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McDonald C, El Yaakoubi NA, Lennon O. Brain (EEG) and muscle (EMG) activity related to 3D sit-to-stand kinematics in healthy adults and in central neurological pathology - A systematic review. Gait Posture 2024; 113:374-397. [PMID: 39068871 DOI: 10.1016/j.gaitpost.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/29/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND The sit-to-stand transfer is a fundamental functional movement during normal activities of daily living. Central nervous system disorders can negatively impact the execution of sit-to-stand transfers, often impeding successful completion. Despite its importance, the neurophysiological basis at muscle (electromyography (EMG)) and brain (electroencephalography (EEG)) level as related to the kinematic movement is not well understood. OBJECTIVES This review synthesises the published literature addressing central and peripheral neural activity during 3D kinematic capture of sit-to-stand transfers. METHODS A pre-registered systematic review was conducted. Electronic databases (PubMed, CINAHL Plus, Web of Science, Scopus and EMBASE) were searched from inception using search operators that included sit-to-stand, kinematics and EMG and/or EEG. The search was not limited by study type but was limited to populations comprising of healthy individuals or individuals with a central neurological pathology. RESULTS From a total of 28,770 identified papers, 59 were eligible for inclusion. Ten of these 59 studies received a moderate quality rating; with the remainder rated as weak using the Effective Public Health Practice Project tool. Fifty-eight studies captured kinematic data of sit-to-stand with associated EMG activity only and one study captured kinematics with co-registered EMG and EEG data. Fifty-six studies examined sit-to-stand transfer in healthy individuals, reporting four dynamic movement phases and three muscle synergies commonly used by most individuals to stand-up. Pre-movement EEG activity was reported in one study with an absence of data during execution. Eight studies examined participants following stroke and two examined participants with Parkinson's disease, both reporting no statistically significant differences between their kinematics and muscle activity and those of healthy controls. SIGNIFICANCE Little is known about the neural basis of the sit-to-stand transfer at brain level with limited focus in central neurological pathology. This poses a barrier to targeted mechanistic-based rehabilitation of the sit-to-stand movement in neurological populations.
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Affiliation(s)
- Caitlin McDonald
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
| | | | - Olive Lennon
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Yang L, Sinsurin K, Shen F, Zhao B, Gao T. Biomechanical changes in lower extremity in individuals with knee osteoarthritis in the past decade: A scoping review. Heliyon 2024; 10:e32642. [PMID: 38961910 PMCID: PMC11219976 DOI: 10.1016/j.heliyon.2024.e32642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 07/05/2024] Open
Abstract
Biomechanic studies can provide a powerful theoretical and scientific basis for studies on knee osteoarthritis (OA), which is of great significance for clinical management as it provides new concepts and methods in clinical and research settings. This study aimed to discuss and summarize biomechanical research on lower extremities in individuals with knee OA in the past ten years. The methodology of this review followed the framework outlined in the Joanna Briggs Institute (JBI) guidelines and strictly followed the checklist for drafting the findings. A literature search was conducted using PubMed, Scopus, Cochrane Library, Embase, Web of Science, Grey literature search in Open Library, and Google Academic databases. Relevant literature was searched from 2011 to 2023. Sixteen studies were included in this scoping review. Biomechanical research on knee OA in the last decade demonstrates that the biomechanics of the hip, knee, and ankle have a profound influence on the pathogenesis and treatment of knee OA. Individuals with knee OA have biomechanical changes in hip, knee, and ankle joints such as a significant defect in the strength of ankle varus muscles, weakness of hip abductor muscle, walking with toes outwards, increased knee adduction moment and angle, and decreased knee extensor moment. As the severity of knee OA increases, the tendency of hip abduction positions also increases. Further research with a longitudinal study design should focus on the determination of the relative importance of different biomechanical and neuromuscular factors in the development and progression of the disease.
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Affiliation(s)
- Liying Yang
- Biomechanics and Sports Research Unit, Faculty of Physical Therapy, Mahidol University, Thailand
| | - Komsak Sinsurin
- Biomechanics and Sports Research Unit, Faculty of Physical Therapy, Mahidol University, Thailand
| | - Fang Shen
- Nursing College of Nursing, Dali University, China
| | - Binquan Zhao
- Dali Bai Autonomous Prefecture People's Hospital, Yunnan, China
| | - Ting Gao
- Dali Nursing Vocational College, Yunnan, China
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Van Der Kruk E, Geijtenbeek T. Is increased trunk flexion in standing up related to muscle weakness or pain avoidance in individuals with unilateral knee pain; a simulation study. Front Bioeng Biotechnol 2024; 12:1346365. [PMID: 38659645 PMCID: PMC11039967 DOI: 10.3389/fbioe.2024.1346365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
The 'Timed Up and Go' test (TUG) is a widely used clinical tool for assessing gait and balance, relying primarily on timing as a measure. However, there are more observable biomechanical compensation strategies within TUG that are indicative of underlying neuromuscular issues and movement priorities. In individuals with unilateral knee osteoarthritis, an increased trunk flexion during TUG is a common phenomenon, often attributed to muscle weakness and/or pain avoidance. Unfortunately, it is difficult to differentiate between these underlying causes using experimental studies alone. This study aimed to distinguish between muscle weakness and pain avoidance as contributing factors, using predictive neuromuscular simulations of the sit-to-walk movement. Muscle weakness was simulated by reducing the maximum isometric force of the vasti muscles (ranging from 20% to 60%), while pain avoidance was integrated as a movement objective, ensuring that peak knee load did not exceed predefined thresholds (2-4 times body weight). The simulations demonstrate that a decrease in muscular capacity led to greater trunk flexion, while pain avoidance led to slower movement speeds and altered muscle recruitments, but not to greater trunk flexion. Our predictive simulations thus indicate that increased trunk flexion is more likely the result of lack of muscular reserve rather than pain avoidance. These findings align with reported differences in kinematics and muscle activations between moderate and severe knee osteoarthritis patients, emphasizing the impact of severe muscle weakness in those with advanced knee osteoarthritis. The simulations offer valuable insights into the mechanisms behind altered movement strategies, potentially guiding more targeted treatment.
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Affiliation(s)
- Eline Van Der Kruk
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Thomas Geijtenbeek
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, Netherlands
- Goatstream, Delft, Netherlands
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Pan J, Fu W, Lv J, Tang H, Huang Z, Zou Y, Zhang X, Liao B. Biomechanics of the lower limb in patients with mild knee osteoarthritis during the sit-to-stand task. BMC Musculoskelet Disord 2024; 25:268. [PMID: 38582828 PMCID: PMC10998381 DOI: 10.1186/s12891-024-07388-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/27/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a prevalent and debilitating condition that markedly affects the sit-to-stand (STS) activity of patients, a prerequisite for daily activities. Biomechanical recognition of movements in patients with mild KOA is currently attracting attention. However, limited studies have been conducted solely on the observed differences in sagittal plane movement and muscle activation. AIM This study aimed to identify three-dimensional biomechanical and muscle activation characteristics of the STS activity in patients with mild KOA. METHODS A cross-sectional study was conducted to observe the differences between patients with mild KOA and a control group (CG). It was conducted to observe the differences in muscle activation, including root mean square (RMS%) and integrated electromyography (items), kinematic parameters like range of motion (ROM) and maximum angular velocity, as well as dynamic parameters such as joint moment and vertical ground reaction force (vGRF). RESULTS Patients with mild KOA had a higher body mass index and longer task duration. In the sagittal plane, patients with KOA showed an increased ROM of the pelvic region, reduced ROM of the hip-knee-ankle joint, and diminished maximum angular velocity of the knee-ankle joint. Furthermore, patients with KOA displayed increased knee-ankle joint ROM in the coronal plane and decreased ankle joint ROM in the horizontal plane. Integrated vGRF was higher in both lower limbs, whereas the vGRF of the affected side was lower. Furthermore, patients showed a decreased peak adduction moment (PADM) and increased peak external rotation moment in the knee joint and smaller PADM and peak internal rotation moment in the ankle joint. The affected side exhibited decreased RMS% and iEMG values of the gluteus medius, vastus medialis, and vastus lateralis muscles, as well as a decreased RMS% of the rectus femoris muscle. Conversely, RMS% and iEMG values of the biceps femoris, lateral gastrocnemius, and medial gastrocnemius muscles were higher. CONCLUSION The unbalanced activation characteristics of the anterior and posterior muscle groups, combined with changes in joint moment in the three-dimensional plane of the affected joint, may pose a potential risk of injury to the irritated articular cartilage.
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Affiliation(s)
- Jing Pan
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, 510000, China
| | - Wei Fu
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, 510000, China
| | - Jinmiao Lv
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, 510000, China
| | - Huiyi Tang
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, 510000, China
| | - Zhiguan Huang
- School of Sports and Health, Guangzhou Sport University, Guangzhou, 510000, China
| | - Yu Zou
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, 510000, China
| | - Xiaohui Zhang
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, 510000, China.
| | - Bagen Liao
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, 510000, China.
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Pan J, Huang W, Huang Z, Luan J, Zhang X, Liao B. Biomechanical analysis of lower limbs during stand-to-sit tasks in patients with early-stage knee osteoarthritis. Front Bioeng Biotechnol 2023; 11:1330082. [PMID: 38173868 PMCID: PMC10763667 DOI: 10.3389/fbioe.2023.1330082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
Background: Knee osteoarthritis (KOA) is a common degenerative disease among the older people that severely affects their daily life. Previous studies have confirmed that movement biomechanics are altered in patients with KOA during task performance. However, changes that occur in lower limb joints and muscles in the three planes during stand-to-sit (STS) tasks in patients with early-stage KOA are unclear. Method: Of the 36 participants recruited in this study, 24 (8 males and 16 females) and 12 (4 males and 8 females) were added to the KOA and control groups, respectively. The Nexus Vicon motion capture system along with Delsys wireless surface electromyography devices and plantar pressure measurement mat was used to record test data. A Visual 3D software was used to process the data and calculate the biomechanical and electromyographic parameters during STS tasks. Results: There was no significant difference in task duration between the two groups. Patients with KOA could perform a greater range of pelvic motion and smaller range of hip and knee joint motion with a lower maximum hip joint angular acceleration in the sagittal plane and greater knee and ankle joint motion in the coronal plane. There was no significant difference in the motion range in the horizontal plane. During the STS task, patients in the KOA group had a lower vertical ground reaction force (GRF) amplitude on the injured side but a higher integrated GRF on both sides than those in the control group. Moreover, patients with KOA demonstrated higher PERM and PABM of the lower limb joints and smaller knee PADM and ankle PEM. Additionally, maximum activation levels of GMed muscle, affected-side gluteus medius (GM), ST, rectus femoris (RF), and tibialis anterior (TA) muscles were lower in patients with KOA than in controls. Conversely, the activation level of biceps femoris (BF) was higher. Furthermore, the integral EMG values of GMed, GM, ST, VL, RF, vastus medialis VM, and TA muscles on the affected side were lower, except for the BF muscle, in patients with KOA. Conclusion: Compared with the participants in the control group, patients with early-stage KOA exhibited consistent changes in sEMG parameters and biomechanical alterations in the sagittal plane, as observed in previous studies. However, differences in parameters were observed in the coronal and transverse planes of these patients. The noninvasive analysis of the 3D parameters of the involved motion patterns may lead to the early detection of KOA.
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Affiliation(s)
- Jing Pan
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, China
| | - Wenqin Huang
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, China
| | - Zhiguan Huang
- School of Sports and Health, Guangzhou Sport University, Guangzhou, China
| | - Jun Luan
- Guangzhou Eleventh People’s Hospital, Guangzhou, China
| | - Xiaohui Zhang
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, China
| | - Bagen Liao
- Department of Sports Medicine, Guangzhou Sport University, Guangzhou, China
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Uritani D, Koda H, Yasuura Y, Kusumoto A. Factors associated with subjective knee joint stiffness in people with knee osteoarthritis: A systematic review. Int J Rheum Dis 2023; 26:425-436. [PMID: 36572505 DOI: 10.1111/1756-185x.14536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/15/2022] [Accepted: 12/02/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Subjective knee stiffness is a common symptom in patients with knee osteoarthritis treated conservatively. However, the influencing factors or effects of knee joint stiffness are unknown. The aim of this study was to explore the factors associated with subjective knee stiffness in patients with knee osteoarthritis. METHODS The MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PEDro databases were searched in November 2021. Prospective or retrospective cohort studies were included. The methodological quality of the selected articles was assessed using the Scottish Intercollegiate Guidelines Network checklist. RESULTS Twenty out of 1943 screened articles were included in this systematic review. Eighteen and two studies were rated as having acceptable and low quality, respectively. All the included studies measured subjective knee stiffness using the Western Ontario and McMaster Universities Osteoarthritis Index. The main findings were that worse preoperative subjective knee stiffness was associated with worse pain, subjective knee stiffness, and patient satisfaction at 1 year after total knee arthroplasty. In addition, worse subjective knee stiffness was associated with future degenerative changes in the knee joint, such as joint space narrowing and osteophyte growth progression. CONCLUSION Subjective knee stiffness may be associated with the prognosis after total knee arthroplasty and degenerative changes in the knee joint. Early detection and treatment of knee stiffness could lead to a good prognosis after total knee arthroplasty and prevent the progression of degenerative changes in the knee joint.
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Affiliation(s)
- Daisuke Uritani
- Department of Physical Therapy, Faculty of Health Science, Kio University, Nara, Japan
| | - Hitoshi Koda
- Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Osaka, Japan
| | - Yuuka Yasuura
- Department of Rehabilitation, Shimada Hospital, Osaka, Japan
| | - Aya Kusumoto
- Department of Rehabilitation, Saiseikai Nara Hospital, Nara, Japan
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Veronese N, Stefanac S, Koyanagi A, Al-Daghri NM, Sabico S, Cooper C, Rizzoli R, Reginster JY, Barbagallo M, Dominguez LJ, Smith L, Maggi S. Lower Limb Muscle Strength and Muscle Mass Are Associated With Incident Symptomatic Knee Osteoarthritis: A Longitudinal Cohort Study. Front Endocrinol (Lausanne) 2021; 12:804560. [PMID: 34975772 PMCID: PMC8716541 DOI: 10.3389/fendo.2021.804560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/26/2021] [Indexed: 11/25/2022] Open
Abstract
Recent literature suggests that sarcopenia, often represented by low lower limbs muscle mass and strength, can be considered a potential risk factor for knee osteoarthritis (OA), but the available literature is still limited. We therefore aimed to investigate whether sarcopenia is associated with a higher risk of radiographic (ROA) and symptomatic knee OA (SxOA) in a large cohort of North American people in the context of the OA initiative. Sarcopenia at baseline was diagnosed in case of low skeletal muscle mass (i.e., lower skeletal mass index) and poor performance in the chair stands test. The outcomes of interest for this study included ROA (radiographical osteoarthritis) if a knee developed a Kellgren and Lawrence (KL) grade ≥2 at follow-up, and SxOA (symptomatic osteoarthritis) defined as new onset of a combination of painful knee OA. Altogether, 2,492 older participants (mean age: 68.4 years, 61.4% females) were included. At baseline, sarcopenia was present in 6.1% of the population. No significant difference in ROA prevalence was observed between those with and without sarcopenia (p=0.76), whilst people with sarcopenia reported a significant higher prevalence of SxOA (p<0.0001). Using a logistic regression analysis, adjusting for potential confounders at baseline and the diagnosis of sarcopenia during follow-up, sarcopenia was associated with a higher incidence of knee SxOA (odds ratio, OR=2.29; 95%CI [confidence interval]: 1.42-3.71; p=0.001), but not knee ROA (OR=1.48; 95%CI: 0.53-4.10; p=0.45). In conclusion, sarcopenia could be associated with a higher risk of negative knee OA outcomes, in particular symptomatic forms.
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Affiliation(s)
- Nicola Veronese
- Department of Internal Medicine, Geriatric Section, University of Palermo, Palermo, Italy
- Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Sinisa Stefanac
- Institute of Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Nasser M. Al-Daghri
- Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Shaun Sabico
- Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Cyrus Cooper
- Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
- Medical Research Council (MRC) Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
- National Institute for Health Research Nutrition Biomedical Research Centre, Southampton General Hospital, University of Southampton and University Hospital Southampton National Health System (NHS) Foundation Trust, Southampton, United Kingdom
| | - Renè Rizzoli
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, CHU Sart Tilman B23, University of Liege, Liège, Belgium
| | - Mario Barbagallo
- Department of Internal Medicine, Geriatric Section, University of Palermo, Palermo, Italy
| | - Ligia J. Dominguez
- Department of Internal Medicine, Geriatric Section, University of Palermo, Palermo, Italy
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
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Fu S, Duan T, Hou M, Yang F, Chai Y, Chen Y, Liu B, Ma Y, Liu A, Wang X, Chen L. Postural Balance in Individuals With Knee Osteoarthritis During Stand-to-Sit Task. Front Hum Neurosci 2021; 15:760960. [PMID: 34803639 PMCID: PMC8595483 DOI: 10.3389/fnhum.2021.760960] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Stand-to-sit task is an important daily function, but there is a lack of research evidence on whether knee osteoarthritis (knee OA) affects the postural balance during the task. This study aimed to compare individuals with knee OA and asymptomatic controls in postural balance and identify kinematic and lower extremity muscle activity characteristics in individuals with knee OA during the stand-to-sit task. Methods: In total, 30 individuals with knee OA and 30 age-matched asymptomatic controls performed the 30-s Chair Stand Test (30sCST) at self-selected speeds. Motion analysis data and surface electromyography (sEMG) were collected while participants performed the 30sCST. To quantify postural balance, the displacement of the center of mass (CoM) and the peak instantaneous velocity of the CoM were calculated. The kinematic data included forward lean angles of the trunk and pelvic, range of motion (RoM) of the hip, knee, and ankle joints in the sagittal plane. The averaged activation levels of gluteus maximus, vastus lateralis, vastus medialis, rectus femoris, biceps femoris (BF), tibialis anterior (TA), and medial head of gastrocnemius muscles were indicated by the normalized root mean square amplitudes. Results: Compared with the asymptomatic control group, the knee OA group prolonged the duration of the stand-to-sit task, demonstrated significantly larger CoM displacement and peak instantaneous CoM velocity in the anterior-posterior direction, reduced ankle dorsiflexion RoM, greater anterior pelvic tilt RoM, and lower quadriceps femoris and muscles activation level coupled with higher BF muscle activation level during the stand-to-sit task. Conclusion: This study indicates that individuals with knee OA adopt greater pelvic forward lean RoM and higher BF muscle activation level during the stand-to-sit task. However, these individuals exist greater CoM excursion in the anterior-posterior direction and take more time to complete the task. This daily functional activity should be added to the rehabilitation goals for individuals with knee OA. The knee OA group performs reduced ankle dorsiflexion RoM, quadriceps femoris, and TA activation deficit. In the future, the rehabilitation programs targeting these impairments could be beneficial for restoring the functional transfer in individuals with knee OA.
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Affiliation(s)
- Shengxing Fu
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fuzhou, China.,Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Tingjin Duan
- Department of Physical Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Meijin Hou
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fuzhou, China.,Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Fengjiao Yang
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yatai Chai
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yongkang Chen
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Benke Liu
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ye Ma
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fuzhou, China.,Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Faculty of Sports Sciences, Research Academy of Grand Health, Ningbo University, Ningbo, China
| | - Anmin Liu
- School of Health and Society, University of Salford, Salford, United Kingdom
| | - Xiangbin Wang
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lidian Chen
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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