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This study aims to synthesize health state utility values (HSUVs) of type 2 diabetes mellitus (T2DM) and its related complications published in the literature, conducting a meta-analysis of the data when possible.We conducted a systematic search in MEDLINE and School of Health and Related Research Health Utilities Database repository. Studies focused on T2DM and its complications reporting utility values elicited using direct and indirect methods were selected. We categorized the results according to the instrument to describe health and meta-analyzed them accordingly. Data included in the analysis were pooled in a fixed-effect model by the inverse of variance mean and random-effects DerSimonian-Laird method. Two approaches on sensitivity analysis were performed: leave-one-out method and including data of HSUVs obtained by foreign population value sets.We identified 70 studies for the meta-analysis from a total of 467 studies. Sufficient data to pool T2DM HSUVs from EQ-5D instrument, hypoglycemia, and stroke were obtained. HSUVs varied from 0.7 to 0.92 in direct valuations, and the pooled mean of 3-level version of EQ-5D studies was 0.772 (95% confidence interval 0.763-0.78) and of 5-level version of EQ-5D 0.815 (95% confidence interval 0.808-0.823). HSUVs of complications varied from 0.739 to 0.843, or reductions of HSUVs between -0.014 and -0.094. In general, HSUVs obtained from 3-level version of EQ-5D and Health Utility Index 3 instruments were lower than those directly elicited. A considerable amount of heterogeneity was observed. Some complications remained unable to be pooled due to scarce of original articles.T2DM and its complications have a considerable impact on health-related quality of life. 5-level version of EQ-5D estimates seems comparable with direct elicited HSUVs.

Purpose To assess the presence of control impairment (CI) of the lumbopelvic region in the axial plane in men without low back pain (LBP) with CI in the sagittal plane. Methods : Twenty-four males,...

Background: Tibialis posterior tendon transfer is performed when loss of dorsiflexion has to be compensated. We evaluated the circumtibial (CT), above-retinaculum transmembranous (TMAR), and under-retinaculum transmembranous (TMUR) transfer gliding resistance and foot kinematics in a cadaveric foot model during ankle range of motion (ROM). Methods: Eight cadaveric foot-ankle distal tibia specimens were dissected free of soft tissues on the proximal end, applying an equivalent force to 50% of the stance phase to every tendon, except for the Achilles tendon. Dorsiflexion was tested with all of the tibialis posterior tendon transfer methods (CT, TMAR, and TMUR) using a tension tensile machine. A 10-repetition cycle of dorsiflexion and plantarflexion was performed for each transfer. Foot motion and the force needed to achieve dorsiflexion were recorded. Results: The CT transfer showed the highest gliding resistance ( P < .01). Regarding kinematics, all transfers decreased ankle ROM, with the CT transfer being the condition with less dorsiflexion compared with the control group (6.8 vs 15 degrees, P < .05). TMUR transfer did perform better than TMAR with regard to ankle dorsiflexion, but no difference was shown in gliding resistance. The CT produced a supination moment on the forefoot. Conclusion: The CT transfer had the highest tendon gliding resistance, achieved less dorsiflexion and had a supination moment. Clinical Relevance We suggest that the transmembranous tibialis posterior tendon transfer should be the transfer of choice. The potential bowstringing effect when performing a tibialis posterior tendon transfer subcutaneously (TMAR) could be avoided if the transfer is routed under the retinaculum, without significant compromise of the final function and even with a possible better ankle range of motion.

Category: Ankle, Basic Sciences/Biologics, Tendon Transfer, Dropfoot Introduction/Purpose: Posterior tibial tendon transfer (PTTT) is performed for a variety of pathologies where loss of dorsiflexion is compensated by the transfer, e.g. cavus foot, neurologic foot (dropfoot), etc. Transfers can be performed subcutaneously through a circumtibial way or deeply through the interosseous membrane (transmembranous). The latter is classically routed above the extensor retinaculum. We evaluated the circumtibial (CT), above-retinaculum transmembranous (ART) and below-retinaculum transmembranous (BRT) transfers gliding resistance and kinematics in a cadaveric model during ankle range of motion (ROM). Our first hypothesis was that the CT would be the transfer with more gliding resistance and with more kinematic alteration. Our second hypothesis was that the ART would not show significant differences against the BRT transfer. Methods: 8 cadaveric foot- ankle – distal tibia were prepared, identifying all extensor and flexor tendons proximally. The skin and subcutaneous tissue were kept intact. Each specimen was mounted on a special frame, and luminous markers were attached to the skin to adapt it to the Oxford Foot Model. A dead weight equal to 50% of the stance phase force was applied to each tendon, except for the Achilles tendon. Each specimen served as its own control, testing dorsiflexion when pulling the tibialis anterior (TA), recording the kinematics and gliding resistance. Then, dorsiflexion was tested with the transfers already described (CT, ART and BRT PTTT). A 10-repetition cycle of dorsiflexion and plantarflexion was performed for each condition. The movement of the foot was recorded using high speed cameras, and the force needed to achieve dorsiflexion was registered in every cycle. Statistical analysis was performed using the SPSS software. Results: The circumtibial transfer showed the highest gliding resistance (p0.05). Regarding kinematics, all transfers decreased ankle ROM, being the CT transfer the condition with less range of motion (-9 degrees, pConclusion: The circumtibial transfer had the highest tendon gliding resistance and the worst kinematics of all transfers. It achieves less dorsiflexion and in an inverted position. Interestingly, there was minimal difference in gliding resistance between the above and below retinaculum transmembranous transfers. Per our results, we suggest that when performing a PTTT the transmembranous route should be the transfer of choice. The potential bowstringing effect which may be painful and not cosmetic for patients when performing a PTTT subcutaneously (ART) could be avoided if the transfer is routed under the retinaculum, without significant compromise of the final function.