For Millennials, the struggle is real when it comes to paying down student loan debt versus saving up for a home down payment. But loan debt doesn’t always block buying.
The post Student Debt Doesn’t Mean the End to Your Homeownership Dreams appeared first on Earnest Blog | Money Advice for Young Professionals.
Business travel can feel so close and yet so far from a vacation. Here are twelve ways to get more out of your work trips than just a business deal.
The post 12 Ways to Optimize Business Travel for Fun appeared first on Earnest Blog | Money Advice for Young Professionals.
Let's make 2019 a debt-free year!
The post 9 Strategies to Pay Off Your Student Loans Quickly in 2018 appeared first on Earnest Blog | Money Advice for Young Professionals.
This blog is a critical appraisal of the following randomized controlled trial: Effectiveness of different exercises and stretching physiotherapy on pain and movement in patellofemoral pain syndrome: a randomized controlled trial.
Patellofemoral Pain Syndrome (PFPS) is patella pain accompanied with high load activity in knee flexion or extension, therefore it is predominately seen in sports medicine clinics (Petersen et al., 2013). PFPS is prevalent mainly in young females. Evidence supports non-surgical treatment and focusing on physical functional issues. Literature has supported and has evidence that taping, exercise programs, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and possible foot orthosis or patella braces are all valid interventions, but these are all short-term solutions.
This study’s researchers enrolled 74 patients that met the following criteria; A pain history of more than 6 months with no previous history of Apophysitis or osteoarthritis, as well they had to have positive results in the Patellofemoral Grinding test and Patellofemoral compression test.
The purpose of this study was to compare the efficacy of proprioceptive neuromuscular facilitation (PNF) combined with exercise, stretching intervention, and educational intervention at improving function and pain in PFPS patients. The participants were sorted into three groups a control group, Classic stretching group, and a PNF stretching group. The stretching intervention consisted of following a soft tissue protocol from a study published by Syme et al, it involved active exercises and stretching exercise for hip and knee muscle, including quadriceps, hamstrings, iliotibial band, gastrocnemius, soleus, and anterior hip structures. The active exercises within the study focused on Quadriceps strengthening, but did not specify which exercises were included. The PNF stretching group followed the PNF stretching protocol which is applied to the quadriceps and hamstrings, the study included a detailed plan that was quite specific. The aerobic exercise portion was only 45 minutes conducted by a personal trainer, however there were no specific exercises stated. A control group received health education around PFPS and were advised not to follow any interventions until after the trial.
Randomisation was done with a random number generator in blocks of eight with no stratification. The person in charge of randomisation was different to the blinded assessor in charge of eligibility. The outcome measures were Anterior knee pain scale, Visual Analog Scale (VAS) for pain, Patellofemoral compression test, Patellofemoral grinding test. Quadriceps angle, Thigh perimeter, and Knee range of motion. Baseline measures were taken and then a 4 month follow up measurement was taken from all participants.
The p value was ≤ 0.001 in the intervention groups, which is smaller than the alpha value from the study that was set at 0.05. Observing that the outcome measures showed an increase in pain relief and function after the two interventions. The control group was shown to have a p-value of 0.621. This shows there is a significant difference in the results from pre-to-post intervention.
To apply the therapy interventions the confidence interval (CI) needs to be considered, in this case they used a 95% CI. This is valid because it says that 95% of the time this study is done it will replicate these results.
To evaluate a study in more depth a guideline must be used, in this critical appraisal the Centre for Evidence-based medicine (CEBM) RCT tool was followed. The study detailed all features of the PICO question – Population, Interventions, Control, and Outcome measure, some in more detail than others.
The population section had a few aspects that could be a deficiency in the study. The sample size was small (74 participants) for the prominence of this condition. This may have been avoidable if there was recruitment following the same eligibility criteria but recruiting from more than one physiotherapy clinic. The groups had an equal spread of participant characteristics within the three groups apart from the male to female ratio. This condition occurs mainly in young females yet there were predominately more males in all three groups.
During follow-up treatment, It is stated that 2 participants were ‘lost’, however there is no intention-to-treat analysis for missing data.
This study had a randomised allocation through a number generator and the assessor involved in eligibility was not involved in randomisation which was carried out off site. The assessor may have been blinded to the specific treatment of the participants, but the physiotherapist cannot be blinded in a clinical intervention as they must oversee the treatment. Also, the participants were not blinded for ethical reasons. Lack of bias creates a clinically accurate study.
The findings of the study discussed using Proprioceptive neuromuscular facilitation techniques and aerobic exercise which showed a decrease in pain and an increase in function in this intervention group vs the stretching group. There needs to be a larger scale study done with more participants for how common the condition is as well as with more female participants. Also, the two intervention groups were quite close so a further follow up would have helped determine more information about the different treatments specificity. Long term solutions for PFPS need to be researched.
CEBM. (2017). Critical Appraisal tools – CEBM. [online] Available at: http://www.cebm.net/blog/2014/06/10/critical-appraisal/ [Accessed 12 Dec. 2017].
Petersen, W., Ellermann, A., Gosele-Koppenburg, A., Best, R., Rembitzki, I., Bruggemann, G. and Liebau, C. (2014). Patellofemoral Pain Syndrome. Knee Surgery, Sports Traumatology, Arthroscopy, 22(10), pp. 2264-2274.
Revelles Moyano, F., Valenza, M., Martin Martin, L., Castellote Caballero, Y., Gonzalez-Jimenez, E. and Valenza Demet, G. (2012). Effectiveness of different exercises and stretching physiotherapy on pain and movement in patellofemoral pain syndrome: a randomized controlled trial. 27(5):409-417.
Syme G, Rowe P, Martin D and Daly G. (2009) Disability in patients with chronic patellofemoral pain syndrome: a randomised controlled trial of VMO selective training versus general quadriceps strengthening.Man Ther, 14(3): 252–263.
The post Effectiveness of different exercises and stretching physiotherapy on pain and movement in Patellofemoral Pain Syndrome: A critical appraisal appeared first on Students 4 Best Evidence.
This blog is a critical appraisal of the following study: Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial.
Chronic degenerative tendon injuries (tendinopathy) occur frequently among both athletes and the general population and often lead to cessation of sporting activities and interfere with daily life. The treatment for Achilles tendinopathy lacks scientific support and individuals with the condition are at risk of unpredictable clinical outcomes and long-term morbidity. Conservative treatment is not always successful, with 25%-45% of patients requiring surgery. Therefore, there is a need for evidence-based studies on conservative treatments (Alfredson 2003). Platelet-rich plasma (PRP) is used increasingly as a treatment, for releasing growth factors into degenerative tendons. However, good evidence for its use is limited (Foster et al 2009).
The objective of the study was to examine whether a PRP injection would improve outcome in chronic midportion Achilles tendinopathy. The study design was a stratified, block-randomised, double-blind, placebo controlled trial. The trial took place at The Hague Medical Centre, Leidschendam, the Netherlands, with 54 randomised patients aged 18-70 with chronic tendinopathy 2-7 cm above the Achilles tendon insertion. The intervention was eccentric exercises (usual care) with either PRP injection (PRP group) or saline injection (placebo group). Randomisation was stratified by activity. The primary outcome measure was the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire, which was completed at baseline and 6, 12 and 24 weeks. The secondary outcome measures were subjective patient satisfaction, return to sports, and adherence of the eccentric exercises.
The trial found that there was no statistical difference in pain and function between the PRP group and the placebo group. There were also no significant differences observed in the secondary outcome measure (subjective patient satisfaction and return to sports activity).
The study set a clear aim and research question, which was addressed. A randomised controlled trial was an appropriate research design for this trial, and is commonly regarded as the gold standard for evaluating the effectiveness of an intervention (Aveyard 2010).
The authors recorded specific inclusion and exclusion criteria, which the participants had to meet to take part in the trial. This enables good judgement regarding the applicability of the trial for the clinical population.
The process for the recruitment of participants with tailored advertisements to medical professionals and the public, adds external validity to the research methods. However, generalisability is an issue with such a small sample size.
The authors justified the number of participants by calculating a sample size, which is an accepted means of estimating the number of participants required to detect a statistically significant difference between groups (Bhalerao and Kadam 2010). Based on previous studies the alternative hypothesis was that the PRP group would be 12 points higher in the VISA-A score in comparison with the placebo group. The standard deviation of the VISA-A score was estimated at 15 points, and by using this it was estimated that a sample size of 27 in each group would be required to detect a difference.
To minimise rater or subject bias, the treating sports medicine physician, researcher and patients were all blinded to what treatment participants received. Block-randomisation was used to assign patients into treatment groups and stratification was used to divide the groups according to ankle activity levels. This meant the groups were blind to treatment, randomly assigned and had a similar distribution of activity levels. These features add validity to the study.
The VISA-A questionnaire is a validated questionnaire designed to evaluate the outcome of Achilles tendinopathy. The disease specific valid and reliable outcome measure adds internal validity to this study.
Another strength is that no participants were lost to follow up and all data was accounted for, so there was no need to perform an intention to treat analysis.
A limitation of the study was that the majority of the participants were active in sports; 22 of 27 in the PRP group and 24 of 27 in the placebo group. Studies have shown that 33% of patients with chronic Achilles tendinopathy are not physically active (Kingma et al 2007). This could influence the applicability of the trial for general practice, as the participants may not be representative of the wider population.
Another limitation of the study was that the number of platelets and amount of activated growth factors present in the PRP injection was unknown. This has implications for research, as not all PRP formulations are the same which makes it hard to compare studies (Andia et al 2014).
A possible weakness of this study was that it was funded by a private medical company (Biomet Biologics LLC), who may have had a financial motive behind the research. However, the article does state that the sponsor had no role in the design and implementation of the study.
This was a clinically robust trial from a peer reviewed journal with findings relevant to practice. The study does not recommend the use of PRP injections as a treatment for chronic mid-portion Achilles tendinopathy. However, this was a small trial in an area that needs more research with greater heterogeneity. A conclusion cannot be based on this study alone and further research is required with larger patient samples to fully investigate a treatment affect.
ALFREDSON, H., 2003. Chronic midportion Achilles tendinopathy: an update on research and treatment. Clinics in Sports Medicine. October, vol. 22, no. 4, pp 727-741.
ANDIA, I., LATORRE, P. M., GOMEZ, M. C., BURGOS-ALONSO, N., ABATE, M. and MAFFULLI, N., 2014. Platelet-rich plasma in the conservative treatment of painful tendinopathy: a systematic review and meta-analysis of controlled studies. British Medical Bulletin. May, vol. 110, no. 7, pp. 99-115.
AVEYARD, H., 2010. Doing a Literature Review in Health and Social Care. 2nd ed. London: McGraw-Hill Education.
BHALERAO, S. and KADAM, P., 2010. Sample size calculation. International Journal of Ayurveda Research. vol. 1, no. 1, pp. 55-57. [viewed 7 January 2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876926/
DE VOS, ROBERT. J., WEIR, A., VAN SCHIE, H. T. M., BIERMA-ZEINSTRA, S. M. A., VERHAAR. J. A. N., WEINANS. H and TOL, J. L., 2010. Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: A Randomized Controlled Trial. Journal of American Medical Association. January. Vol. 303, no. 2. pp. 144-149.
FOSTER, T. E., PUSKAS, B. L., MANDELBAUM, B. R., GERHARDT, M. B. and RODEO, S. A., 2009. Platelet-Rich Plasma: From Basic Science to Clinical Applications. The American Journal of Sports Medicine. Vol. 37, no.11, pp. 2259-2272.
KINGMA, J. J., KNIKKER, R. DE., WITTINK, H. M. and TAKKEN, T., 2007. Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. British Journal of Sports Medicine. [online]. June, vol. 41, no. 6. [viewed 5 January 2018]. Available from: http://bjsm.bmj.com/content/41/6/e3.short
The post Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: A Randomized Controlled Trial appeared first on Students 4 Best Evidence.
There are many options for both grad and undergrad students who do not have a cosigner for student loans.
The post How to Borrow Student Loans Without a Cosigner appeared first on Earnest Blog | Money Advice for Young Professionals.
We talked with Jo Ling Kent about her work as a journalist and how she finds time to keep her own financial future in focus.
The post How a Business & Tech Reporter Keeps Her Own Finances in Line appeared first on Earnest Blog | Money Advice for Young Professionals.
Finding your new home and signing the papers might be the hard part, but figuring out how to decorate it isn’t exactly easy, either.
The post How to Decorate Your New Home on a Budget appeared first on Earnest Blog | Money Advice for Young Professionals.
While often discussed in the same breath, student loan debt consolidation and refinancing are not the same.
The post Can I Consolidate My Federal and Private Student Loans? appeared first on Earnest Blog | Money Advice for Young Professionals.
We are delighted to introduce the German translations of the Informed Health Choices (IHC) ‘Key Concepts’ videos! Thanks to a group of 4th year Physiotherapy students from hochschule 21 (Buxtehude, Germany), led by Dr Cordula Braun, the 36 Key Concepts that people may need to understand to assess treatment claims will be accessible to more people.
You can find more information below and on the blog Wissen Was Wirkt.
Click here to access all of the translated videos.
Als wir, sieben Studierende des Studiengangs BSc Physiotherapie an der hochschule 21, Buxtehude, Deutschland, von der Blogserie von Students4BestEvidence zu den 36 Key Concepts (deutsch: Schlüsselkonzepte) aus dem Informed Health Choices (IHC) Projekt (http://www.informedhealthchoices.org/) hörten und die zu ihnen erstellten ‚gelben Videos‘ sahen, war uns klar: dieses Projekt wollen wir unterstützen! Als unsere Dozentin Dr. Cordula Braun vorschlug, die Videotexte im Rahmen eines Projektmoduls im Abschlussjahr zu übersetzen und deutsche Versionen von ihnen anzufertigen waren wir sofort dabei. Wir haben dieses Projekt, bei dem uns die Cochrane Deutschland Stiftung unterstützt hat, kürzlich abgeschlossen und freuen uns sehr, alle 36 Videos nun auf Deutsch – und in blau! – präsentieren zu können.
Wir würden uns sehr freuen, wenn die Videos breit genutzt werden und hoffen, dass die die IHC Schlüsselkonzepte so viele Menschen wie möglich erreichen werden – denn: gute Gesundheit bedarf guter Entscheidungen…!
Die IHC Schlüsselkonzepte 3.1 – 3.6 Videos: Informierte Entscheidungen treffen
Vinzenz Becker-Mosen, Alina Brand, Christian Diepold, Thomas Kleinophorst, Nikolas Mallwitz, Vivien Aline Reimers, Jonas Wagener und Cordula Braun.
Informationen zum IHC Projekt und den Videos gibt es in diesem Blogbeitrag von Wissen Was Wirkt.
Die untenstehende Info-Box gibt einen Überblick über die 36 Schlüsselkonzepte. Zur deutschen Übersetzung des Glossars zu den Schlüsselkonzepten geht es hier: Glossar: Schlüsselkonzepte der Informierten Entscheidungsfindung zu Gesundheitsfragen (IHC Key Concepts)
The post Deutsche Übersetzungen der Informed Health Choices (IHC) Schlüsselkonzepte appeared first on Students 4 Best Evidence.
We are delighted to introduce the German translations of the Informed Health Choices (IHC) ‘Key Concepts’ videos! Thanks to a group of 4th year Physiotherapy students from the University of hochschule 21, led by Dr Cordula Braun, the 36 Key Concepts that people may need to understand to assess treatment claims will be accessible to more people.
You can find more information below and on the blog Wissen Was Wirkt.
Click here to access all of the translated videos.
Als wir, sieben Studierende des Studiengangs BSc Physiotherapie an der hochschule 21, Buxtehude, Deutschland, von der Blogserie von Students4BestEvidence zu den 36 Key Concepts (deutsch: Schlüsselkonzepte) aus dem Informed Health Choices (IHC) Projekt (http://www.informedhealthchoices.org/) hörten und die zu ihnen erstellten ‚gelben Videos‘ sahen, war uns klar: dieses Projekt wollen wir unterstützen! Als unsere Dozentin Dr. Cordula Braun vorschlug, die Videotexte im Rahmen eines Projektmoduls im Abschlussjahr zu übersetzen und deutsche Versionen von ihnen anzufertigen waren wir sofort dabei. Wir haben dieses Projekt, bei dem uns die Cochrane Deutschland Stiftung unterstützt hat, kürzlich abgeschlossen und freuen uns sehr, alle 36 Videos nun auf Deutsch – und in blau! – präsentieren zu können.
Wir würden uns sehr freuen, wenn die Videos breit genutzt werden und hoffen, dass die die IHC Schlüsselkonzepte so viele Menschen wie möglich erreichen werden – denn: gute Gesundheit bedarf guter Entscheidungen…!
Die IHC Schlüsselkonzepte 3.1 – 3.6 Videos: Informierte Entscheidungen treffen
Vinzenz Becker-Mosen, Alina Brand, Christian Diepold, Thomas Kleinophorst, Nikolas Mallwitz, Vivien Aline Reimers, Jonas Wagener und Cordula Braun
Informationen zum IHC Projekt und den Videos gibt es in diesem Blogbeitrag von Wissen Was Wirkt.
Die untenstehende Info-Box gibt einen Überblick über die 36 Schlüsselkonzepte. Zur deutschen Übersetzung des Glossars zu den Schlüsselkonzepten geht es hier: Glossar: Schlüsselkonzepte der Informierten Entscheidungsfindung zu Gesundheitsfragen (IHC Key Concepts)
The post Deutsche Übersetzungen der ‘Informed Health Choices (IHC)’ Schlüsselkonzepten appeared first on Students 4 Best Evidence.
The idea that high cholesterol causes heart disease is so widespread you’d have thought it was pretty much an established fact by now. High cholesterol is listed as one of the five main risk factors for heart disease by the British Heart Foundation [1], and the NHS public guidelines on cholesterol claim that “your risk of developing coronary heart disease rises as your blood’s cholesterol level increases” [2]. In supermarkets, you’ll find a significant array of spreads, yoghurts and cereals which claim to improve your cholesterol levels and decrease your risk of heart disease.
But what actually is the evidence that having high cholesterol, or high LDL (low density lipoprotein) levels, increases your chance getting heart disease? You may be surprised to learn that the studies available to us do not all point towards a causal connection between high cholesterol and heart disease. Different studies point towards a number of conflicting conclusions, and ultimately the picture is a lot more complicated than most media on the topic would suggest.
At first glance, it seems that we have substantial reasons to believe that high cholesterol and heart disease are closely linked. For one thing, we have a plausible-sounding explanation as to why they should be. This explanation posits that LDLs are the “bad” type of cholesterol, which can stick to the inner walls of your blood vessels and potentially clog them, leading to heart conditions such as stroke, atherosclerosis, angina and coronary heart disease (CHD). Whereas HDLs (high density lipoproteins), are the “good” type of cholesterol, and these have the opposite effect. [3]
There are some reasons to suggest that this hypothesis is correct. Firstly, there is evidence of a correlation between high cholesterol/LDL levels and heart disease. The Framingham Study, a prospective cohort study beginning with over 5,000 participants, published a paper in 1977 which concluded that higher HDL levels and lower LDL levels were associated with a reduced risk of coronary heart disease. [4]
In addition to this, some medical treatments which reduce cholesterol/LDL levels also reduce your risk of heart disease. Statins, for example are effective in both lowering cholesterol levels, and reducing the rates of CHD, cardiovascular disease (CVD) and stroke. [5]
This evidence seems to point towards there being a causal connection between cholesterol in heart disease. However, a closer examination of the issue may make us sceptical of this conclusion.
Firstly, the evidence about the association between high LDL levels and heart disease is more complicated than it first appears. A follow-up from the initial Framingham study suggested that there was only an increase in mortality, by heart disease or other causes, in people with higher cholesterol levels under the age of 50 [6]. This is significant if we want to offer medication or lifestyle advice about preventing heart disease to those over 50 years old. A recent systematic review even suggests that patients over the age of 60 actually lived longer if they had higher LDL levels, directly contradicting the hypothesis that you are more likely to die of heart disease the higher your cholesterol levels are. [7]
Moreover, despite statins showing a correlation between lowered cholesterol levels and a reduced risk of heart disease, some other medications do not show this connection. Niacin, for example, is a cholesterol lowering drug which is known to decrease LDL levels, but has been shown to cause no significant reduction in risk of heart attack, stroke or mortality by heart disease [8] . Even more worrying is the case of Torcetrapib. This experimental drug was designed to reduce rates of heart disease by lowering patients’ LDL levels, but the research was discontinued early because it was linked to an increased risk of mortality and heart disease [9].
You might be wondering how we ended up at this point, with significant amounts of evidence about cholesterol and heart disease pointing in completely opposite directions. There’s no straightforward answer to why the evidence about this problem is so messy, but one thing that I think should give us pause for thought is exactly what we mean when we talk about ‘causes’ in medicine.
In the case of risk factors like cholesterol, a ‘cause’ does not mean that the presence of this risk factor will always and invariably lead to a certain pathology. This depends on a number of other factors, like age, co-morbidities, lifestyle, and possibly plain luck. What we are actually trying to establish here isn’t nearly as straightforward as claims like ‘the TB bacterium causes tuberculosis’. Instead we are looking at a complex array of inter-related mechanisms, all of which may or may not lead to someone becoming ill. And when we are unclear about exactly how these mechanisms work or how they relate to each other, making predictions about health outcomes will inevitably be difficult and confounded.
For a more in-depth look at evidence about heart disease and cholesterol, I recommend this video by Dr Daniel Aronov: The Truth About Cholesterol – Does It Cause Heart Disease?
The post Cholesterol and Heart Disease – What’s the Evidence? appeared first on Students 4 Best Evidence.
