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Background. Optimal physical activity levels have health benefits for patients with acute coronary syndrome (ACS) and are an important goal of cardiac rehabilitation (CR). Purpose. The purpose of this study was to systematically review literature regarding short-term effects (6 months after completion) of standard CR on physical activity levels in patients with ACS. Data Sources. PubMed, EMBASE, CINAHL, and PEDro were systematically searched for relevant randomized clinical trials (RCTs) published from 1990 until 2012. Study Selection. Randomized clinical trials investigating CR for patients with ACS reporting physical activity level were reviewed. Data Extraction. Two reviewers independently selected articles, extracted data, and assessed methodological quality. Result were summarized with a best evidence synthesis. Results were categorized as: (1) center-based/home-based CR versus no intervention, (2) comparison of different durations of CR, and (3) comparison of 2 types of CR. Data Synthesis. A total of 26 RCTs were included. Compared with no intervention, there was, at most, conflicting evidence for center-based CR and moderate evidence for home-based CR for short-term effectiveness. Limited evidence and no evidence were found for long-term maintenance for center-based and home-based CR, respectively. When directly compared with center-based CR, moderate evidence showed that home-based CR has better long-term effects. There was no clear evidence that increasing training volume, extending duration of CR, or adding an extra intervention to CR is more effective. Limitations. Because of the variety of CR interventions in the included RCTs and the variety of outcome measures in the included RCTs, pooling of data was not possible. Therefore, a best evidence synthesis was used. Conclusions. It would appear that center-based CR is not sufficient to improve and maintain physical activity habits. Home-based programs might be more successful, but the literature on these programs is limited. More research on finding successful interventions to improve activity habits is needed., New drug therapies and revascularization techniques developed since the 1980s have dramatically changed the care of patients with cardiovascular conditions. Although cardiovascular disease is still the leading cause of death [...]

Background. Trigger finger is characterized by sometimes painful snapping or locking when flexing the finger. Although trigger finger is frequently seen in clinical practice, no standard treatment protocol has been established as 'best practice.' Objective. The aim of this study was to achieve consensus on a multidisciplinary treatment guideline for trigger finger. Design. A European Delphi consensus strategy was initiated. Systematic reviews reporting on the effectiveness of surgical and nonsurgical interventions were conducted and used as an evidence-based starting point for this study. Setting. In total, 35 experts (hand therapists and hand surgeons selected by the national member associations of their European federations and physical medicine and rehabilitation physicians) participated in the Delphi consensus strategy. Measurements. Each Delphi round consisted of a questionnaire, an analysis, and a feedback report. Results. After 4 Delphi rounds, consensus was achieved on the description, symptoms, and diagnosis of trigger finger. The experts agreed that use of orthoses (splinting), corticosteroid injections, corticosteroid injections plus use of orthoses, and surgery are suitable treatment options. Relevant details for the use of orthoses, corticosteroid injections, and surgery were described. Main factors for selecting one of these treatment options were identified as severity and duration of the disease and previous treatments received. A relationship between the severity and duration of the disorder and the choice of therapy was indicated by the experts and reported on in the guideline. Limitations. The results represent a group's opinion at a given point in time. When the evidence for the effectiveness of interventions increases, experts' opinions will change, and the guideline should be re-evaluated and adjusted in view of these new insights. Conclusions. This multidisciplinary treatment guideline may help involved therapists and physicians in the treatment of trigger finger and indicate areas needing additional research., Locking and sometimes painful snapping are characteristics of trigger finger (stenosing tenosynovitis). In less severe cases, patients have pain in the affected finger, stiffness (especially in the morning), and tenderness [...]

Background. De Quervain disease is a common pathology resulting in pain caused by resisted gliding of the abductor pollicis longus and extensor pollicis brevis tendons in the fibro-osseous canal. In a situation of wavering assumptions and expanding medical knowledge, a treatment guideline is useful because it can aid in implementation of best practices, the education of health care professionals, and the identification of gaps in existing knowledge. Objective. The aim of this study was to achieve consensus on a multidisciplinary treatment guideline for de Quervain disease. Design. A Delphi consensus strategy was used. Methods. A European Delphi consensus strategy was initiated. A systematic review reporting on the effectiveness of surgical and nonsurgical interventions was conducted and published and was used as an evidence-based starting point for this study. In total, 35 experts (hand therapists and hand surgeons selected by the national member associations of their European federations and physical medicine and rehabilitation physicians) participated in the Delphi consensus strategy. Each Delphi round consisted of a questionnaire, an analysis, and a feedback report. Results. Consensus was achieved on the description, symptoms, and diagnosis of de Quervain disease. The experts agreed that patients with this disorder should always receive instructions and that these instructions should be combined with another form of treatment and should not be used as a sole treatment. Instructions combined with nonsteroidal anti-inflammatory drugs (NSAIDs), splinting, NSAIDs plus splinting, corticosteroid injection, corticosteroid injections plus splinting, or surgery were considered suitable treatment options. Details on the use of instructions, NSAIDs, splinting, corticosteroid injections, and surgery were described. Main factors for selecting one of these treatment options (ie, severity and duration of the disorder, previous treatments given) were identified. A relationship between the severity and duration of the disorder and the choice of therapy was indicated by the experts and reported in the guideline. Limitations. One of the limitations of a Delphi method is its inability to forecast future developments. It investigated current opinions of the treatment of people with de Quervain disease. Conclusions. This multidisciplinary treatment guideline may help in the treatment of and research on de Quervain disease., De Quervain disease was first described in 1895 (1) and seems a relatively straightforward disease with a straightforward treatment. However, all is not as it seems, as there has been [...]