Emilija Dubljanin-raspopović - Academia.edu (original) (raw)
Papers by Emilija Dubljanin-raspopović
PLOS ONE, 2019
Decreased muscle strength is not only a risk factor for hip fracture in older patients, but plays... more Decreased muscle strength is not only a risk factor for hip fracture in older patients, but plays a role in recovery of physical function. Our aim was to assess the role of grip strength measured early after hip fracture, and classified according to the EWGSOP2 criteria in predicting short-and long-term functional recovery. One hundred ninety-one patients with acute hip fracture consecutively admitted to an orthopaedic hospital have been selected. A multidimensional geriatric assessment evaluating sociodemographic variables, cognitive status, functional status and quality of life prior to fracture, as well as perioperative variables were performed. Follow-ups at 3 and 6 months after surgery were carried out to evaluate functional recovery. Multivariate regression models were used to assess the predictive role of handgrip strength. The mean age of the participants was 80.3 ±6.8 years. Thirty-five percent of our patients with clinically relevant hand grip strength weakness were significantly older, more often female, had a lower BMI, and were of worse physical health. They also had a lower cognitive level, lower Barthel index, and lower EQ5D scores before fracture. Multivariate regression analysis adjusted for age and gender revealed that hand grip weakness was an independent predictor of worse functional outcome at 3 and 6 months after hip fracture for both genders and in all age populations. Our study supports the prognostic role of hand grip strength assessed at hospital admission in patients with hip fracture. Thus, clinicians should be encouraged to include hand grip assessment in their evaluation of hip fracture patients in the acute setting in order to optimize treatment of high-risk individuals.
Srpski Arhiv Za Celokupno Lekarstvo, 2006
KRATAK SADRŽAJ Uvod Optimalno lečewe predwe ukrštene veze (LCA) jedna je od najdinamičnijih tema ... more KRATAK SADRŽAJ Uvod Optimalno lečewe predwe ukrštene veze (LCA) jedna je od najdinamičnijih tema savremene ortopedije. Uprkos veli kom broju objavqenih radova, zlatni rehabilitacioni standard posle hirurški lečene povrede LCA nije utvrđen. Ciq rada Ciq rada je bio da se uporede rezultati ispitivawa dve grupe ispitanika na konzervativnom i intenzivnom rehabilitacionom protokolu i utvrde brzina i bezbednost oporavka u obe grupe, te, na osnovu toga, predloži savremen pristup u rehabilitaciji. Metod rada U prospektivnoj studiji ispitano je 45 bolesnika s jednostranom povredom LCA, koji su metodom slučajnog izbora svrstani u dve grupe: sa konzervativnim rehabilitacionom protokolom (TH-C) i intenzivnim rehabilitacionom protokolom (TH-I). Kao hirurški metod primewena je artroskopska rekonstrukcija LCA pomoću BTBP (bone-patellar-tendonbone) i STG (semitendinosus-gracilis) grafta. Posle operacije ispitanicima TH-C grupe je zabrawen oslonac, a ograničewe obima pokreta je bilo 0/0/90 u prve četiri nedeqe, dok je oporavak ispitanika grupe TH-I bio ograničen jedino otokom kolena i bolom. Ispitanici su upoređivani u odnosu na obim pokreta, kolena i natkolene muskulature, rezultate testova stabilnosti, Lisholmovog (Lysholm), Texnerovog (Tegner) i testa skakawa na jednoj nozi, kao i testa stajawa na jednoj nozi. Testirawe je izvedeno pre hirurškog lečewa, posle šest nedeqa, četiri meseca, šest, devet i 12 meseci. Dobijeni rezul tati upoređivani su primenom Pirsonovog (Pearson) χ 2 testa, Studentovog ttesta, ManVitnijevog (Mann-Whitney), Kraskal Volisovog (Kruskal-Wallis), Fridmanovog (Friedman) i Kohranovog (Cochran) testa, kao i putem jednofaktorske i dvofaktorske analize varijanse. Rezultati Ispitivane grupe su se već posle šest nedeqa statistički značajno razlikovale po pitawu obima pokreta (p<0,05), obima natkolene muskulature (p<0,01) i rezultata na Lisholmovom testu (p<0,01), posle četiri meseca po rezulta tima testa skakawa na jednoj nozi (p<0,05), a posle šest meseci po rezultatima Texnerovog testa (p<0,01). U TH-I grupi ni kod jednog bolesnika klinički nije narušen integritet grafta, niti je došlo do postoperacionog ograničewa pokreta. Zakqučak Ovaj rad nedvosmisleno pokazuje da rani intenzivni rehabilitacioni pristup dovodi do bržeg funkcional nog oporavka, bez nežeqenih posledica, nego konzervativni rehabilitacioni režim.
Vojnosanitetski Pregled, 2012
Uvod/cilj. Prevencija posledica osteoporoze postaje sve zna ajnija. Cilj rada bio je da se odredi... more Uvod/cilj. Prevencija posledica osteoporoze postaje sve zna ajnija. Cilj rada bio je da se odredi prisustvo relevantnih faktora rizika od nastanka pada i preloma, stepen rizika od nastanka preloma, kao i adekvatnost le enja osteoporoze pre povrede kod bolesnika hospitalizovanih zbog preloma kuka. Metode. Ispitivanjem su bila obuhva ena 342 bolesnika, starosti 65 godina, koji su zbog akutnog preloma kuka le eni na Klinici za ortopedsku hirurgiju i traumatologiju Klini kog centra Srbije u periodu od 12 meseci. Kod svih ispitivanih bolesnika analizirani su faktori rizika od nastanka preloma i pada putem Fracture Risk Assessment (FRAX ®) algoritma, a bolesnici su razvrstavani u odnosu na nivo rizika od nastanka preloma. Rezultati. Prelom kuka nastao je naj eš e kod onih bolesnika koji su pripadali grupi sa visokim nivoom rizika (74,2%). Manje od 10% bolesnika je imalo dijagnozu osteo-poroze pre povrede, dok je manje od 2% bolesnika le eno od osteoporoye. Od faktora rizika od pada najzastupljeniji bili su: kognitivno ošte enje (95,3%), ošte enje vida (58,2%), sniženje aktivnosti dnevnog života (51,8%) i depresija (47,1%) Zaklju ak. Rezultati našeg istraživanja jasno ukazuju na nedovoljno prepoznavanje klini kih faktora rizika od zna aja za nastanak preloma i pada na nivou primarne zaštite, na neadekvatno le enje osteoporoze, te, posledi no, izrazito lošu prevenciju preloma kuka u gerijatrijskoj populaciji u našoj sredini. U le enju starijih bolesnika savetuje se integrisani klini ki pristup, koji podrazumeva merenje koštane gustine, kao i obaveznu rutinsku procenu klini kih faktora rizika od nastanka preloma i pada.
International Journal of Environmental Research and Public Health, 2021
The data about the incidence and risk factors for surgical site infections (SSIs) following total... more The data about the incidence and risk factors for surgical site infections (SSIs) following total joint arthroplasty (TJA) in middle-income countries are still scant. The aim of this study was to assess the incidence and risk factors associated with 30-day SSIs following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The study was conducted at the Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Serbia (CCS) in Belgrade, from May 2016 to April 2018. All patients undergoing THA or TKA were followed throughout hospitalization until day 30 after discharge. Of the 1073 admitted patients, 459 had THA and 230 had TKA. The incidence rate of surgical site infections (SSIs) among the patients who underwent THA was 5.4%, which is 3.8 per 1000 postoperative patient-days, while the rate among those who had TKA was 4.8%, i.e., 3.4 per 1000 postoperative patient-days. Out of the 36 SSIs, 15 were deep and 21 were superficial incisional ones. Among the variables e...
Acta chirurgica Iugoslavica, 2013
Hip fractures are the most serious consequence of falling in older people with osteoporosis. Earl... more Hip fractures are the most serious consequence of falling in older people with osteoporosis. Early ambulation is one of the main goals of inpatient rehabilitation aimed at reducing negative effects of immobilization, and promoting functional recovery. Recognizing the role of different factors that are associated with time to ambulation time after hip fracture surgery may help decrease morbidity and mortality rates. The aim of this study was to examine the impact of postoperative pain time to ambulation following hip fracture surgery. A total of 96 patients who consecutively presented at the Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Serbia during a 6 month period were included in the study. Subjects were assessed regarding socioedemographic characteristics, prefracture functional status, cognitive status, general health status, fracture type, type of anaesthesia, and waiting time for surgery. The VAS scale (0-100) was used to measure pain intensity on the first...
Acta Neurologica Belgica, 2015
Relapse of disease is one of the most prominent characteristics of multiple sclerosis. Effectiven... more Relapse of disease is one of the most prominent characteristics of multiple sclerosis. Effectiveness of rehabilitation programmes on fatigue, self-efficacy (SE) and physical activity (PA) has not been investigated so far in context of relapse. The aim of our study was to examine if rehabilitation programme in addition to high-dose methylprednisolone (HDMP) during relapse of disease can influence fatigue, SE and PA more than corticosteroid therapy alone. Patients were randomized in control group receiving only HDMP and experimental group which was in addition included in rehabilitation programme. Outcome measures used were Fatigue Severity Scale (FSS), Multiple Sclerosis Self-Efficacy scale (MSSES), Godin Leisure-Time Exercise Questionnaire (GLTEQ), completed on baseline, 1 and 3 months later. There was no significant change in FSS in both time points, despite different trend seen between groups. The mean MSSES for function and control improved significantly in treatment group after 1 month (807.1 ± 96.8, p = 0.005; 665.3 ± 145.1, p = 0.05) and 3 months (820 ± 83.5, p = 0.004; 720.0 ± 198.2, p = 0.016.) compared to baseline values. The mean GLTEQ score was significantly higher in the treatment group compared to the control at both follow-up time points (45.7 ± 7.6, p \ 0.001; 34.3 ± 22.4, p \ 0.01). Rehabilitation started along with corticosteroid treatment induced significant improvement in PA compared to HDMP therapy alone. It also influenced noticeable changes in self-efficacy, but effect on fatigue was insufficient.
Srpski medicinski casopis Lekarske komore
Complex regional pain syndrome (CRPS) is a chronic complex disorder that significantly affects th... more Complex regional pain syndrome (CRPS) is a chronic complex disorder that significantly affects the quality of life of the people suffering from it. This syndrome affects the extremities after trauma or nerve injury. Hyperalgesia and allodynia of the extremities often accompany this condition. Diagnosing and treating this disease is very complex. The Budapest criteria are currently the most widely accepted diagnostic criteria. Early diagnosis and treatment are essential for a favorable outcome in CRPS. Therapeutic modalities available for the treatment of CRPS include physical therapy, pharmacotherapy, and interventional techniques. Additional high-quality studies are needed to determine the best therapeutic option.
Geriatrics, 2020
The aim of this study was to determine the outcome for patients who sustain a second hip fracture... more The aim of this study was to determine the outcome for patients who sustain a second hip fracture compared with those who sustain a first fracture, and to define the optimal measure to evaluate functional outcome after second hip fracture. Methods: 343 patients with acute hip fractures who presented during a 12 month period were included in the study. Patients with a first (318 patients, 78.10 +/− 7.53 years) and second (25 patients, 78.96 +/− 6.02) hip fracture were compared regarding all baseline variables. Regression analysis was also performed to assess the independent relationship between the presence of a second hip fracture and observed outcome variables at discharge (physical disability, complications, length of stay, and mortality) and one-year after surgery (physical disability and mortality). Results: Disability when performing instrumentalized activities of daily living (IADL) at one-year follow-up is independently related to the presence of a second hip fracture. There ...
Galenika Medical Journal
Topical nonsteroidal anti-inflammatory drugs are an effective and safe therapeutic option for the... more Topical nonsteroidal anti-inflammatory drugs are an effective and safe therapeutic option for the treatment of acute and chronic musculoskeletal disorders. Based on evidence from the literature, topical NSAID's have a clearly defined place in the treatment of acute musculoskeletal pain and in the treatment of osteoarthritis of the hands and knees. Due to the rare systemic side effects, they should always be advised as the first therapeutic line for the treatment of musculoskeletal pain in osteoarthritis of the hands and knees of patients ≥75 years of age. It is very important that there are no recommendations for the use of other topical preparations, such as rubefaciens and capsaicin for the treatment of painful musculoskeletal conditions. Clinical assessment of the patient, the condition of medical issue and the choice of the optimal NSAID's formulation, contribute to the success of the treatment. Gel formulations represent the optimal substrate for topical NSAID's bot...
Use of early indicators in rehabilitation process to predict one-year mortality in elderly hip fr... more Use of early indicators in rehabilitation process to predict one-year mortality in elderly hip fracture patients Article in Hip international: the journal of clinical and experimental research on hip pathology and therapy ·
Clinical research Is pre-fracture functional status better than cognitive level in predicting sho... more Clinical research Is pre-fracture functional status better than cognitive level in predicting short-term outcome of elderly hip fracture patients?
Complex regional pain syndrome (CRPS) is a pain syndrome in which the pain is accompanied by loss... more Complex regional pain syndrome (CRPS) is a pain syndrome in which the pain is accompanied by loss of function and evidence of autonomic dysfunction. In clinical practice it is usually seen as a complication of Colles fracture. The theory that CRPS is a consequence of increased sympathetic activity is challenged, but remains most widely accepted. Three stages of severity have been described. Stage I consists of pain out of proportion to any injury, abnormal sensitivity, swelling, vasomotor and sudomotor changes, and diffuse osteoporosis. Stage II is characterized by persistence of pain and disability with increasing dystrophy. Stage III is marked by skin and subcutaneous tissue atrophy and contractures. CRPS is diagnosed on the basis of its typical clinical picture, radiographic changes of spotty osteopenica, the results obtained on bone scintigraphy, and termography. Early diagnosis and treatment of reflex sympathetic dystrophy is of enormous importance for prevention of potential d...
Introduction: Uncontrolled postoperative pain is a major problem for functional recovery after or... more Introduction: Uncontrolled postoperative pain is a major problem for functional recovery after orthopedic surgery. There is evidence that following patient discharge, moderate to severe pain is commonly reported early on and later in the postoperative period. The aim of the study was to analyze analgesic prescription habits at discharge of patients who went through surgery on the orthopedic department. The second aim was to determine if there are any disparities in the prescribed analgesics, depending on whether the operation was elective or traumatic. Methods: We performed a retrospective study including all patients who underwent surgery at the Clinic for orthopaedic surgery and traumatology over a 6 month period. The study included 371 patients. We recorded demographic data, discharge diagnoses, types of surgery and pain medications prescribed for use at home. Results: 87.9% patients received no analgesic prescriptions at all at hospital discharge. In the group of patients who ha...
![Research paper thumbnail of [The effects of functional knee bracing after anterior cruciate ligament reconstruction]](https://attachments.academia-assets.com/80527334/thumbnails/1.jpg)
](INTRODUCTION Limited surgical technology in treating injuries of the anterior cruciate ligament (... more INTRODUCTION Limited surgical technology in treating injuries of the anterior cruciate ligament (ACL) in the past led to the development of a huge number of functional braces. Today, with the advance of the surgical techniques and a more aggressive rehabilitation approach in the postoperative course the use of functional braces after the ACL reconstruction is seriously questioned. The aim of this study was to review the basic functions of functional braces. Mechanical, and biomechanical functions of functional braces have been described, the psychological aspect of wearing them, their impact on thigh circumference, functional performance, muscle activity and postural control and propriocepation have also been addressed. Functional braces definitely increase the knee stability under low clinical loads. However, biomechanical investigations show that functional knee braces do not restore the normal knee stability under high forces related to certain activities. Furthermore, functional...
Geriatrics
Introduction: A minority of patients with hip fractures sustain concomitant wrist fractures. Litt... more Introduction: A minority of patients with hip fractures sustain concomitant wrist fractures. Little is known about the rehabilitation outcome in this group of patients. Aim of study: Prospective investigation of functional outcome and survival in patients with combined hip and wrist fractures compared with patients who sustain an isolated hip fracture. Methods: 341 patients who presented with an acute hip fracture during a 12 month period were included in the study. Outcome at discharge and 4 months follow-up was compared between patients with isolated hip fractures and those patients who sustained simultaneous distal wrist fractures. Results: The actual incidence of concurrent hip and wrist fractures in our cohort was 4.7%. Patients who sustained a concurrent hip and wrist fracture showed no differences regarding short- and long-term functional outcome and survival. Conclusion: Our results imply that patients with simultaneous hip and wrist fractures have no difference in rehabilit...
Annals of Physical and Rehabilitation Medicine
Introduction/Background Early rehabilitation, return to daily life activities and function are th... more Introduction/Background Early rehabilitation, return to daily life activities and function are the ultimate goals of perioperative care. It is unclear which pain-related patient-reported outcome measures (PROM) mirror treatment effects, or are related to early and late functional outcomes. Material and method We examined associations between two approaches of pain management (scheduled vs. ‘on demand’) and PROMs on postoperative days one and five (POD1, 5) with function on POD5 and 3 months after surgery in patients undergoing total knee arthroplasty (TKA) in a single center. Results On POD1, patients in the scheduled treatment group reported reduced severity of worst pain, less interference of pain with activities in-bed and sleep, and a higher proportion got out of bed. Furthermore, tests of function, extension and flexion ranges, Barthel index and 6 minutes walking test on POD5, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) 3 months later were better in the scheduled treatment compared to the ‘on demand’ treatment group. PROMs of perceived pain relief at POD1 and worst pain, time in severe pain, interference with activities in bed and with sleep, and participation in treatment decisions on POD5 were significantly associated with KOOS 3 months later. Conclusion Our study demonstrates that insufficient pain management immediately after TKA has substantial impact not only on PROMs in the early days after surgery but also on important physical function up to 3 months later. Pain-related PROMs assessed at POD1 and especially at PO5 are associated with functional recovery up to 3 months.
Zdravstveno varstvo, 2017
Medical students are mainly exposed to needle stick and sharp object injuries in the course of th... more Medical students are mainly exposed to needle stick and sharp object injuries in the course of their clinical activities during studying. They are at high risk due to their undeveloped skills, restricted clinical experience, lack of knowledge and risk perception. The objectives of this study were to determine the prevalence of needle stick injuries of the fourth and final year medical students, and to estimate their knowledge about blood-borne pathogens disease transmission and standard precautions. This cross-sectional study was conducted at the Faculty of Medicine, in February 2014. The students were invited to self-administer a questionnaire of 26 closed questions prepared for this study. The questionnaire was filled in and returned by 637 students. The prevalence of needle sticks and sharp object injuries was 29.5%. Needle stick injuries were the most common type of accidents, more frequent among the fourth compared to the sixth year students (p=0.002). The majority of accidents...
Restorative Neurology and Neuroscience, 2016
A growing body of evidence supports the effectiveness of using transcranial direct current stimul... more A growing body of evidence supports the effectiveness of using transcranial direct current stimulation (tDCS) in patients with chronic hand motor impairment resulting from stroke. In this study, we investigate and compare the combined effects of anodal tDCS and occupational therapy (OT) to sham stimulation with OT (control) on fine motor skill deficits of chronic stroke patients. A total of 26 stroke patients (at ≥ 9 months) were randomly assigned to an active treatment or a control group in a double-blinded, sham-controlled, parallel design study. Each group received OT for 45 min/day (10 sessions for 2 weeks). Treatment was preceded by either 20 minutes of 2 mA anodal tDCS over ipsilesional M1 or sham tDCS. A modified Jebsen-Taylor Hand Function Test (mJTHFT) was administered as primary outcome measure, and handgrip dynamometer and upper limb Fugl-Meyer (ULFM) assessments were performed as secondary outcomes. The assessment was done at baseline (T0), after the interventions on day 1(T1), day 10 (T2) and day 40 (T3). We observed a statistically significant effect in the tDCS group when the results were compared to the sham group. The mJTHFT times were significantly shorter immediately after treatment and at day 40. The intervention had no effect on handgrip strength or ULFM score. Fine motor skill deficits in chronic stroke survivors can be improved when intensive OT is primed with anodal tDCS over the ipsilesional hemisphere.
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Apstrakt Uvod/cilj. Prevencija posledica osteoporoze postaje sve znaajnija. Cilj rada bio je da s... more Apstrakt Uvod/cilj. Prevencija posledica osteoporoze postaje sve znaajnija. Cilj rada bio je da se odredi prisustvo relevantnih faktora rizika od nastanka pada i preloma, stepen rizika od nastanka preloma, kao i adekvatnost leenja osteoporoze pre povrede kod bolesnika hospitalizovanih zbog preloma kuka. Metode. Ispitivanjem su bila obuhvaena 342 bolesnika, sta-rosti 65 godina, koji su zbog akutnog preloma kuka leeni na Klinici za ortopedsku hirurgiju i traumatologiju Klinikog centra Srbije u periodu od 12 meseci. Kod svih ispitivanih bolesnika analizirani su faktori rizika od nastanka preloma i pada putem Fracture Risk Assessment (FRAX ®) algoritma, a bolesnici su razvrstavani u odnosu na nivo rizika od nastanka preloma. Rezultati. Prelom kuka nastao je naješe kod onih bolesnika koji su pripadali grupi sa visokim nivoom rizika (74,2%). Manje od 10% bolesnika je imalo dijagnozu osteo-poroze pre povrede, dok je manje od 2% bolesnika leeno od osteoporoye. Od faktora rizika od pada najz...
PLOS ONE, 2019
Decreased muscle strength is not only a risk factor for hip fracture in older patients, but plays... more Decreased muscle strength is not only a risk factor for hip fracture in older patients, but plays a role in recovery of physical function. Our aim was to assess the role of grip strength measured early after hip fracture, and classified according to the EWGSOP2 criteria in predicting short-and long-term functional recovery. One hundred ninety-one patients with acute hip fracture consecutively admitted to an orthopaedic hospital have been selected. A multidimensional geriatric assessment evaluating sociodemographic variables, cognitive status, functional status and quality of life prior to fracture, as well as perioperative variables were performed. Follow-ups at 3 and 6 months after surgery were carried out to evaluate functional recovery. Multivariate regression models were used to assess the predictive role of handgrip strength. The mean age of the participants was 80.3 ±6.8 years. Thirty-five percent of our patients with clinically relevant hand grip strength weakness were significantly older, more often female, had a lower BMI, and were of worse physical health. They also had a lower cognitive level, lower Barthel index, and lower EQ5D scores before fracture. Multivariate regression analysis adjusted for age and gender revealed that hand grip weakness was an independent predictor of worse functional outcome at 3 and 6 months after hip fracture for both genders and in all age populations. Our study supports the prognostic role of hand grip strength assessed at hospital admission in patients with hip fracture. Thus, clinicians should be encouraged to include hand grip assessment in their evaluation of hip fracture patients in the acute setting in order to optimize treatment of high-risk individuals.
Srpski Arhiv Za Celokupno Lekarstvo, 2006
KRATAK SADRŽAJ Uvod Optimalno lečewe predwe ukrštene veze (LCA) jedna je od najdinamičnijih tema ... more KRATAK SADRŽAJ Uvod Optimalno lečewe predwe ukrštene veze (LCA) jedna je od najdinamičnijih tema savremene ortopedije. Uprkos veli kom broju objavqenih radova, zlatni rehabilitacioni standard posle hirurški lečene povrede LCA nije utvrđen. Ciq rada Ciq rada je bio da se uporede rezultati ispitivawa dve grupe ispitanika na konzervativnom i intenzivnom rehabilitacionom protokolu i utvrde brzina i bezbednost oporavka u obe grupe, te, na osnovu toga, predloži savremen pristup u rehabilitaciji. Metod rada U prospektivnoj studiji ispitano je 45 bolesnika s jednostranom povredom LCA, koji su metodom slučajnog izbora svrstani u dve grupe: sa konzervativnim rehabilitacionom protokolom (TH-C) i intenzivnim rehabilitacionom protokolom (TH-I). Kao hirurški metod primewena je artroskopska rekonstrukcija LCA pomoću BTBP (bone-patellar-tendonbone) i STG (semitendinosus-gracilis) grafta. Posle operacije ispitanicima TH-C grupe je zabrawen oslonac, a ograničewe obima pokreta je bilo 0/0/90 u prve četiri nedeqe, dok je oporavak ispitanika grupe TH-I bio ograničen jedino otokom kolena i bolom. Ispitanici su upoređivani u odnosu na obim pokreta, kolena i natkolene muskulature, rezultate testova stabilnosti, Lisholmovog (Lysholm), Texnerovog (Tegner) i testa skakawa na jednoj nozi, kao i testa stajawa na jednoj nozi. Testirawe je izvedeno pre hirurškog lečewa, posle šest nedeqa, četiri meseca, šest, devet i 12 meseci. Dobijeni rezul tati upoređivani su primenom Pirsonovog (Pearson) χ 2 testa, Studentovog ttesta, ManVitnijevog (Mann-Whitney), Kraskal Volisovog (Kruskal-Wallis), Fridmanovog (Friedman) i Kohranovog (Cochran) testa, kao i putem jednofaktorske i dvofaktorske analize varijanse. Rezultati Ispitivane grupe su se već posle šest nedeqa statistički značajno razlikovale po pitawu obima pokreta (p<0,05), obima natkolene muskulature (p<0,01) i rezultata na Lisholmovom testu (p<0,01), posle četiri meseca po rezulta tima testa skakawa na jednoj nozi (p<0,05), a posle šest meseci po rezultatima Texnerovog testa (p<0,01). U TH-I grupi ni kod jednog bolesnika klinički nije narušen integritet grafta, niti je došlo do postoperacionog ograničewa pokreta. Zakqučak Ovaj rad nedvosmisleno pokazuje da rani intenzivni rehabilitacioni pristup dovodi do bržeg funkcional nog oporavka, bez nežeqenih posledica, nego konzervativni rehabilitacioni režim.
Vojnosanitetski Pregled, 2012
Uvod/cilj. Prevencija posledica osteoporoze postaje sve zna ajnija. Cilj rada bio je da se odredi... more Uvod/cilj. Prevencija posledica osteoporoze postaje sve zna ajnija. Cilj rada bio je da se odredi prisustvo relevantnih faktora rizika od nastanka pada i preloma, stepen rizika od nastanka preloma, kao i adekvatnost le enja osteoporoze pre povrede kod bolesnika hospitalizovanih zbog preloma kuka. Metode. Ispitivanjem su bila obuhva ena 342 bolesnika, starosti 65 godina, koji su zbog akutnog preloma kuka le eni na Klinici za ortopedsku hirurgiju i traumatologiju Klini kog centra Srbije u periodu od 12 meseci. Kod svih ispitivanih bolesnika analizirani su faktori rizika od nastanka preloma i pada putem Fracture Risk Assessment (FRAX ®) algoritma, a bolesnici su razvrstavani u odnosu na nivo rizika od nastanka preloma. Rezultati. Prelom kuka nastao je naj eš e kod onih bolesnika koji su pripadali grupi sa visokim nivoom rizika (74,2%). Manje od 10% bolesnika je imalo dijagnozu osteo-poroze pre povrede, dok je manje od 2% bolesnika le eno od osteoporoye. Od faktora rizika od pada najzastupljeniji bili su: kognitivno ošte enje (95,3%), ošte enje vida (58,2%), sniženje aktivnosti dnevnog života (51,8%) i depresija (47,1%) Zaklju ak. Rezultati našeg istraživanja jasno ukazuju na nedovoljno prepoznavanje klini kih faktora rizika od zna aja za nastanak preloma i pada na nivou primarne zaštite, na neadekvatno le enje osteoporoze, te, posledi no, izrazito lošu prevenciju preloma kuka u gerijatrijskoj populaciji u našoj sredini. U le enju starijih bolesnika savetuje se integrisani klini ki pristup, koji podrazumeva merenje koštane gustine, kao i obaveznu rutinsku procenu klini kih faktora rizika od nastanka preloma i pada.
International Journal of Environmental Research and Public Health, 2021
The data about the incidence and risk factors for surgical site infections (SSIs) following total... more The data about the incidence and risk factors for surgical site infections (SSIs) following total joint arthroplasty (TJA) in middle-income countries are still scant. The aim of this study was to assess the incidence and risk factors associated with 30-day SSIs following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The study was conducted at the Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Serbia (CCS) in Belgrade, from May 2016 to April 2018. All patients undergoing THA or TKA were followed throughout hospitalization until day 30 after discharge. Of the 1073 admitted patients, 459 had THA and 230 had TKA. The incidence rate of surgical site infections (SSIs) among the patients who underwent THA was 5.4%, which is 3.8 per 1000 postoperative patient-days, while the rate among those who had TKA was 4.8%, i.e., 3.4 per 1000 postoperative patient-days. Out of the 36 SSIs, 15 were deep and 21 were superficial incisional ones. Among the variables e...
Acta chirurgica Iugoslavica, 2013
Hip fractures are the most serious consequence of falling in older people with osteoporosis. Earl... more Hip fractures are the most serious consequence of falling in older people with osteoporosis. Early ambulation is one of the main goals of inpatient rehabilitation aimed at reducing negative effects of immobilization, and promoting functional recovery. Recognizing the role of different factors that are associated with time to ambulation time after hip fracture surgery may help decrease morbidity and mortality rates. The aim of this study was to examine the impact of postoperative pain time to ambulation following hip fracture surgery. A total of 96 patients who consecutively presented at the Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Serbia during a 6 month period were included in the study. Subjects were assessed regarding socioedemographic characteristics, prefracture functional status, cognitive status, general health status, fracture type, type of anaesthesia, and waiting time for surgery. The VAS scale (0-100) was used to measure pain intensity on the first...
Acta Neurologica Belgica, 2015
Relapse of disease is one of the most prominent characteristics of multiple sclerosis. Effectiven... more Relapse of disease is one of the most prominent characteristics of multiple sclerosis. Effectiveness of rehabilitation programmes on fatigue, self-efficacy (SE) and physical activity (PA) has not been investigated so far in context of relapse. The aim of our study was to examine if rehabilitation programme in addition to high-dose methylprednisolone (HDMP) during relapse of disease can influence fatigue, SE and PA more than corticosteroid therapy alone. Patients were randomized in control group receiving only HDMP and experimental group which was in addition included in rehabilitation programme. Outcome measures used were Fatigue Severity Scale (FSS), Multiple Sclerosis Self-Efficacy scale (MSSES), Godin Leisure-Time Exercise Questionnaire (GLTEQ), completed on baseline, 1 and 3 months later. There was no significant change in FSS in both time points, despite different trend seen between groups. The mean MSSES for function and control improved significantly in treatment group after 1 month (807.1 ± 96.8, p = 0.005; 665.3 ± 145.1, p = 0.05) and 3 months (820 ± 83.5, p = 0.004; 720.0 ± 198.2, p = 0.016.) compared to baseline values. The mean GLTEQ score was significantly higher in the treatment group compared to the control at both follow-up time points (45.7 ± 7.6, p \ 0.001; 34.3 ± 22.4, p \ 0.01). Rehabilitation started along with corticosteroid treatment induced significant improvement in PA compared to HDMP therapy alone. It also influenced noticeable changes in self-efficacy, but effect on fatigue was insufficient.
Srpski medicinski casopis Lekarske komore
Complex regional pain syndrome (CRPS) is a chronic complex disorder that significantly affects th... more Complex regional pain syndrome (CRPS) is a chronic complex disorder that significantly affects the quality of life of the people suffering from it. This syndrome affects the extremities after trauma or nerve injury. Hyperalgesia and allodynia of the extremities often accompany this condition. Diagnosing and treating this disease is very complex. The Budapest criteria are currently the most widely accepted diagnostic criteria. Early diagnosis and treatment are essential for a favorable outcome in CRPS. Therapeutic modalities available for the treatment of CRPS include physical therapy, pharmacotherapy, and interventional techniques. Additional high-quality studies are needed to determine the best therapeutic option.
Geriatrics, 2020
The aim of this study was to determine the outcome for patients who sustain a second hip fracture... more The aim of this study was to determine the outcome for patients who sustain a second hip fracture compared with those who sustain a first fracture, and to define the optimal measure to evaluate functional outcome after second hip fracture. Methods: 343 patients with acute hip fractures who presented during a 12 month period were included in the study. Patients with a first (318 patients, 78.10 +/− 7.53 years) and second (25 patients, 78.96 +/− 6.02) hip fracture were compared regarding all baseline variables. Regression analysis was also performed to assess the independent relationship between the presence of a second hip fracture and observed outcome variables at discharge (physical disability, complications, length of stay, and mortality) and one-year after surgery (physical disability and mortality). Results: Disability when performing instrumentalized activities of daily living (IADL) at one-year follow-up is independently related to the presence of a second hip fracture. There ...
Galenika Medical Journal
Topical nonsteroidal anti-inflammatory drugs are an effective and safe therapeutic option for the... more Topical nonsteroidal anti-inflammatory drugs are an effective and safe therapeutic option for the treatment of acute and chronic musculoskeletal disorders. Based on evidence from the literature, topical NSAID's have a clearly defined place in the treatment of acute musculoskeletal pain and in the treatment of osteoarthritis of the hands and knees. Due to the rare systemic side effects, they should always be advised as the first therapeutic line for the treatment of musculoskeletal pain in osteoarthritis of the hands and knees of patients ≥75 years of age. It is very important that there are no recommendations for the use of other topical preparations, such as rubefaciens and capsaicin for the treatment of painful musculoskeletal conditions. Clinical assessment of the patient, the condition of medical issue and the choice of the optimal NSAID's formulation, contribute to the success of the treatment. Gel formulations represent the optimal substrate for topical NSAID's bot...
Use of early indicators in rehabilitation process to predict one-year mortality in elderly hip fr... more Use of early indicators in rehabilitation process to predict one-year mortality in elderly hip fracture patients Article in Hip international: the journal of clinical and experimental research on hip pathology and therapy ·
Clinical research Is pre-fracture functional status better than cognitive level in predicting sho... more Clinical research Is pre-fracture functional status better than cognitive level in predicting short-term outcome of elderly hip fracture patients?
Complex regional pain syndrome (CRPS) is a pain syndrome in which the pain is accompanied by loss... more Complex regional pain syndrome (CRPS) is a pain syndrome in which the pain is accompanied by loss of function and evidence of autonomic dysfunction. In clinical practice it is usually seen as a complication of Colles fracture. The theory that CRPS is a consequence of increased sympathetic activity is challenged, but remains most widely accepted. Three stages of severity have been described. Stage I consists of pain out of proportion to any injury, abnormal sensitivity, swelling, vasomotor and sudomotor changes, and diffuse osteoporosis. Stage II is characterized by persistence of pain and disability with increasing dystrophy. Stage III is marked by skin and subcutaneous tissue atrophy and contractures. CRPS is diagnosed on the basis of its typical clinical picture, radiographic changes of spotty osteopenica, the results obtained on bone scintigraphy, and termography. Early diagnosis and treatment of reflex sympathetic dystrophy is of enormous importance for prevention of potential d...
Introduction: Uncontrolled postoperative pain is a major problem for functional recovery after or... more Introduction: Uncontrolled postoperative pain is a major problem for functional recovery after orthopedic surgery. There is evidence that following patient discharge, moderate to severe pain is commonly reported early on and later in the postoperative period. The aim of the study was to analyze analgesic prescription habits at discharge of patients who went through surgery on the orthopedic department. The second aim was to determine if there are any disparities in the prescribed analgesics, depending on whether the operation was elective or traumatic. Methods: We performed a retrospective study including all patients who underwent surgery at the Clinic for orthopaedic surgery and traumatology over a 6 month period. The study included 371 patients. We recorded demographic data, discharge diagnoses, types of surgery and pain medications prescribed for use at home. Results: 87.9% patients received no analgesic prescriptions at all at hospital discharge. In the group of patients who ha...
INTRODUCTION Limited surgical technology in treating injuries of the anterior cruciate ligament (... more INTRODUCTION Limited surgical technology in treating injuries of the anterior cruciate ligament (ACL) in the past led to the development of a huge number of functional braces. Today, with the advance of the surgical techniques and a more aggressive rehabilitation approach in the postoperative course the use of functional braces after the ACL reconstruction is seriously questioned. The aim of this study was to review the basic functions of functional braces. Mechanical, and biomechanical functions of functional braces have been described, the psychological aspect of wearing them, their impact on thigh circumference, functional performance, muscle activity and postural control and propriocepation have also been addressed. Functional braces definitely increase the knee stability under low clinical loads. However, biomechanical investigations show that functional knee braces do not restore the normal knee stability under high forces related to certain activities. Furthermore, functional...
Geriatrics
Introduction: A minority of patients with hip fractures sustain concomitant wrist fractures. Litt... more Introduction: A minority of patients with hip fractures sustain concomitant wrist fractures. Little is known about the rehabilitation outcome in this group of patients. Aim of study: Prospective investigation of functional outcome and survival in patients with combined hip and wrist fractures compared with patients who sustain an isolated hip fracture. Methods: 341 patients who presented with an acute hip fracture during a 12 month period were included in the study. Outcome at discharge and 4 months follow-up was compared between patients with isolated hip fractures and those patients who sustained simultaneous distal wrist fractures. Results: The actual incidence of concurrent hip and wrist fractures in our cohort was 4.7%. Patients who sustained a concurrent hip and wrist fracture showed no differences regarding short- and long-term functional outcome and survival. Conclusion: Our results imply that patients with simultaneous hip and wrist fractures have no difference in rehabilit...
Annals of Physical and Rehabilitation Medicine
Introduction/Background Early rehabilitation, return to daily life activities and function are th... more Introduction/Background Early rehabilitation, return to daily life activities and function are the ultimate goals of perioperative care. It is unclear which pain-related patient-reported outcome measures (PROM) mirror treatment effects, or are related to early and late functional outcomes. Material and method We examined associations between two approaches of pain management (scheduled vs. ‘on demand’) and PROMs on postoperative days one and five (POD1, 5) with function on POD5 and 3 months after surgery in patients undergoing total knee arthroplasty (TKA) in a single center. Results On POD1, patients in the scheduled treatment group reported reduced severity of worst pain, less interference of pain with activities in-bed and sleep, and a higher proportion got out of bed. Furthermore, tests of function, extension and flexion ranges, Barthel index and 6 minutes walking test on POD5, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) 3 months later were better in the scheduled treatment compared to the ‘on demand’ treatment group. PROMs of perceived pain relief at POD1 and worst pain, time in severe pain, interference with activities in bed and with sleep, and participation in treatment decisions on POD5 were significantly associated with KOOS 3 months later. Conclusion Our study demonstrates that insufficient pain management immediately after TKA has substantial impact not only on PROMs in the early days after surgery but also on important physical function up to 3 months later. Pain-related PROMs assessed at POD1 and especially at PO5 are associated with functional recovery up to 3 months.
Zdravstveno varstvo, 2017
Medical students are mainly exposed to needle stick and sharp object injuries in the course of th... more Medical students are mainly exposed to needle stick and sharp object injuries in the course of their clinical activities during studying. They are at high risk due to their undeveloped skills, restricted clinical experience, lack of knowledge and risk perception. The objectives of this study were to determine the prevalence of needle stick injuries of the fourth and final year medical students, and to estimate their knowledge about blood-borne pathogens disease transmission and standard precautions. This cross-sectional study was conducted at the Faculty of Medicine, in February 2014. The students were invited to self-administer a questionnaire of 26 closed questions prepared for this study. The questionnaire was filled in and returned by 637 students. The prevalence of needle sticks and sharp object injuries was 29.5%. Needle stick injuries were the most common type of accidents, more frequent among the fourth compared to the sixth year students (p=0.002). The majority of accidents...
Restorative Neurology and Neuroscience, 2016
A growing body of evidence supports the effectiveness of using transcranial direct current stimul... more A growing body of evidence supports the effectiveness of using transcranial direct current stimulation (tDCS) in patients with chronic hand motor impairment resulting from stroke. In this study, we investigate and compare the combined effects of anodal tDCS and occupational therapy (OT) to sham stimulation with OT (control) on fine motor skill deficits of chronic stroke patients. A total of 26 stroke patients (at ≥ 9 months) were randomly assigned to an active treatment or a control group in a double-blinded, sham-controlled, parallel design study. Each group received OT for 45 min/day (10 sessions for 2 weeks). Treatment was preceded by either 20 minutes of 2 mA anodal tDCS over ipsilesional M1 or sham tDCS. A modified Jebsen-Taylor Hand Function Test (mJTHFT) was administered as primary outcome measure, and handgrip dynamometer and upper limb Fugl-Meyer (ULFM) assessments were performed as secondary outcomes. The assessment was done at baseline (T0), after the interventions on day 1(T1), day 10 (T2) and day 40 (T3). We observed a statistically significant effect in the tDCS group when the results were compared to the sham group. The mJTHFT times were significantly shorter immediately after treatment and at day 40. The intervention had no effect on handgrip strength or ULFM score. Fine motor skill deficits in chronic stroke survivors can be improved when intensive OT is primed with anodal tDCS over the ipsilesional hemisphere.
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Apstrakt Uvod/cilj. Prevencija posledica osteoporoze postaje sve znaajnija. Cilj rada bio je da s... more Apstrakt Uvod/cilj. Prevencija posledica osteoporoze postaje sve znaajnija. Cilj rada bio je da se odredi prisustvo relevantnih faktora rizika od nastanka pada i preloma, stepen rizika od nastanka preloma, kao i adekvatnost leenja osteoporoze pre povrede kod bolesnika hospitalizovanih zbog preloma kuka. Metode. Ispitivanjem su bila obuhvaena 342 bolesnika, sta-rosti 65 godina, koji su zbog akutnog preloma kuka leeni na Klinici za ortopedsku hirurgiju i traumatologiju Klinikog centra Srbije u periodu od 12 meseci. Kod svih ispitivanih bolesnika analizirani su faktori rizika od nastanka preloma i pada putem Fracture Risk Assessment (FRAX ®) algoritma, a bolesnici su razvrstavani u odnosu na nivo rizika od nastanka preloma. Rezultati. Prelom kuka nastao je naješe kod onih bolesnika koji su pripadali grupi sa visokim nivoom rizika (74,2%). Manje od 10% bolesnika je imalo dijagnozu osteo-poroze pre povrede, dok je manje od 2% bolesnika leeno od osteoporoye. Od faktora rizika od pada najz...