NPI News Story: UT study: Students who are more physically fit perform better academically. Middle school students who are more physically fit make better grades and outperform their classmates on standardized tests, according to a newly published study at the University of Tennessee by Dawn Coe, researcher. Learn more-NPI's Certificate in School Nutrition and Wellness:  http://www.npionline.org/programs/professional/schoolnutrition.htm

National Posture Institute News: Chronic pain common complication of clot-caused strokes

American Heart Association Rapid Access Journal Report

Chronic or persistent pain is a common — and likely under-recognized — complication of ischemic strokes (caused by a blocked blood vessel) according to new research in the American Heart Association journal Stroke.

In a large trial of treatments to prevent a second stroke, researchers found that 10.6 percent of more than 15,000 stroke survivors developed chronic pain.

"Chronic pain syndromes are common, even following strokes of mild to moderate severity," said Martin J. O'Donnell, M.D., lead author and professor of translational medicine at the National University of Ireland in Galway and associate clinical professor at McMaster University in Hamilton, Ontario, Canada. "It is associated with greater decline in physical and cognitive function, making it an important medical complication after stroke."

Researchers examined data on 15,754 people who had survived mild to moderate strokes and were followed for an average 30 months in PRoFESS (Prevention Regimen for Effectively Avoiding Second Strokes), the largest study to determine the prevalence of chronic pain after ischemic stroke.

Of the 1,665 stroke survivors reporting chronic pain beginning after their stroke:

• 431 (2.7 percent) were classified as having central stroke pain, which is due to injury to the brain caused by stroke that can present as touch, temperature or other sensations being perceived as pain. Previous research has shown that central post-stroke pain may not manifest for many months after stroke has occurred, O'Donnell said.
• 238 (1.5 percent) had peripheral neuropathic pain, a tingling, burning or shooting pain due to damage to nerves outside the brain and spinal cord
• 208 (1.3 percent) reported pain from continuously tight or stiff muscles also called spasticity
• 136 (0.9 percent) experienced shoulder pain caused by stroke-related weakness or spasticity
• 86 (0.6 percent) said they had more than one type of pain
• 739 (4.7 percent) reported other causes of pain, or had unclassified pain syndromes.

Significant risk factors for post-stroke pain included increased severity of stroke; female gender; greater alcohol intake; recent symptoms of depression; diabetes and vascular disease of blood vessels supplying the lower limbs.

Patients who developed post-stroke chronic pain were more than twice as likely to become more dependent during the follow-up period, than those whose recovery wasn't complicated by pain. Patients with non-central causes of pain were more likely to experience cognitive decline.

"We suspect that some of the association between chronic pain and decline in cognitive test performance may be related to the use of medications to treat pain, but this was not evaluated in our study" said O'Donnell. "Our study emphasizes the importance of evaluating interventions to prevent post-stroke pain in high-risk individuals."  

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National Posture Institute News: Not all patients benefit equally from hip or knee replacement: Study finds

TORONTO, ON, April 5, 2013 — Only half of people with arthritis who had a hip or knee replacement reported a significant improvement in pain and mobility after surgery, according to a new study led by Women's College Hospital and the Institute for Clinical and Evaluative Sciences (ICES).

"Many patients with hip and knee arthritis have the condition in more than one of their hip or knee joints," said the study's lead author Dr. Gillian Hawker. "So it's not surprising that replacing a single joint doesn't alleviate all their pain and disability — patients may need subsequent surgeries to maximize the benefits of joint replacement."

The study, published in the journal Arthritis & Rheumatism, followed a cohort of 2,400 patients with osteoarthritis and inflammatory arthritis in Ontario. Nearly 480 had a hip or knee replacement and of the 202 patients included in the study, only half reported a meaningful improvement in their overall hip and knee pain and disability one to two years after surgery. What's more, researchers found the patients who had worse knee or hip pain to begin with but fewer general health problems and no arthritis outside of the replaced joint were more likely to report benefits.

According to the study authors, nearly 83 per cent of study participants had at least two troublesome hips and or knees. In general, an estimated 25 per cent of patients who undergo a single joint replacement will have another joint replacement — usually the other hip or knee — within two years.

"While demand for joint replacement surgery has increased as our population ages, physicians lack a set of established criteria to help determine what patients will benefit from surgery and at what point during the course of the disease," said Dr. Hawker, physician-in-chief at Women's College Hospital and a senior scientist at ICES. "As physicians, we need to do a better job of targeting treatments to the right patient at the right time by the right provider."

Arthritis is a leading cause of disability in men and women in Canada. According to the Arthritis Society, joint damage from osteoarthritis is responsible for more than 80 per cent and 90 per cent of hip replacement and knee surgeries in Canada, respectively.

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About Women's College Hospital

For more than 100 years, Women's College Hospital (WCH) has been dedicated to groundbreaking advances in health care. Today, this legacy continues. WCH is delivering health system solutions by creating new models of ambulatory care and improving access. As a teaching hospital affiliated with the University of Toronto, Women's College Hospital is also training the health professionals of the future to work in ambulatory settings.

About ICES

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.  

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