Adrian Martinez-De la Torre

The assessment of functioning is a critical component of evaluating patient progress in rehabilitation, as it captures a patient’s ability to perform daily activities and is closely linked to overa...

Background/Objectives: This study describes, first, healthcare pathways, including inpatient rehabilitation, and, second, functional outcomes for these low-trauma hip fracture (LTHF) types (femoral neck (FN-F), trochanteric (Tr-F), and acetabulum/periprosthetic (Ac/Pp-F) fractures). Methods: This single-center, retrospective cohort study, 2020–2023, included patients aged ≥65 years, with FN-F, Tr-F, or Ac/Pp-F, admitted to inpatient rehabilitation. Pathways comprised acute care, inpatient rehabilitation, and temporary care homes, bounded by pre-fracture situation and discharge destination. Pairwise Standardized Mean Differences (SMDs) were calculated to determine between-group differences. Results: Of 294 individuals (mean age 81.0 ± 7.4 years; 191 (65%) women; 152 Tr-F, 118 FN-F, and 24 Ac/Pp-F), four main pathways were identified: (1) acute care to inpatient rehabilitation in 208 (70.7%) individuals, (2) temporary care home stays before rehabilitation in 25 (8.5%), (3) temporary care home stays after rehabilitation in 17 (5.8%), and (4) re-hospitalization in 44 (15.0%). Median pathway length was 33.0 days (IQR 26.0–40.0) for FN-F, 35.0 (IQR 29.0–46.0) for Tr-F, and 60.5 (IQR 37.0–86.5) for Ac/Pp-F. Between-group differences in pathway type were moderate to large (SMDs: FN-F vs. Tr-F = 0.47; FN-F vs. Ac/Pp-F = 1.25; Tr-F vs. Ac/Pp-F = 0.84), and for length, small to large (SMDs: FN-F vs. Tr-F = 0.36; FN-F vs. Ac/Pp-F = 1.2; Tr-F vs. Ac/Pp-F = 0.69). Overall, 246 (83.7%) returned to a permanent private living setting. A total of 88 (29.9%) required new or increased home support or care. At discharge from rehabilitation, among participants who completed the program, the Functional Independence Measure and the Timed Up and Go test showed small-to-moderate between-group differences. Conclusions: Individuals with FN-F, Tr-F, and Ac/Pp-F fractures follow healthcare pathways in different frequencies and have different pathway durations. The findings may support the identification of future opportunities to improve continuity of healthcare, including orthogeriatric management and specialized rehabilitation.

This preprint has been withdrawn at the request of the authors.

Summary Anemia seems to be associated with an increased risk of fracture. This cohort study of the UK primary care data shows in 84,932 anemic patients and 158,731 controls an increased fracture risk in anemic patients, also including patients < 50 years of age. Severe anemia was associated with 2 × vertebral fracture risk. Awareness of this clinically relevant association should increase. Purpose In this study, we evaluated the risk of fracture among adult patients with anemia, compared to propensity score matched controls, stratifying by fracture site, age, and severity of anemia. Methods We conducted a cohort study using the UK IQVIA Medical Research Database (IMRD), incorporating The Health Improvement Network (THIN), a Cegedim database. Adults with a diagnosis of anemia and an eligible hemoglobin value (< 13 g/dL (men) or < 12 g/dL (women)) were matched to controls using propensity score matching. Cox proportional hazard models estimated the hazard ratios (HRs) for the risk of any fracture (stratified by fracture site, sex, and age (defined < 50 years and > = 50 years)). Results 84,932 anemic patients were matched to 158,731 controls. Overall, anemia was associated with a significant 20% risk of any fracture (driven by a 32% (HR 1.32, 1.20–1.47) increase among males, no difference among females). When stratified by sex, males had a significant risk at all fracture sites (27% (HR 1.27, 1.03–1.58) risk for vertebral, 89% (HR 1.89, 1.52–2.34) risk for humerus fractures). In females, only hip (HR 1.14, 1.05–1.25) and vertebral fractures (HR 1.24, 1.07–1.43) were significantly associated with anemia. Patients ≥ 50 years had elevated risks for all sites. In patients < 50 years, only hip fracture was elevated (HR 1.86, 1.04–3.33). Conclusion Anemia was associated with a significant 20% increase of any fracture; however, this was driven by the elevated risk among males and those over the age of 50 years. Among females, only hip and vertebral fracture risk was elevated, while males had an elevated risk at all sites.

Loperamide, a peripherally acting μ-opioid receptor agonist, is widely used as an over-the-counter anti-diarrheal medication. Because of its low bioavailability (0.3%) and limited ability to cross ...

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting approximately 0.5–1.0% of the adult population and is a significant contributor of disability worldwide. While Phase III randomized controlled trials (RCTs) remain the gold standard for evaluating pharmacological treatments, they often fail to capture outcomes that reflect patients’ lived experiences, also referred to as functioning. The International Classification of Functioning, Disability and Health (ICF) Brief Core Set for RA offers a standardized, patient-centered framework for assessing functioning across relevant domains. Objective: To examine the extent to which functioning-related outcomes in Phase III pharmacological RCTs for RA align with the ICF Brief Core Set for RA and to identify the most frequently represented functioning categories. Methods: A scoping review was conducted following PRISMA-ScR guidelines. Literature was searched in MEDLINE, EMBASE, and ClinicalTrials.gov from 2010 to 2025. Phase III RCTs evaluating pharmacological interventions in adult patients with RA were included. Functioning-related outcomes were extracted and mapped to ICF categories using standardized linking rules. Results: Of 852 records screened, 91 met the inclusion criteria. Functioning was frequently assessed through patient-reported outcomes and composite clinical measures. The most commonly linked ICF categories included sensation of pain (b280) and mobility of joint functions (b710) from the body functions domain; walking (d450) and carrying out daily routine (d230) from the activities and participation domain; and structures of the shoulder (s720), upper (s730), and lower extremities (s740) from the body structures domain. However, none of the studies explicitly used the ICF framework. Conclusion: Functioning is implicitly assessed in RA pharmacological trials, yet the ICF framework remains underutilized. Explicit integration of the ICF Brief Core Set for RA into trial design could improve the standardization, comparability, and patient-centeredness of outcome measurement, ensuring that clinical research better reflects what matters most to individuals living with RA.

Background: To compare the clinical, radiologic, and functional outcomes between shockwave and operative treatments for proximal fifth metatarsal stress fractures in soccer players in a pilot study. Methods: Between 2017 and 2019, 18 soccer players with fifth metatarsal stress fractures attended at Mutualidad de Futbolistas Españoles–Delegación Catalana were included. Patients were randomly assigned into 2 groups receiving either surgery with an intramedullary screw (group 1) or high-energy focused extracorporeal shockwave treatment (group 2 performed once a week for 3 weeks using 2000 impulses at an energy flux density of 0.21 mJ/mm² and 4 Hz frequency). Clinical (pain), radiologic (bone healing), and functional (Tegner Activity Scale and American Orthopaedic Foot & Ankle Society [AOFAS] ankle-hindfoot scales) outcomes before and after receiving the treatment were compared between both groups. In addition, ability and time to return to play was also compared between groups. Results: No patients were lost to follow-up. There were no statistically significant differences at last follow-up between surgery and extracorporeal shockwave treatment for bone healing, pain relief, AOFAS ankle-hindfoot score, Tegner score, and time return to play. No complications were reported in either of the 2 groups. Conclusion: In this pilot study, extracorporeal shockwave treatment and operative treatment were found to be equally effective at reducing pain, achieving bone healing, and allowing the soccer players to return to play after proximal fifth metatarsal stress fractures. This study suggests that ESWT may be a good option for the management of proximal fifth metatarsal stress fractures in soccer players. If this approach proves successful in larger trials, the shockwave approach might help avoid known complications of the surgical treatment like wound problems, nerve injury, and hardware intolerance. Further investigations with larger sample size should be conducted in order to confirm the present conclusions. Level of Evidence: Level II, therapeutic, pilot randomized controlled trial.

Purpose: With increased concomitant chronic diseases in type 2 diabetes mellitus (T2DM), the use of multiple drugs increases as well as the risk of drug-drug interac-tions (DDI) and adverse drug reactions (ADR). Nevertheless, how medication patterns vary in T2DM patients across different sex and age groups is unclear. This study aims to identify and quantify common drug combinations in first-time metformin users with polypharmacy (>_5 co-medications).Methods: New users of metformin were identified from the IQVIA Medical Research Data incorporating data from THIN, A Cegedim Database (2016-2019). A descriptive cohort study explored prescription patterns in patients with polypharmacy. The Apriori algorithm, used to find frequent item-sets in databases, was first-time applied to identify and quantify drug combinations of up to seven drugs to investigate poten-tial harmful polypharmacy patterns.Results: The cohort included 34 169 new-users of metformin, of which 20 854 (61.0%) received polypharmacy. Atorvastatin was the most frequently co-prescribed drug with metformin overall (38.7%), in women (34.3%) and men (42.6%). In the strati-fied analysis, a higher proportion of women received polypharmacy (65.6%) compared to men (57.4%). Moreover, the proportion of patients receiving polypharmacy increased with age (18-39 years = 30.4%, 40-59 years = 50.5%, 60-74 years = 70.9%, and >= 75 years = 84.3%).Conclusion: This study is the first to identify and quantify commonly prescribed com-binations of drugs compounds in patients with polypharmacy using the Apriori algorithm. The high polypharmacy prevalence at all strata indicates the need to optimize polypharmacy to minimize DDI and ADR.