Rationale: People with neuromuscular disease frequently have difficulty clearing pulmonary secretions, which leads to pneumonia and respiratory failure. High-frequency chest wall oscillation (HFCWO) is one intervention used to facilitate secretion clearance.
Objectives: The objective of this study was to determine if HFCWO therapy leads to improved outcomes as measured by lower healthcare use for patients who have a chronic neuromuscular disease.
Methods: We performed a cohort study comparing healthcare claims before and after initiation of HFCWO. Data were obtained from two large databases of commercial insurance claims. Study subjects were commercial insurance members with an International Classification of Diseases, Ninth Revision, code for a neuromuscular disease and a claim for HFCWO between 2007 and 2011. The study included both children and adults.
Measurements And Main Results: There were 426 patients in this study. Their mean age was 29.9 ± 22 years. Total medical costs per member per month decreased by $1,949 (18.6%) after initiation of HFCWO (P = 0.002). Inpatient admission costs decreased by $2,392 (41.7%) (P = 0.001), and pneumonia costs decreased by $514 (18.1%) (P = 0.015). To account for the possibilities of misclassification based on diagnosis and bias due to loss to follow-up, we compared outcomes between those lost to follow-up and those not, and we found similar results.
Conclusions: Total medical costs, hospitalizations, and pneumonia claims were less after than before initiation of HFCWO in a broad group of patients with neuromuscular disease. Subject to the limitations that administrative data did not capture how HFCWO was used and that HFCWO may be a marker of generally better care, our findings lend support to the routine use of this intervention in the care of patients with neuromuscular diseases.
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http://dx.doi.org/10.1513/AnnalsATS.201509-597OC | DOI Listing |
Front Rehabil Sci
December 2024
Department of Spine Surgery, Central Hospital of Dalian University of Technology, Dalian, Liaoning, China.
Objective: To analyze and study the causes and treatment approaches for lumbar disc herniation, focusing on office workers.
Methods: The concept of spinal internal balance disorder as a foundation for treating traumatic spinal diseases was introduced. Pathological changes occurring with single (or multiple) vertebral displacement were considered.
J Child Orthop
December 2024
Children's Orthopedic Center, Ankara, Turkey.
Introduction: The field of pediatric spine surgery has encountered major changes and evolutions lately, with new treatment options available and the development of enabling technologies. This article aims to summarize the most relevant recent literature.
Materials And Methods: The five most relevant topics were selected and assigned to one or two authors who performed a comprehensive Pubmed database search for articles published in the last 4 years (2021-2024).
Cureus
November 2024
Neurological Surgery, Baylor College of Medicine, Houston, USA.
Background The management of adductor spasticity and long-term sequelae for cerebral palsy (CP) patients is complex. Hip displacement is a common consequence of CP, and obturator neurectomy (ON) is a potentially underutilized procedure to address the underlying adductor spasticity. The aim of this study is to describe the operational technique of ON and highlight the potential efficacy of ON in reducing spasticity, as well as pain, hip, and functional outcomes in these patients.
View Article and Find Full Text PDFHealth Care Transit
November 2024
University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
Introduction: Children with cerebral palsy (CP) are treated by well-co-ordinated multi-disciplinary neuromuscular teams. With a comprehensive multidisciplinary team, co-ordinating the transfer to adult care is a challenge. Orthopaedic care becomes fragmented as patients transfer from paediatric orthopaedic surgeons with training in multi-joint neuromuscular conditions (NMCs), to adult orthopaedic surgeons where this expertise rarely exists.
View Article and Find Full Text PDFFront Genet
December 2024
Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Myotonia congenita, both in a dominant (Thomsen disease) and recessive form (Becker disease), is caused by molecular defects in that encodes the major skeletal muscle chloride channel, ClC-1. This channel is important for the normal repolarization of muscle action potentials and consequent relaxation of the muscle, and its dysfunction leads to impaired muscle relaxation after voluntary or evoked contraction and muscle stiffness. More than 300 pathogenic variants have been found in association with congenital myotonia, inherited as recessive or dominant traits (with complete or incomplete penetrance).
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