2 MFI was higher in both CXCR5+ cells (median, 757; p=0.03) and CXCR5− cells (median, 884; p=0.002) in uninfected cultures compared to freshly isolated tonsil cells. Bcl-2 MFI was higher in GFP+CD3+CD8− R5-producing cells (median, 554) than in X4-producing cells (median, 393; p=0.02). Bcl-2 MFI was higher in R5-producing CXCR5+ cells (median, 840) compared to all other subsets including R5-producing CXCR5− cells (median, 524; p=0.04), X4-producing CXCR5+ cells (median, 401; p=0.02), and X4-producing CXCR5− cells (median, 332; p=0.008). Bcl-2 expression is elevated in R5 HIV-1-producing CXCR5+ T cells in vitro, which may contribute to propagation of R5 virus in B cell follicles in vivo. [ABSTRACT FROM AUTHOR]

• Pre-specified analyses of neuropathic pain in MS SMART randomised controlled trial. • We analyzed 445 participants with secondary progressive multiple sclerosis. • Study agents Fluoxetine, riluzole and amiloride compared separately to placebo. • No benefit of trial agents was observed in any neuropathic pain outcome measure. • No benefit of trial agents in overall pain, nor perceived impact of pain. Evidence-based treatment of pain in people with MS presents a major unmet need. We aimed to establish if use of Fluoxetine, Riluzole or Amiloride improved neuropathic pain outcomes in comparison to placebo, in adults with secondary progressive MS participating in a trial of these putative neuroprotectants. In pre-specified secondary analyses of the MS SMART phase-2b double-blind randomised controlled trial (NCT01910259), we analyzed reports of neuropathic pain, overall pain, and pain interference. Multivariate analyses included adjustment for baseline pain severity. Additionally, we explored associations of pain severity with clinical and MRI brain imaging variables. 445 Participants were recruited from 13 UK neuroscience centres. We found no statistically significant benefit of active intervention on any rating of neuropathic pain, or pain overall. Compared to placebo, adjusted mean difference in pain intensity was 0.38 (positive values favouring placebo, 95%CI -0.30 to 1.07, p = 0.27) for Amiloride; 0.52 (-0.17 to 1.22, p = 0.14) for Fluoxetine; and 0.40 (-0.30 to 1.10, p = 0.26) for Riluzole. Pain severity was positively correlated with depressive symptoms (Spearman correlation 0.19, 95%CI 0.10–0.28) and fatigue (Rho 0.30, 95%CI 0.20–0.39). Use of Fluoxetine, Riluzole or Amiloride was not associated with improvement in neuropathic pain symptoms, in comparison to placebo. [ABSTRACT FROM AUTHOR]

• Hidden disability is present in most newly diagnosed people with multiple sclerosis. • 26% of participants improve in hidden disability burden one year after diagnosis. • Fingolimod and cladribine are associated with improvement in a small subgroup. • Overall disease modifying therapy has no substantial impact on hidden disability. In addition to motor disability, "hidden disability" such as depression, anxiety, fatigue, sleep disturbance, cognitive impairment and pain is a major complaint of people with multiple sclerosis. We explored changes in hidden disability burden in the early post-diagnostic period and examined the hypothesis that disease modifying therapies have a beneficial effect on hidden disability burden. Adults with recently diagnosed (< 6 months) relapsing-remitting multiple sclerosis (n = 440, mean age 37.4 ± 10.4, 76% female), from a national multicentre cohort study (FutureMS) underwent testing with clinical and neuropsychological instruments as well as brain MRI at baseline and after 12-months. Disease modifying therapies were only started after baseline assessment and were classified into injectables (n = 70, interferons, glatiramer acetate), other DMTs (n = 215) and no DMT (n = 117, reference). Sensitivity analyses were undertaken using alternative classifications (disease modifying therapy vs none, and a 3-category system). We performed latent transition analysis with hidden disability burden as the latent variable including propensity score weights. We identified three classes with low (58%), moderate (25%) and high (17%) hidden disability burden. 70% did not transition ("unchanged", reference), 26% transitioned into a lower burden class ("improvement") and 4% transitioned into a higher burden class ("worsening"). Median treatment duration was 11 months (IQR 9–12). Injectables [OR 1.3 (95%CIs 0.7, 2.3); P = 0.4] and other DMTs [OR 1.4 (95%CIs 0.9, 2.1); P = 0.2] were not associated with significant change in hidden disability burden in either direction ("improvement" or "worsening"). In the alternative 3-category classification, category 2 treatment (fingolimod, cladribine, n = 22) was associated with improvement [OR 4.3 (2.6, 7.0); P < 0.001]. Hidden disability was present in most newly diagnosed people with multiple sclerosis. The majority remained unchanged and approximately a quarter improved over the immediate post-diagnostic period. Disease modifying therapy had no significant influence on hidden disability burden in the study period of one year following diagnosis. The trend towards favourable outcomes with fingolimod and cladribine should be interpreted with caution due to the small sample size. Our exploratory data are observational, with scope for attendant biases, but highlight the need for further study including longer-term evaluation as well as randomised trials for non-motor disability. [ABSTRACT FROM AUTHOR]

Paralympic classification systems aim to promote participation in sport by people with disabilities by controlling for the impact of impairment on the outcome of competition. Valid systems of classification ensure that successful athletes are those who have the most advantageous combination of anthropometric, physiological, and/or psychological attributes, and who have enhanced them to the best effect. Classification systems that are not valid pose a significant threat to Paralympic sport and, therefore, the International Paralympic Committee (IPC) has a Classification Code which includes policy commitment to the development of evidence‐based methods of classification. The aim of this article is to provide an overview of current best practice in classification for athletes with physical impairments, and to update research advances in the area. Currently, classification has 4 stages: (1) establish whether the athlete has a health condition that will lead to one or more of the 8 eligible types of physical impairment, (2) determine whether the athlete has an eligible impairment type, (3) determine whether the impairment is severe enough, and (4) determine in what class the athlete should compete. A sequential 4‐step process that outlines how to initiate and develop evidence‐based methods of classification is described: (1) specification of impairment types that are eligible for the sport; (2) development of valid measures of impairment(s); (3) development of standardized, sport‐specific measures of performance; and (4) assessment of the relative strength of association between measures of impairment and measures of performance. Of these, the development and reporting of valid measures of impairment is currently the most pressing scientific challenge in the development of evidence‐based methods of classification. [ABSTRACT FROM AUTHOR]

Paralympic classification systems aim to promote participation in sport by people with disabilities by controlling for the impact of impairment on the outcome of competition. Valid systems of classification ensure that successful athletes are those who have the most advantageous combination of anthropometric, physiological, and/or psychological attributes, and who have enhanced them to the best effect. Classification systems that are not valid pose a significant threat to Paralympic sport and, therefore, the International Paralympic Committee (IPC) has a Classification Code which includes policy commitment to the development of evidence‐based methods of classification. The aim of this article is to provide an overview of current best practice in classification for athletes with physical impairments, and to update research advances in the area. Currently, classification has 4 stages: (1) establish whether the athlete has a health condition that will lead to one or more of the 8 eligible types of physical impairment, (2) determine whether the athlete has an eligible impairment type, (3) determine whether the impairment is severe enough, and (4) determine in what class the athlete should compete. A sequential 4‐step process that outlines how to initiate and develop evidence‐based methods of classification is described: (1) specification of impairment types that are eligible for the sport; (2) development of valid measures of impairment(s); (3) development of standardized, sport‐specific measures of performance; and (4) assessment of the relative strength of association between measures of impairment and measures of performance. Of these, the development and reporting of valid measures of impairment is currently the most pressing scientific challenge in the development of evidence‐based methods of classification. [ABSTRACT FROM AUTHOR]

Paralympic classification systems aim to promote participation in sport by people with disabilities by controlling for the impact of impairment on the outcome of competition. Valid systems of classification ensure that successful athletes are those who have the most advantageous combination of anthropometric, physiological, and/or psychological attributes, and who have enhanced them to the best effect. Classification systems that are not valid pose a significant threat to Paralympic sport and, therefore, the International Paralympic Committee (IPC) has a Classification Code which includes policy commitment to the development of evidence-based methods of classification. The aim of this article is to provide an overview of current best practice in classification for athletes with physical impairments, and to update research advances in the area. Currently, classification has 4 stages: (1) establish whether the athlete has a health condition that will lead to one or more of the 8 eligible types of physical impairment, (2) determine whether the athlete has an eligible impairment type, (3) determine whether the impairment is severe enough, and (4) determine in what class the athlete should compete. A sequential 4-step process that outlines how to initiate and develop evidence-based methods of classification is described: (1) specification of impairment types that are eligible for the sport; (2) development of valid measures of impairment(s); (3) development of standardized, sport-specific measures of performance; and (4) assessment of the relative strength of association between measures of impairment and measures of performance. Of these, the development and reporting of valid measures of impairment is currently the most pressing scientific challenge in the development of evidence-based methods of classification. [ABSTRACT FROM AUTHOR]

The article discusses the throwing frame configurations classified by nonprofit sports governing body International Paralympic Committee among athletes who throw from a seated position based on their neuromusculoskeletal impairments affecting the activity. It notes the authors' developed standardized seating configurations, one with assistive pole and one without. Results suggest that non-disabled people preferred seated throwing configurations.

AbstractMultiple impairments in HIV-1-specific cytotoxic T cells (CTL) have been reported, but derangements in HIV-1-specific CD8T-cell chemotaxis have not been described previously. We assessed migration to SDF-1α(stromal cell-derived factor 1-alpha) and CX3CL1 in vitroand expression of cognate receptors, CXCR4 and CX3CR1, by flow cytometry in peripheral blood and lymph node CD8T cells from HIV-1-seropositive and -seronegative individuals. Compared with seronegative individuals, percentages of CXCR4CD8T cells were reduced (median, 26 versus 74, p< 0.001) and percentages of CX3CR1CD8T cells were increased (median, 33 versus 15, p 0.03) in seropositive individuals. Robust migration of peripheral blood mononuclear cell (PBMC) CD8T cells to SDF-1α(1 μg/ml) was observed in both HIV-1-seropositive (median chemotactic index [CI] 4.9) and -seronegative (median CI 2.8) subjects (p 0.46). CI to SDF-1αwas not significantly related to percentage of CXCR4CD8T cells or density of CXCR4, but correlated inversely with plasma HIV-1 RNA concentration (r −0.82, p 0.03). Little chemotaxis was observed in response to CX3CL1 and it was unrelated to CX3CR1 expression. Lymph node CD8T-cell chemotaxis to SDF-1αand CX3CL1 in four subjects demonstrated the same patterns observed in PBMC. HIV-1-specific tetramer-staining CD8T cells exhibited chemotaxis of similar magnitude as PBMC CD8T cells in a subset of subjects. These data suggest that SDF-1αis a potent chemoattractant for HIV-1-specific CTL, but that impairments in migration of HIV-1-specific CTL may exist at high viral loads. Improved understanding of the determinants of CTL localization may provide insight into novel therapies to enhance delivery of CTL to sites of HIV-1 replication. [ABSTRACT FROM AUTHOR]