Clinical Briefs
No Payoff to Physical Therapy After Healed Ankle Fracture
SOURCE: Moseley AM, et al. Rehabilitation after immobilization for ankle fracture: The EXACT Randomized Clinical Trial. JAMA 2015;314:1376-1385.
Ankle fracture is a very common injury afflicting persons of all ages and degrees of athleticism. After initial healing, some persons have availed themselves of a program of physical therapy (PT), anticipating improved functional outcome as a result. In the face of remarkably limited data confirming the efficacy of PT after healed ankle fracture, Moseley et al performed a randomized, controlled trial of an intensive program of PT vs simple advice alone for adults who had had immobilization casts removed subsequent to healed ankle fracture. Researchers followed up with study subjects at 1, 3, and 6 months after enrollment into treatment arms.
Participants randomized to a supervised exercise program administered by physical therapists did not enjoy any greater degree of improved mobility or quality of life than subjects simply given a single session discussion of education about return to activity and a brochure with pictures describing some exercise activities they might perform.
Quality of life and functional activity outcomes did not differ between the two groups at the conclusion of the trial. The lack of efficacy of PT was similar across subgroups, including gender, age, and fracture severity. After successful healing of an ankle fracture, a program of supervised PT does not appear to improve outcomes.
Bisphosphonates May Impact Bone Recurrence in Postmenopausal Women with Breast Cancer
SOURCE: Early Breast Cancer Trialists’ Collaborative Group. Adjuvant bisphosphonate treatment in early breast cancer: Meta-analyses of individual patient data from randomised trials. Lancet 2015;386:1353-1361.
It has been recognized for more than a decade that selective estrogen receptor modulators may exert a protective effect on breast cancer. While typically thought of as an osteoporosis drug, raloxifene demonstrated breast cancer benefits in the Multiple Outcomes for Raloxifene Evaluation (MORE) trial. Bisphosphonates, while not possessing any known effects on estrogen receptors, could affect characteristics of bone that might reduce the likelihood of cancer cell adhesion to, or proliferation within, bone.
The Early Breast Cancer Trialists’ Collaborative Group evaluated individual patient data from randomized trials in early breast cancer in which data on bisphosphonates were available (n = 18,766). Although the rates of distant recurrence and breast cancer mortality were statistically and significantly superior in women who had been treated with bisphosphonates, the absolute degree of benefit was of dubious clinical relevance.
On the other hand, among the subgroup of postmenopausal women with breast cancer, bisphosphonates treatment was associated with meaningful (and statistically significant) reductions in overall recurrence, bone recurrence, and breast cancer mortality; similar benefits were not seen in the premenopausal population. Various bisphosphonates agents were studied in clinical trials, with no clear advantage demonstrated of one over another. Postmenopausal women with breast cancer who merit consideration of bisphosphonates for osteoporosis prevention or treatment may also enjoy risk reduction in reference to their breast cancer.
Manipulating the Microbiome to Enhance Metabolic Functions
SOURCE: Simon MC, et al. Intake of Lactobacillus reuteri improves incretin and insulin secretion in glucose-tolerant humans: A proof of concept. Diabetes Care 2015;38:1827-1834.
The content of the microbiome — that is, the diversity and relative proportion of various intestinal bacteria — has been increasingly recognized as an important component in fundamental metabolic paths. Indeed, it has been suggested that an altered microbiome may be a key factor in the development and maintenance of overweight and obesity. Animal studies have shown that altering the microbiome by means of probiotics resulted in enhanced plasma levels of glucagon-like peptide (GLP).
Simon et al performed a double-blind, randomized, prospective trial among healthy volunteers who ingested capsules of the probiotic Lactobaccilus reuteri (or placebo) twice daily for 4 weeks. The healthy volunteers were comprised of both lean and obese individuals.
The group that received the probiotics demonstrated increased insulin levels. Enhanced GLP levels were also seen in the probiotic group, albeit only in lean volunteers. Markers of insulin sensitivity were unchanged. Summarily, the data support that concept that addition of L. reuteri enhances release of incretins in healthy subjects. The recognition that incretin secretion is impaired in type 2 diabetes stimulates consideration of a similar trial in diabetic patients. Because this was a short-term trial, these data cannot speak to the issue of whether probiotic utilization might impart long-term benefits.
In this section: no payoff to physical therapy after healed ankle fracture; bisphosphonates and bone recurrence; and manipulating the microbiome.
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