Hospital Universitario Virgen de las Nieves

Background Information on infective endocarditis (IE) caused by Cutibacterium spp. is limited and new Duke-ISCVID criteria have not yet been properly assessed. We examined clinical characteristics, outcomes and performance of diagnostic tests for Cutibacterium valvular and cardiac implantable electronic device-related IE (CIED-IE). Methods Data corresponding to all episodes of Cutibacterium IE recorded from 2008 to 2023 in a prospective national cohort including 46 Spanish hospitals were examined. Possible IE cases were reassessed using the new criteria. The sensitivity of blood cultures, valvular and CIED cultures, and PCR of the 16SrRNA gene and sequencing (16SPCR) was evaluated. Results There were 67/6,692 (1%) episodes of IE caused by Cutibacterium spp., 85% affecting men. Of these, 50 were valve-related (45 prosthetic, 5 native) and 17 CIED-related. The new criteria identified 8 additional cases and reclassified 15 as definite IE. Intracardiac complications (abscess, pseudoaneurysm, perforation or intracardiac fistula) occurred in 23/50 (46%) valvular IE episodes, leading to 18% mortality, and up to 40% mortality if surgery was indicated but could not be performed. All CIED-IE cases underwent device removal and no deaths were recorded. Positive diagnosis rates for blood cultures, valve/device cultures and 16SPCR were 52%, 70% and 82%, respectively. Conclusion Cutibacterium IE is a rare yet potentially life-threatening condition that warrants a high index of suspicion in men with endovascular prosthetic material. The new Duke-ISCVID criteria and molecular techniques are useful for its diagnosis. Considering a significant complication rate, cardiac surgery and removal of CIEDs play a key role in reducing mortality.

Colorectal cancer (CRC) has a 5-year overall survival rate of over 60%. The decrease in the rate of metastatic disease is due to screening programs and the population’s awareness of healthy lifestyle. Similarly, advancements in surgical methods and the use of adjuvant chemotherapy have contributed to a decrease in the recurrence of resected disease. Before evaluating a patient’s treatment, it is recommended to be discussed in a multidisciplinary tumor board. In stage II tumors, the pathologic characteristics of poor prognosis must be known (T4, number of lymph nodes analyzed less than 12, lymphovascular or perineural invasion, obstruction or perforation, poor histologic grade, presence of tumor budding) and it is mandatory to determine the MSI/MMR status for avoiding administering fluoropyridimidines in monotherapy to patients with MSI-H/dMMR tumors. In stage III tumors, the standard treatment consists of a combination of fluoropyrimidine (oral or intravenous) with oxaliplatin for 6 months although the administration of CAPOX can be considered for 3 months in low-risk tumors. Neoadjuvant treatment is not consolidated yet although immunotherapy is achieving very good preliminary results in MSI-H patients. The use of ctDNA to define the treatment and monitoring of resected tumors is only recommended within studies. These guidelines are intended to help decision-making to offer the best management of patients with non-metastatic colon cancer.

PLAIN LANGUAGE SUMMARY What is the context? Hypertension is a strong independent risk factor for development of chronic kidney disease (CKD) and progression of CKD to ESKD. Improved adherence to the guidelines in the treatment of CKD is believed to provide further reduction of cardiorenal events. European Society of Hypertension Excellence Centres (ESH-ECs) have been developed in Europe to provide excellency regarding management of patients with hypertension and implement guidelines. Numerous deficits regarding general practitioner CKD screening, use of nephroprotective drugs and referral to nephrologists prior to referral to ESH-ECs have been reported. In contrast, real-life management of these patients among ESH-ECs is unknown. Before implementation of strategies to improve guideline adherence in Europe, we aimed to investigate how patients with CKD are managed among the ESH-ECs. What is the study about? In this study, a survey was conducted in 2023 by the ESH to assess management of CKD patients referred to ESH-ECs. The questionnaire contained 64 questions asking ESH-ECs representatives to estimate how patients with CKD are managed among their centres. What are the results? RAAS blockers are initiated in 90% of ESH-ECs in CKD patients, but the initiation of MRA and SGLT2i is less frequently done. Hyperkalemia is the main barrier for initiation or adequate dosing of RAAS blockade, and its most reported management was RAAS blockers dosage reduction. These findings will be crucial to implement strategies in order to improve management of patients with CKD and guideline adherence among ESH-ECs.

In this original research, we present the results in terms of effectiveness and safety of bimekizumab for hidradenitis suppurativa in real clinical practice. Results indicated significant improvement in all activity scores and patient‐reported outcomes at week 16, including a notable decrease in mean IHS4 from 27.1 to 15.6 ( p < 0.001), HS‐PGA from 5.1 to 3.2 ( p < 0.001), VAS pain from 8.3 to 4.7 ( p < 0.001) and DLQI from 21.6 to 12.6 ( p < 0.001). Bimekizumab, administered every 2 or 4 weeks, was well‐tolerated with no discontinuations and no new safety concerns identified. These findings corroborate the drug's effectiveness and favourable safety profile observed in phase 3 clinical trials, supporting its use in real‐world clinical practice for treating HS.

The concept of a window of opportunity in hidradenitis suppurativa (HS) management suggests that early initiation of biological therapy leads to better outcomes, though its timing remains uncertain. We conducted a retrospective observational multicenter study, including consecutive patients with moderate to severe HS who initiated secukinumab treatment following prior failure with systemic antibiotics or adalimumab. Therapeutic burden was defined as the sum of previous systemic treatment cycles and previous major surgical interventions for HS. Patients were followed up for 24 weeks. Main outcomes were safety and effectiveness, assessed through the proportion of patients achieving HS Clinical Response (HiSCR) and a 55% reduction in International HS Severity Score System (IHS4-55). Additionally, potential predictors of response to secukinumab were studied. Analysis was performed on an intention-to-treat basis. A total of 67 patients (33 men, 34 women) were included, with a mean age of 41.55 (11.94) years and a mean baseline IHS4 of 17.88 (11.13). The mean therapeutic burden was 6.06 (3.49). At week 24, 10.45% (7/67) of patients experienced adverse events, with three leading to treatment discontinuation. At week 24, 41.79% (28/67) of patients achieved HiSCR, and 44.78% (30/67) of patients achieved IHS4-55. HiSCR could not be calculated in 12 patients with a baseline AN count < 3. A lower therapeutic burden was significantly associated with a higher likelihood of achieving HiSCR and IHS4-55 at week 24. Secukinumab showed safety and efficacy in real-world patients with HS, and the inverse correlation found between therapeutic burden and treatment response supports the concept of a window of opportunity, offering insights into its timing.

Introduction Pain is a common adverse event in survivors of breast cancer (sBCs). As there is no gold standard to assess pain experience predominantly related to central sensitization (CS) symptoms, we designed the PaiNEd app, which includes an algorithm to report whether patients are under predominant CS pain mechanisms. Objective We aimed to assess the reliability of the PaiNEd app to estimate whether sBC pain experience is predominantly related to CS symptoms. Methods An observational, descriptive reliability design was employed to assess the inter- and intrarater reliability of the PaiNEd app. This app includes an algorithm that considers the number of painful body parts and some questionnaires related to pain, such as the Numeric Pain-Rating Scale, the Brief Pain Inventory, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, and the Central Sensitization Inventory (CSI). Results A total of 21 sBCs with persistent pain were recruited. We observe a general trend of close agreement between the paper-based and app-based formats (ICCs ranged between 0.802 and 0.972; Cronbach's alpha ranged between 0.797 and 0.971). Test–retest reliabilities were moderate to excellent (ICCs ranged between 0.510 and 0.941; Cronbach's alpha ranged between 0.499 and 0.938). The agreement between the categorization of the CS algorithm and the CSI (cut-off point ≥ 40 for CS symptoms) was 95.24%. Conclusion The PaiNEd app emerges as a robust tool for evaluating pain experience predominantly related to CS and pain-related symptoms in sBCs. Its demonstrated reliability not only bolsters its utility but also signifies its potential as a valuable asset for healthcare professionals engaged in pain education programs.

The aim of this work is to compare the functional and esthetic outcome of the submental flap and radial forearm free flap for the reconstruction of medium-sized soft tissue defect in the oral cavity. Patients diagnosed with squamous cell carcinoma of the oral cavity and reconstructed with a submental flap or radial forearm free flap between 2015 and 2020 were reviewed and analyzed. Tumor site, complication at the donor site, complication at the recipient site, duration of the hospital stay, local or cervical recurrence, and esthetic results were also analyzed to compare the difference in outcomes between the two groups. Submental flap represents a safe and useful reconstructive recourse for head and neck reconstructive surgeons when it is correctly indicated. Lower rate of complication at the donor site, better esthetic result, and a shorter hospital stay represent the strengths of this flap when it is not necessary to perform compartment surgery. However, more studies are needed with a larger number of patients.

Atopic dermatitis is a prevalent skin condition that affects up to 17% of adult population. It can lead to itching, pain, and other symptoms such as sleep disturbance, anxiety, and depression. Due to its high prevalence and limiting symptoms, atopic dermatitis often has a great impact on patients’ quality of life but there is scarce information regarding how atopic dermatitis affects women’s sexual health and reproductive desires. The purpose of this article was to assess the impact of atopic dermatitis on sexual function and reproductive wishes in women. A cross-sectional study was conducted from February to March 2022. A total of 102 women with atopic dermatitis were recruited through online questionnaires sent through the Spanish Atopic Dermatitis Association; 68.6% of the patients acknowledged impairment in sexual function, especially those with more severe disease and those with genital and gluteal involvement. In addition, 51% of the women considered that atopic dermatitis may have an influence on their gestational desire, particularly those with gluteal involvement. In conclusion, atopic dermatitis has a great impact on sexual function and reproductive desires in women.

Background Chronic kidney disease (CKD) is a complex disorder that has become a high prevalence global health problem, with diabetes being its predominant pathophysiologic driver. Autosomal genetic variation only explains some of the predisposition to kidney disease. Variations in the mitochondrial genome (mtDNA) and nuclear-encoded mitochondrial genes (NEMG) are implicated in susceptibility to kidney disease and CKD progression, but they have not been thoroughly explored. Our aim was to investigate the association of variation in both mtDNA and NEMG with CKD (and related traits), with a particular focus on diabetes. Methods We used the UK Biobank (UKB) and UK-ROI, an independent collection of individuals with type 1 diabetes mellitus (T1DM) patients. Results Fourteen mitochondrial variants were associated with estimated glomerular filtration rate (eGFR) in UKB. Mitochondrial variants and haplogroups U, H and J were associated with eGFR and serum variables. Mitochondrial haplogroup H was associated with all the serum variables regardless of the presence of diabetes. Mitochondrial haplogroup X was associated with end-stage kidney disease (ESKD) in UKB. We confirmed the influence of several known NEMG on kidney disease and function and found novel associations for SLC39A13, CFL1, ACP2 or ATP5G1 with serum variables and kidney damage, and for SLC4A1, NUP210 and MYH14 with ESKD. The G allele of TBC1D32-rs113987180 was associated with higher risk of ESKD in patients with diabetes (OR:9.879; CI95%:4.440–21.980; P = 2.0E-08). In UK-ROI, AGXT2-rs71615838 and SURF1-rs183853102 were associated with diabetic nephropathies, and TFB1M-rs869120 with eGFR. Conclusions We identified novel variants both in mtDNA and NEMG which may explain some of the missing heritability for CKD and kidney phenotypes. We confirmed the role of MT-ND5 and mitochondrial haplogroup H on renal disease (serum variables), and identified the MT-ND5-rs41535848G variant, along with mitochondrial haplogroup X, associated with higher risk of ESKD. Despite most of the associations were independent of diabetes, we also showed potential roles for NEMG in T1DM.

Background In recent years, the advent of molecular targeted therapies including TNF inhibitors and IL-6 inhibitors or janus kinase inhibitors (JAKi), have contributed to dramatic progress in the treatment of rheumatoid arthritis (RA). With these therapeutic advancements, many patients have experienced favourable outcomes; however, disease control remains challenging for some patients. Diet and nutrition are considered environmental factors that can affect the course of RA and the response to pharmacotherapy. Intake of fish rich in n-3 polyunsaturated fatty acids (n-3 PUFA) has been suggested to relate with the clinical course of RA. Notably, both Japanese diets and Mediterranean diets are known for their high fish consumption. Objectives This study aims to assess the relationship between the intake of fish rich in n-3 PUFA and treatment response in RA patients living in Japan or in Spain. Methods This retrospective cross-sectional study included RA patients receiving molecular targeted therapy including biologics or JAKi at Hokkaido University Hospital in Sapporo, Japan and Virgen de las Nieves University Hospital in Granada, Spain. From April 2021 to March 2023, patients answered to the brief-type self-administered diet history questionnaire (BDHQ) and detailed fish frequency questionnaire (DFFQ). At Hokkaido University Hospital, 218 patients with RA were registered, of which 205 were eligible after excluding cases with insufficient disease activity assessment in the electronic medical records and incomplete questionnaire responses. At Virgen de las Nieves University Hospital, 117 patients with RA were registered, with 74 included after excluding 43 patients. The patients who responded to molecular targeted therapy (Responder group) were defined as cases with Disease Activity Score 28 (DAS28)-ESR < 2.6 and DAS28-CRP < 2.4, and the control group was the non-Responders. The association of patient characteristics, the amount, and frequency of fish intake in the Responder and non-Responder group was evaluated using chi-squared tests, Fisher’s exact test, and contributing factors to the Responder group were assessed using multivariate logistic regression analysis. Results Among the 205 Japanese RA patients, 162 were female, with a median age of 67 years. Of them, 87% were treated with biologics and 13% with JAKi. The Responder group criteria were met in 59%. The estimated daily intake of n-3 PUFA was higher in the Responder group (2.49 g/day [Q1-Q3 1.82-3.23] vs. non-Responder group: 1.99 g/day [Q1-Q3 1.33-2.94], p = 0.04). Moreover, a higher frequency of fish intake rich in n-3 PUFA, at least once a week, was seen in the Responder group (30% vs. non-Responder group: 14%, p = 0.01). Multivariate logistic regression analysis indicated that consuming n-3 PUFA at least once a week was an independent factor contributing to favourable outcomes in the Responder group (p = 0.04, Odds Ratio [OR] 2.50, 95% Confidence Interval [CI] 1.06-5.88). Among the 74 Spanish RA patients, 58 were female, with a median age of 60 years. 96% were treated with biologics, and 4% with JAK inhibitors. 36% met the Responder group criteria. No significant differences were found between the Responder and non-Responder groups in the estimated daily intake of n-3 PUFA (1.29 g/day [Q1-Q3 1.13-1.90] vs. non-Responder group: 1.70 g/day [Q1-Q3 1.12-2.61], p = 0.11) or the frequency of fish consumption rich in n-3 PUFA (26% vs. non-Responder group: 25%, p = 1.00). Conclusion In the Japanese population, the frequency of consumption of fish rich in n-3 PUFA has been suggested to potentially affect treatment response in patients with RA undergoing molecular targeted therapies. However, this association was not observed in the Spanish population. These findings indicate that the impact of fish consumption on treatment outcomes may vary across ethnicities. REFERENCES NIL Acknowledgements Acknowledgements:NIL.to Ms. Y. Ikea and S. Kumagai for their enriching support on the nutritional properties of fish. Supported by the Kakenhi C grant number 20K11597 from the Japan Society for the Promotion of Science. Disclosure of Interests None declared

Background Prolonged stressful situations could increase pain and reduce physical function. Individuals with non-specific chronic low back pain (NSCLBP) experience persistent pain and inhibited neuromuscular control system. A non-pharmacological multimodal treatment, such as exercise and mindfulness, might be effective to reduce pain in this population. Objectives Compare the effects of a multimodal approach (exercise and exercise+mindfulness) with usual rehabilitation care on pressure pain threshold (PPT) in individuals with NSCLBP. Methods From 105 participants recruited and randomized, a total of 54 patients with NSCLBP aged 52±9 years attended >65% of the program and included all the measurements: control group (CG, n=20), exercise group (EG, n=14) and exercise+mindfulness group (EMG, n=20). All groups received an 8-week intervention program twice a week for 45 minutes/session. The CG followed usual rehabilitation care (stretching, breathing and motor control exercises in different positions). The EG and EMG received an exercise intervention program focused on muscle strengthening exercises. Additionally, the EMG attended to a mindfulness program once a week for 2.5 hours/session. The PPT was measured with a manual pressure algometer (FPK 20). All groups completed three assessments before (pre) and after (post) the intervention program and after a detraining period (re) of 3 months. Results Repeated measures analysis of the variance (ANOVA) showed that all groups increased PPT after the intervention (post-pre mean difference (MD)= -1.37; 95% confidence interval (CI)=-2.11,-0.62; p=0.001, MD=-1.14; CI=-2.11,-0.17; p=0.025, and MD=-1.04; CI=-1.81,-0.27; p=0.11 for the CG, the EG, and the EMG, respectively). After the detraining period, all groups showed non-significant PPT values compared to the baseline values (all p>0.05). The analysis of the covariance (ANCOVA) showed that changes from baseline (post-pre) did not differ between groups in PPT (MD=0.13; CI=-1.22, 1.5, MD=0.32; CI=-0.9, 1.5, MD=0.18, CI=-1.16, 1.5 for the CG, EG and EMG). After the detraining period (re-pre) PPT did not differ between groups (MD=0.39; CI=-1.05,1.8 for CG and EG, MD=-0.04; CI=-1.3,1.2 for CG and EMG, MD=-0.44, CI=-1.87,0.99 for EG and EMG). Conclusion Exercise and mindfulness and usual rehabilitation care were not effective to increase PPT in individuals with NSCLBP. Future studies are warranted to introduce a multimodal approach with higher exercise intensity, mindfulness and pain education to study its’ effectiveness on PPT in these individuals. REFERENCES NIL Acknowledgements Participants are deeply acknowledged for their collaboration. This study was supported by the Instituto de Salud Carlos III through the research contract Miguel Servet (CP20/00178) co-funded by European Social Fund. Furthermore, GT was supported by the Instituto de Salud Carlos III through the PFIS contract (FI23/00034) co-funded by European Social Fund+. Disclosure of Interests None declared

Background Fatigue and pain are part of a complex network of co-occurring biological, psychological, and social factors. Furthermore, the levels reflecting problems on these factors are assumed to differ between people with rheumatoid arthritis (RA). Objectives In people with RA, to estimate a network of relationships between fatigue, pain, and seven other biopsychosocial factors (objective 1) and to describe subgroups (clusters) of people based on their levels on factors (objective 2). Methods The protocol of this study was published [1]. People from patient associations collaborated in setting up the study, recruiting participants, and interpreting results. Participants were recruited in five European countries. Self-report measures of fatigue, pain and seven other biopsychosocial factors were assessed using numeric (0 to 10) rating scales. Factors were derived from literature and interviews with patients and health professionals in rheumatology including rheumatologists. Priority was given to factors that are modifiable by self-management or interventions. Estimation of the partial correlation network was done with LASSO regularization using the R package mgm (objective 1). K-means cluster analysis in SPSS was performed to parsimoniously allocate participants to clusters (objective 2). Results Data from 189 people with RA without another rheumatic and musculoskeletal disease (RMD) from Ireland (n=44), the Netherlands (n=60), Portugal (n=42), Spain (n=8), the United Kingdom (n=16), and other countries (n=19) were analyzed. Other demographics were: 163 women, 26 men; mean age 51 (range 22 to 79) yrs.; education: primary (n=1), secondary (n=39), advanced (n=68), higher (n=81). Mean (SD) levels on the nine factors were: fatigue 6.4 (2.2), pain 5.1 (2.5), sleep problems 5.0 (2.7), disease activity 5.0 (2.5), inactive lifestyle 4.4 (2.7), lack of understanding 4.2 (3.2), unhealthy diet 3.6 (2.2), unhealthy body weight 3.6 (2.9), and psychological problems 3.6 (2.6). The network (see Figure 1) shows the estimated partial correlations (rp) of fatigue, pain and the other factors; zero correlations are not shown. The thickness of circles represents mean levels at the nine factors and thickness of connecting lines reflect the strength of partial correlations between these factors. Pain was associated with disease activity (rp=.71), fatigue (rp=.20), inactive lifestyle (rp=.06), and unhealthy body weight (rp=.03). Fatigue was associated with pain (rp=.20), sleep problems (rp=.27), lack of understanding (rp=.14), psychological problems (rp=.09), and unhealthy diet (rp=.04). Cluster analysis yielded six clusters (see Table 1). Fatigue levels in all clusters and pain in four clusters were medium (4 to 6) to high (>6). Cluster 2 showed low levels on the seven other factors and cluster 5 high levels on all but one of the seven other factors. The four remaining groups showed varied levels on the other factors. Conclusion The network model highlights that pain was associated with other factors than fatigue. Cluster analysis evidenced individual variations in the perceived severity of these biopsychosocial factors. For management, the network model in the whole sample indicates that interventions may be somewhat different for pain and fatigue, while cluster analysis indicates that specific subgroups of patients with RA may benefit from an approach focused on distinct factors. REFERENCES [1] Gavilán-Carrera et al. NET-RMDs study: networks of fatigue and pain in rheumatic and musculoskeletal diseases – protocol for an international cross-sectional study. BMJ Open 2022; 12(11), e061099. • Download figure • Open in new tab • Download powerpoint Figure 1. Table 1 • Download figure • Open in new tab • Download powerpoint Acknowledgements The authors gratefully acknowledge all participants, the collaborating representatives from patient associations, and the European alliance for associations of rheumatology (EULAR) for funding the project (HPR045). Disclosure of Interests None declared

Background Prolonged time spent in sedentary behavior (SB) and less time spent in physical activity (PA) might be associated with lower quality of life in individuals suffering of chronic low back pain. Objectives To determine the associations of SB and PA with eight different dimensions of health-related quality of life (HRQoL) in individuals with non-specific chronic low back pain (NSCLBP). Methods A total of 147 individuals with NSCBLP (mean ± standard deviation= 51.3 ± 10.4 years) of which 95 were women participated in this cross-sectional study. SB and PA intensity levels (light, moderate and moderate-to-vigorous), expressed as percentage of total accelerometer wear time, were measured with a triaxial accelerometer (Actigraph GT3X+) worn in the non-dominant wrist for 1 week. Eight different dimensions of HRQoL [physical function (PF), physical role (PR), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), emotional role (ER) and mental health (MH)] were assessed with a validated self-reported questionnaire (36-item Short-Form Health Survey, SF-36). Results Linear regression analysis showed that in women, greater time in SB was associated with lower PF (b=-0.41; 95% confidence interval (CI)=-0.74, -0.081; p=0.017) and PR (b=-0.57; CI=-0.95, -0.19; p=0.003), reduced SF (b=-0.6; CI=-1.01, -0.18; p=0.005), and ER (b=-0.74; CI=-1.18, -0.31; p=0.001). Greater time spent in light PA was associated with higher PF (b=0.63; CI=0.03,1.23; p=0.04), PR (b=0.80; CI=0.13,1.47; p=0.019), SF (b=1.01; CI=0.28,1.74; p=0.007) and ER (b=1.35; CI=0.59,2.10; p=0.001). Greater time spent on moderate-to-vigorous PA was associated with higher PR (b=0.76; CI=0.17, 1.35; p=0.012) and ER (b=0.72; CI=0.18, 1.43; p=0.045). In men, greater time spent in SB was associated with reduced ER (b=-0.63; CI=-1.27, -0.002; p=0.049). No additional associations were found (all p>0.05). Conclusion In individuals with NSCLBP, more time spent in SB and less time spent in light and moderate-to-vigorous PA was associated with lower HRQoL in multiple dimensions. These associations were mainly observed in women. Future studies with greater sample size in men are warranted. REFERENCES NIL Acknowledgements Participants are deeply acknowledged for their collaboration. This study was supported by the Instituto de Salud Carlos III (through the research contract Miguel Servet CP20/00178 and the project PI22/01791) co-funded by the European Union. Furthermore, GT was supported by the Instituto de Salud Carlos III through the PFIS research contract (FI23/00034) co-funded by European Social Fund+. Disclosure of Interests None declared

Background Mobile health (mHealth) systems are a promising alternative for rehabilitation of hip fracture, addressing constrained healthcare resources. Half of older adults fails to recover their pre-fracture routines, which imposes a burden on caregivers. We aimed to test the effectiveness of the 3-month ActiveHip + mHealth intervention on physical and psychological outcomes of older adults with hip fracture and their family caregivers. Methods In a multicentre open-label randomised controlled trial conducted across 3 hospitals in Andalusia (Spain), patients older than 65 with a hip fracture, who were previously independent and lacked cognitive impairment were recruited alongside with their caregivers. Participants were randomly allocated (1:1) to the intervention group (ActiveHip+) or control (usual care) group. The intervention group underwent a 12-week health education and tele-rehabilitation programme through the ActiveHip + mHealth intervention. The primary outcome, physical performance, was assessed using the Short Physical Performance Battery at three time points: at hospital discharge (baseline), 3-month after surgery (post intervention) and 1-year after surgery follow-up. Primary analyses of primary outcomes and safety data followed an intention-to-treat approach. This study is registered at ClinicalTrials.gov, NCT04859309. Findings Between June 1st, 2021 and June 30th, 2022 data from 105 patients and their caregivers were analysed. Patients engaged in the ActiveHip + mHealth intervention (mean 7.11 points, SE 0.33) showed higher physical performance compared with patients allocated in the control group (mean 5.71 points, SE 0.32) at 3 months after surgery (mean difference in change from baseline 1.40 points, SE 0.36; puncorrected = 0.00011). These benefits were not maintained at 1-year after surgery follow-up (mean difference in change from baseline 0.19 points, SE 0.47; puncorrected = 0.68). No adverse events, including falls and refractures, were reported during the tele-rehabilitation sessions. At 3-months, the intervention group had 2 falls, compared to 4 in the control group, with no observed refractures. At the 1-year follow-up, the intervention group experienced 7 falls and 1 refracture, while the control group had 13 falls and 2 refractures. Interpretation This study suggests that the ActiveHip + mHealth intervention may be effective for recovering physical performance in older adults with hip fracture. Importantly, the implementation of ActiveHip + into daily clinical practice may be feasible and has already been adopted in 18 hospitals, mostly in Spain but also in Belgium and Portugal. Thus, ActiveHip + could offer a promising solution when rehabilitation resources are limited. However, its dependence on caregiver support and the exclusion of participants with cognitive impairment makes it necessary to be cautious about its applicability. In addition, the non-maintenance of the effectiveness at 1-year follow-up highlights the need of refinement the ActiveHip + intervention to promote long-lasting behavioural changes.

Rheumatoid arthritis causes progressive joint destruction in the long term, causing a deterioration of the foot and ankle. A clinical practice guideline has been created with the main objective of providing recommendations in the field of podiatry for the conservative management of rheumatoid arthritis. Thus, healthcare professionals involved in foot care of adults with rheumatoid arthritis will be able to follow practical recommendations. A clinical practice guideline was created including a group of experts (podiatrists, rheumatologists, nurses, an orthopaedic surgeon, a physiotherapist, an occupational therapist and patient with rheumatoid arthritis). Methodological experts using GRADE were tasked with systematically reviewing the available scientific evidence and developing the information which serves as a basis for the expert group to make recommendations. Key findings include the efficacy of chiropody in alleviating hyperkeratotic lesions and improving short-term pain and functionality. Notably, custom and standardized foot orthoses demonstrated significant benefits in reducing foot pain, enhancing physical function, and improving life quality. Therapeutic footwear was identified as crucial for pain reduction and mobility improvement, emphasizing the necessity for custom-made options tailored to individual patient needs. Surgical interventions were recommended for cases which were non-responsive to conservative treatments, aimed at preserving foot functionality and reducing pain. Moreover, self-care strategies and education were underscored as essential components for promoting patient independence and health maintenance. A series of recommendations have been created which will help professionals and patients to manage podiatric pathologies derived from rheumatoid arthritis.