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IntroductionPatients with lumbar spinal stenosis may have poor balance, decreased physical function and problems maintaining physical activity levels due to radiculopathy. Decompressive surgery is often indicated if conservative management fails to achieve a satisfactory clinical outcome. While surgical management has proven effective at treating radiculopathy, and patients report increased physical function postoperatively, objective measures of postural control and physical activity remain sparse. This study aims to investigate the effects of decompressive surgery on postural control and activity levels of elderly patients with lumbar spinal stenosis using objective measurements.Methods and analysisThis is a 24-month, multicentre, prospective cohort study. Patients ≥65 years of age with MRI-verified symptomatic lumbar central canal stenosis will be recruited from two separate inclusion centres, and all participants will undergo decompressive surgery. Preoperative data are collected up to 3 months before surgery, with follow-up data collected at 3, 6, 12 and 24 months postoperatively. Postural control measurements are performed using the Wii Balance Board, mini Balance Evaluation Systems Test and Tandem test, and data concerning physical activity levels are collected using ActiGraph wGT3X-BT accelerometers. Patient-reported outcomes regarding quality-of-life and physical function are collected from the EuroQol-5D, 36-Item Short Form Health Survey and Zurich Claudication Questionnaire. Primary outcomes are the change in the sway area of centre of pressure and total activity counts per day from baseline to follow-up at 24 months. A sample size of 80 participants has been calculated.Ethics and disseminationThe study has been approved by the Regional Ethics Committee of Region Zealand (ID EMN-2022-08110) and the Danish Data Protection Agency (ID REG-100-2022). Written informed consent will be required from all participants before enrolment. All results from the study, whether positive, negative or inconclusive, will be published in international peer-reviewed journals and presented at national and international scientific meetings. Study findings will be further disseminated through national patient associations.Trial registration numbersNCT06075862 and NCT06057428.

Study Design Cross-sectional rater agreement. Objectives This study assessed whether inter- and intra-rater agreement for the AO spine-DGOU Osteoporotic Fracture (OF) Classification system differs between classifications based on computed tomography (CT) or radiography. Methods Radiography and CT were retrieved for 64 consecutive patients with a single osteoporotic vertebral fracture (OVF) treated at our institution having both imaging modalities performed on the same date. Four spine surgeons independently classified the fractures twice 1 week apart after training on 10 cases. Classifications were based on radiography and CT separately. Crude (%) and Fleiss’ Kappa (k) agreements were calculated for radiography and CT, respectively, and for intrarater agreement between radiography and CT within each rater. The proportion of cases with complete agreement among raters (concordant cases) was compared between radiography and CT using McNemar’s test. Fracture-type distribution differences were analyzed using McNemar’s test as well. Results Intra-rater agreement ranged 75%–81% (k = 0.49-0.64) for radiography and 64%–77% (k = 0.42-0.63) for CT. Inter-rater agreement was 56% (k = 0.49) with radiography and 50% (k = 0.51) with CT. No significant difference in the proportion of concordant cases was found between imaging modalities (P = 0.37). Fractures were classified as higher-order OF types with CT (P < 0.001). Conclusions We found moderate to substantial reliability of the OF system for radiography and CT. Using CT over radiography for classification did not increase the rater agreement. However, fractures are likely to be categorized as a higher-order OF type when the classification is based on CT compared to radiography.

Background Sporadic inclusion body myositis (sIBM) is clinically characterised by progressive proximal and distal muscle weakness and impaired physical function while skeletal muscle tissue displays abnormal cellular infiltration of T cells, macrophages, and dendritic cells. Only limited knowledge exists about the effects of low-load blood flow restriction exercise in sIBM patients, and its effect on the immunological responses at the myocellular level remains unknown. The present study is the first to investigate the longitudinal effects of low-load blood flow restriction exercise on innate and adaptive immune markers in skeletal muscle from sIBM patients. Methods Twenty-two biopsy-validated sIBM patients were randomised into either 12 weeks of low-load blood flow restriction exercise (BFRE) or no exercise (CON). Five patients from the control group completed 12 weeks of BFRE immediately following participation in the 12-week control period leading to an intervention group of 16 patients. Muscle biopsies were obtained from either the m. tibialis anterior or the m. vastus lateralis for evaluation of CD3-, CD8-, CD68-, CD206-, CD244- and FOXP3-positive cells by three-colour immunofluorescence microscopy and Visiopharm-based image analysis quantification. A linear mixed model was used for the statistical analysis. Results Myocellular infiltration of CD3 − /CD8 + expressing natural killer cells increased following BFRE ( P  < 0.05) with no changes in CON. No changes were observed for CD3 + /CD8 − or CD3 + /CD8 + T cells in BFRE or CON. CD3 + /CD244 + T cells decreased in CON, while no changes were observed in BFRE. Pronounced infiltration of M1 pro-inflammatory (CD68 + /CD206 − ) and M2 anti-inflammatory (CD68 + /CD206 + ) macrophages were observed at baseline; however, no longitudinal changes in macrophage content were observed for both groups. Conclusions Low-load blood flow restriction exercise elicited an upregulation in CD3 − /CD8 + expressing natural killer cell content, which suggests that 12 weeks of BFRE training evokes an amplified immune response in sIBM muscle. However, the observation of no changes in macrophage or T cell infiltration in the BFRE-trained patients indicates that patients with sIBM may engage in this type of exercise with no risk of intensified inflammatory activity.

BackgroundClassification of ankle fracture is important when deciding for operative or conservative treatment. This study rates the reproducibility of ankle stability assessment and compares it with the classification by Lauge-Hansen and Arbeitsgemeinschaft für Osteosyntesefragen (AO) in adult patients with primary ankle fractures.MethodsA total of 496 consecutive ankle fractures were included, and the X-ray images were reviewed 2 times by 2 medical students, 2 residents, and 1 consultant in orthopedic traumatology. The raters were blinded to each other and to their own results. Unweighted Kappa statistics were used to assess reproducibility.ResultsOverall mean (95% CI) interrater Kappa results were 0.65 (0.64; 0.68) for Lauge-Hansen, 0.62 (0.60; 0.63) for AO and 0.61 (0.57; 0.62) for the stability assessment. The intrarater results ranged from a mean Kappa of 0.64–0.80 for the medical students, 0.65–0.81 for the residents and 0.82–0.84 for the consultant.ConclusionThe stability assessment has substantial to almost-perfect agreement which is comparable to the Lauge-Hansen and AO classifications.

Background. Hip fracture patients represent a challenge to pain rating due to the high prevalence of cognitive impairment. Methods. Patients prospectively rated pain on the VRS. Furthermore, patients described the changes in pain after raising their leg, with one of five descriptors. Agreement between paired measures on the VRS at rest and by passive straight leg raise with a one-minute interval between ratings at rest and three-minute interval for straight leg raise was expressed by kappa coefficients. Reliability of this assessment of pain using the VRS was compared to the validity of assessing possible change in pain from the selected descriptors. Cognitive status was quantified by the short Orientation-Memory-Concentration Test. Results. 110 patients were included. Paired scores with maximum disagreement of one scale point reached 97% at rest and 95% at straight leg raise. Linear weighted kappa coefficients ranged from 0.68 (95% CI = 0.59–0.77) at leg raise to 0.75 (95% CI = 0.65–0.85) at rest. Unweighted kappa coefficients of agreement in recalled pain compared to agreement of paired VRS scores ranged from 0.57 (95% CI = 0.49–0.65) to 0.36 (95% CI = 0.31–0.41). Interpretation. The VRS is reliable for assessment of pain after hip fracture. The validity of intermittent questioning about possible change in pain intensity is poor.

Sporadic inclusion body myositis (sIBM) is a subgroup of idiopathic inflammatory myopathies characterised by progressive muscle weakness and skeletal muscle inflammation. Quantitative data on the myofibre morphology in sIBM remains scarce. Further, no previous study has examined fibre type association of satellite cells (SC), myonuclei number, macrophages, capillaries, and myonuclear domain (MD) in sIBM patients. Muscle biopsies from sIBM patients (n = 18) obtained previously (NCT02317094) were included in the analysis for fibre type-specific myofibre cross-sectional area (mCSA), SCs, myonuclei and macrophages, myonuclear domain, and capillarisation. mCSA (p < 0.001), peripheral myonuclei (p < 0.001) and MD (p = 0.005) were higher in association with type 1 (slow-twitch) than type 2 (fast-twitch) fibres. Conversely, quiescent SCs (p < 0.001), centrally placed myonuclei (p = 0.03), M1 macrophages (p < 0.002), M2 macrophages (p = 0.013) and capillaries (p < 0.001) were higher at type 2 fibres compared to type 1 fibres. In contrast, proliferating (Pax7+/Ki67+) SCs (p = 0.68) were similarly associated with each fibre type. Type 2 myofibres of late-phase sIBM patients showed marked signs of muscle atrophy (i.e. reduced mCSA) accompanied by higher numbers of associated quiescent SCs, centrally placed myonuclei, macrophages and capillaries compared to type 1 fibres. In contrast, type 1 fibres were suffering from pathological enlargement with larger MDs as well as fewer nuclei and capillaries per area when compared with type 2 fibres. More research is needed to examine to which extent different therapeutic interventions including targeted exercise might alleviate these fibre type-specific characteristics and countermeasure their consequences in impaired functional performance.

Myositis is associated with reduced quality of life, which is accompanied by significant impairments in muscle endurance and strength, altogether representing cardinal traits in patients with myositis. This randomised controlled trial aimed to investigate the effect of high-intensity resistance training on quality of life in patients with myositis. Thirty-two patients with established, stable myositis were randomised to 16 weeks of high-intensity resistance training (intervention group) or 16 weeks of usual care (control group). Primary outcome was quality of life assessed as the change in the physical component summary score (PCS) of the Short Form-36 health questionnaire from baseline to post-intervention. Secondary outcomes included functional capacity measures, such as functional index 3, and International Myositis Assessment and Clinical Studies Group (IMACS) disease activity and damage core set measures, including manual muscle testing 8 (MMT8). The primary outcome PCS showed an improvement in favour of high-intensity resistance training with a between-group difference of 5.33 (95% CI 0.61; 10.05) (p = 0.03). Additionally, functional index 3 showed a between-group difference indicating greater gains with high-intensity resistance training 11.49 (95% CI 3.37; 19.60) (p = 0.04), along with a between-group improvement in MMT8 1.30 (95% CI 0.09; 2.51) (p = 0.04). High-intensity resistance training for 16 weeks effectively improved quality of life in patients with myositis. Clinical measures of muscle endurance and muscle strength were also found to improve with high-intensity resistance training, while patients stayed in disease remission. Consequently, progressively adjusted high-intensity resistance training is feasible and causes no aggravation of the disease, while benefitting patients with myositis.Clinical trial registration: Clinicaltrials.gov ID: NCT04486261—https://clinicaltrials.gov/study/NCT04486261.

Reduced quality of life in patients with myositis is partly due to impairments in muscle strength, muscle endurance and functional capacity. In a recent randomised controlled trial (RCT) (NCT04486261) we showed that high-intensity resistance training improved quality of life, muscle strength, and endurance. This follow-up study aimed to investigate if these improvements remained persistent one year after completing 16 weeks of high-intensity resistance training. A total of 32 participants (intervention group (IG): 15; control group (CG): 17) were enrolled in the RCT, with 27 (IG: 13; CG: 14) completing the 1-year follow-up. Outcomes were assessed at three time points: baseline (weeks − 4 − 0), post-intervention (weeks 17–18), and 1-year follow-up (weeks 52–54). Outcomes included quality of life (QoL, SF36), functional capacity, muscle endurance (functional index 3 (FI3)), body composition (DEXA), and disease activity/damage, including manual muscle test 8 (MMT8). Training-induced improvements in muscle endurance (FI3) remained at 1-year follow-up, with a mean change of 10.7 (CI95: 2.2;19.1) in favour of IG ( p  = 0.01). Within-group improvements in IG were sustained for QoL (SF36, physical component summary) (4.8 (CI95: 0.9;8.7), p  = 0.02), muscle strength (MMT8) (1.8 (CI95: 0.8; 2.9), p  < 0.01), and functional capacity measures ( p  ≤ 0.04), although not significantly different from CG at 1-year follow-up. Disease activity and disease damage were similar between IG and CG at 1-year follow-up. Patients with myositis completing 16 weeks of high-intensity resistance training showed sustained improvements in muscle endurance at 1-year follow-up compared to controls. Indications of lasting enhancements in quality of life and strength were also present, with no increase in disease activity or damage. NCT04486261.