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Porserud A, Karlsson P, Aly M, Rydwik E, Torikka S, Henningsohn L, Nygren-Bonnier M, Hagströmer M. Effects of an exercise intervention in primary care after robot-assisted radical cystectomy for urinary bladder cancer: a randomised controlled trial. BMC Cancer 2024; 24:891. [PMID: 39048933 PMCID: PMC11267740 DOI: 10.1186/s12885-024-12647-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION After radical cystectomy physical activity is important to reduce risk of complications, but patients with urinary bladder cancer have difficulties in achieving general recommendations on physical activity and exercise. The aim of this randomised controlled trial was therefore to evaluate the effects of a physical exercise programme in primary care, following discharge from hospital after robot-assisted radical cystectomy for urinary bladder cancer. MATERIALS AND METHODS Patients with urinary bladder cancer scheduled for robot-assisted radical cystectomy at Karolinska University Hospital, Sweden between September 2019 and October 2022 were invited to join the study. At discharge, they were randomised to intervention or active control group. The intervention group was planned to start exercise with physiotherapist in primary care during the third week; the programme included aerobic and strengthening exercises, twice a week for 12 weeks, and daily walks. The control group received unsupervised home-based exercise with daily walks and a sit-to-stand exercise. Assessments were conducted before surgery, at discharge and after four months regarding the primary outcome physical function (Six-minute walk test), and secondary outcomes physical activity, pain, health-related quality of life, fatigue, and psychological wellbeing. RESULTS Ninety patients were included, mean (sd) age 71.5 (8.5) years. An intention-to-treat analysis showed no intervention effect on the primary outcome physical function, or on pain or psychological wellbeing, but effect on physical activity with a difference from discharge to four months with a median (IQR) of 4790 (3000) and 2670 (4340) daily steps in the intervention and control group, respectively (p = 0.046), and for fatigue, and health-related quality of life, in favour of the intervention group. CONCLUSION Both the intervention and control groups improved physical function, but the patients who exercised in primary care experienced additional positive effects on physical activity, fatigue, and health-related quality of life. Hence, exercise in primary care after discharge from hospital could be a promising method after radical cystectomy for urinary bladder cancer. TRIAL REGISTRATION The study was registered in Clinical Trials with registration number NCT03998579, 20,190,607.
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Affiliation(s)
- Andrea Porserud
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
| | - Patrik Karlsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Markus Aly
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Patient Area Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Rydwik
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Simon Torikka
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Henningsohn
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Malin Nygren-Bonnier
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Hagströmer
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
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Wagatsuma M, Mihy JA, Cain SM, Hafer JF. Gait kinematics differ by bout duration and setting. Gait Posture 2024; 113:232-237. [PMID: 38959554 DOI: 10.1016/j.gaitpost.2024.06.011] [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: 03/20/2024] [Revised: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Gait kinematics differ between settings and among young and older adults with and without knee osteoarthritis. Out-of-lab data has a variety of walking bout characteristics compared to controlled in-lab settings. The effect of walking bout duration on gait analysis results is unclear, and there is no standardized procedure for segmenting or selecting out-of-lab data for analysis. RESEARCH QUESTION Do gait kinematics differ by bout duration or setting in young and older adults with and without knee osteoarthritis? METHODS Ten young (28.1±3.5 yrs), ten older adults (60.8±3.3 yrs), and ten older adults with knee osteoarthritis (64.1±3.6 yrs) performed a standard in-lab gait analysis followed by a prescribed walking route outside the lab at a comfortable speed with four IMUs. Walking speed, stride length, and sagittal hip, knee, and ankle angular excursion (ROM) were calculated for each identified stride. Out-of-lab strides included straight-line, level walking divided into strides that occurred during long (>60 s) or short (≤60 s) bouts. Gait kinematics were compared between in-lab and both out-of-lab bout durations among groups. RESULTS Significant main effects of setting or duration were found for walking speed and stride length, but there were no significant differences in hip, knee, or ankle joint ROM. Walking speed and stride length were greater in-lab followed by long and short bout out-of-lab. No significant interaction was observed between group and setting or bout duration for any spatiotemporal variables or joint ROMs. SIGNIFICANCE Out-of-lab gait data can be beneficial in identifying gait characteristics that individuals may not encounter in the traditional lab setting. Setting has an impact on walking kinematics, so comparisons of in-lab and free-living gait may be impacted by the duration of walking bouts. A standardized approach for to analyzing out-of-lab gait data is important for comparing studies and populations.
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Affiliation(s)
- Mayumi Wagatsuma
- Department of Kinesiology & Applied Physiology, University of Delaware, United States
| | - Julien A Mihy
- Department of Kinesiology & Applied Physiology, University of Delaware, United States
| | - Stephen M Cain
- Department of Chemical and Biomedical Engineering, West Virginia University, United States
| | - Jocelyn F Hafer
- Department of Kinesiology & Applied Physiology, University of Delaware, United States.
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Kharazi M, Theodorakis C, Mersmann F, Bohm S, Arampatzis A. Contractile Work of the Soleus and Biarticular Mechanisms of the Gastrocnemii Muscles Increase the Net Ankle Mechanical Work at High Walking Speeds. BIOLOGY 2023; 12:872. [PMID: 37372156 DOI: 10.3390/biology12060872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Increasing walking speed is accompanied by an increase of the mechanical power and work performed at the ankle joint despite the decrease of the intrinsic muscle force potential of the soleus (Sol) and gastrocnemius medialis (GM) muscles. In the present study, we measured Achilles tendon (AT) elongation and, based on an experimentally determined AT force-elongation relationship, quantified AT force at four walking speeds (slow 0.7 m.s-1, preferred 1.4 m.s-1, transition 2.0 m.s-1, and maximum 2.6 ± 0.3 m.s-1). Further, we investigated the mechanical power and work of the AT force at the ankle joint and, separately, the mechanical power and work of the monoarticular Sol at the ankle joint and the biarticular gastrocnemii at the ankle and knee joints. We found a 21% decrease in maximum AT force at the two higher speeds compared to the preferred; however, the net work of the AT force at the ankle joint (ATF work) increased as a function of walking speed. An earlier plantar flexion accompanied by an increased electromyographic activity of the Sol and GM muscles and a knee-to-ankle joint energy transfer via the biarticular gastrocnemii increased the net ATF mechanical work by 1.7 and 2.4-fold in the transition and maximum walking speed, respectively. Our findings provide first-time evidence for a different mechanistic participation of the monoarticular Sol muscle (i.e., increased contractile net work carried out) and the biarticular gastrocnemii (i.e., increased contribution of biarticular mechanisms) to the speed-related increase of net ATF work.
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Affiliation(s)
- Mohamadreza Kharazi
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10115 Berlin, Germany
- Berlin School of Movement Science, 10115 Berlin, Germany
| | - Christos Theodorakis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10115 Berlin, Germany
- Berlin School of Movement Science, 10115 Berlin, Germany
| | - Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10115 Berlin, Germany
- Berlin School of Movement Science, 10115 Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10115 Berlin, Germany
- Berlin School of Movement Science, 10115 Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10115 Berlin, Germany
- Berlin School of Movement Science, 10115 Berlin, Germany
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Banks JJ, Wedge RD, Caldwell GE, Umberger BR. Are lower back demands reduced by improving gait symmetry in unilateral transtibial amputees? Clin Biomech (Bristol, Avon) 2022; 95:105657. [PMID: 35500413 DOI: 10.1016/j.clinbiomech.2022.105657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gait asymmetry and a high incidence of lower back pain are typical for people with unilateral lower limb amputation. A common therapeutic objective is to improve gait symmetry; however, it is unknown whether better gait symmetry reduces lower back pain risk. To begin investigating this important clinical question, we examined a preexisting dataset to explore whether L5/S1 vertebral joint forces in people with unilateral lower limb amputation can be improved with better symmetry. METHODS L5/S1 compression and resultant shear forces were estimated in each participant with unilateral lower limb amputation (n = 5) with an OpenSim musculoskeletal model during different levels of guided gait asymmetry. The amount of gait asymmetry was defined by bilateral stance times and guided via real-time feedback. A theoretical lowest L5/S1 force was determined from the minimum of a best-fit quadratic curves of L5/S1 forces at levels of guided asymmetry ranging from -10 to +15%. The forces found at the theoretical lowest force and during the 0% asymmetry level were compared to forces at preferred levels of asymmetry and to those from an able-bodied group (n = 5). FINDINGS Results indicated that the forces for the people with unilateral lower limb amputation group at the preferred level of asymmetry were not different then at their 0% asymmetry condition, theoretical lowest L5/S1 forces, or the able-bodied group (all p-values > .23). INTERPRETATION These preliminary results challenge the premise that restoring symmetric gait in people with unilateral lower limb amputation will reduce risk of lower back pain.
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Affiliation(s)
- Jacob J Banks
- Department of Kinesiology, University of Massachusetts Amherst, Totman Building 30 Eastman Lane, Amherst, MA 01003, United States; Department of Orthopedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue Boston, MA 02215, United States.
| | - Ryan D Wedge
- Department of Kinesiology, University of Massachusetts Amherst, Totman Building 30 Eastman Lane, Amherst, MA 01003, United States; Department of Physical Therapy, East Carolina University, Health Sciences Building 600 Moye Blvd, Greenville, NC 27834, United States.
| | - Graham E Caldwell
- Department of Kinesiology, University of Massachusetts Amherst, Totman Building 30 Eastman Lane, Amherst, MA 01003, United States.
| | - Brian R Umberger
- Department of Kinesiology, University of Massachusetts Amherst, Totman Building 30 Eastman Lane, Amherst, MA 01003, United States; School of Kinesiology, University of Michigan, 830 North University, Ann Arbor, MI 48109, United States.
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Wedge RD, Sup FC, Umberger BR. Metabolic cost of transport and stance time asymmetry in individuals with unilateral transtibial amputation using a passive prostheses while walking. Clin Biomech (Bristol, Avon) 2022; 94:105632. [PMID: 35364403 DOI: 10.1016/j.clinbiomech.2022.105632] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND People with unilateral amputation typically walk with greater metabolic cost than able-bodied individuals, while preferring asymmetric walking characteristics. It is unclear if asymmetric walking is energetically optimal and how metabolic cost accounts for asymmetric patterns in people with amputation. The purpose of this study was to determine the effects of stance-time asymmetry on the metabolic cost of transport. METHODS Fourteen participants (seven with amputation) completed two laboratory sessions where they walked on a treadmill while receiving real-time visual feedback about stance-time asymmetry. Expired gases were collected to determine the metabolic cost for a range of asymmetries (-15% to +15% in 5% increments, positive percentages represent more time on intact [dominant] limb). FINDINGS Participants with amputation walked with greater (P = 0.008) stance-time asymmetry (4.34 ± 1.09%) compared with able-bodied participants (0.94 ± 2.44%). Stance-time asymmetry had a significant effect on metabolic cost (P < 0.001). The asymmetries coinciding with the predicted minimum metabolic cost for people with (3.23 ± 2.90%) and without (1.81 ± 2.18%) amputation were not different from preferred asymmetries (P = 0.365; p = 0.513), respectively. The cost of symmetric walking was 13.6% greater than near preferred walking for people with amputation (5% more time on intact limb). INTERPRETATION Metabolic cost is not the only objective of walking, but like able-bodied individuals, it may influence how people with amputation walk. Rehabilitation typically tries to restore inter-limb symmetry after an injury, yet if the limbs are asymmetric, symmetric gait may not be optimal with current assistive devices.
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Affiliation(s)
- Ryan D Wedge
- Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, 30 Eastman Lane, 110 Totman Building, Amherst, MA 01003-9258, United States; Motion Analysis Laboratory, Quinnipiac University, 275 Mount Carmel Avenue, Hamden, CT 06518, United States; Department of Physical Therapy, Health Sciences Building, East Carolina University, 600 Moye Blvd, Greenville, NC 27834, United States.
| | - Frank C Sup
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, 120 E Marston Hall, 160 Governor's Drive, Amherst, MA 01003-2210, United States.
| | - Brian R Umberger
- Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, 30 Eastman Lane, 110 Totman Building, Amherst, MA 01003-9258, United States; School of Kinesiology, University of Michigan, SKB 1210, 830 North University, Ann Arbor, MI 48109-1048, United States.
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Parker SM, Crenshaw J, Hunt NH, Burcal C, Knarr BA. Outdoor walking exhibits peak ankle and knee flexion differences compared to fixed and adaptive-speed treadmills in older adults. Biomed Eng Online 2021; 20:104. [PMID: 34654416 PMCID: PMC8518157 DOI: 10.1186/s12938-021-00941-0] [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: 06/08/2021] [Accepted: 09/30/2021] [Indexed: 11/21/2022] Open
Abstract
Background Walking mechanics recorded with a traditional treadmill may not be the same as the mechanics exhibited during activities of daily living due to constrained walking speeds. Adaptive-speed treadmills allow for unconstrained walking speeds similar to outdoor walking. The aim of this study was to determine differences in kinematic walking parameters of older adults between adaptive-speed treadmill (AST), fixed-speed treadmill (FST) and outdoor walking. We hypothesized that self-selected walking speed (SSWS) during AST walking and outdoor walking would increase compared to FST walking. Furthermore, we hypothesized that AST walking and outdoor walking would increase peak knee flexion, hip flexion, and ankle plantarflexion angles compared to FST walking independent of walking speed changes. Methods Fourteen older adult participants were asked to complete 3 min of FST and AST walking on a split-belt treadmill. Participants were also asked to complete 6 min of outdoor walking following a circular route in a neighboring park. A wireless inertial measurement unit-based motion capture system was used to record lower extremity kinematics during all walking conditions. Results The outdoor walking condition produces significantly higher SSWS compared to FST (p < 0.001) and AST (p = 0.02) conditions. A significantly faster SSWS was exhibited during the AST condition compared to the FST condition (p = 0.026). Significantly higher peak ankle plantarflexion angles are exhibited during the outdoor walking condition compared to the AST (p < 0.001, g = 1.14) and FST (p < 0.001, g = 1.13) conditions after accounting for walking speed. There was a significantly lowered difference between the outdoor walking condition and both AST (p = 0.029, g = 0.49) and FST (p = 0.013, g = 0.63) conditions in peak knee flexion angles after accounting for SSWS. There are no significant differences between outdoor, AST, and FST conditions on peak hip flexion angles. Older adults exhibit changes in peak ankle plantarflexion and peak knee flexion angles during outdoor walking compared to treadmill walking but not between treadmill controller types. We found no differences in the kinematics exhibited by older adults between both AST and FST walking. Conclusions Incorporating unconstrained walking speed with the AST while maintaining similar FST sagittal plane kinematics may allow for more translatable conditional balance and walking rehabilitation.
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Affiliation(s)
- Sheridan M Parker
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Dr S., Omaha, NE, 68182, USA.
| | - Jeremy Crenshaw
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Nathaniel H Hunt
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Dr S., Omaha, NE, 68182, USA
| | - Christopher Burcal
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | - Brian A Knarr
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Dr S., Omaha, NE, 68182, USA
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Parrington L, King LA, Weightman MM, Hoppes CW, Lester ME, Dibble LE, Fino PC. Between-site equivalence of turning speed assessments using inertial measurement units. Gait Posture 2021; 90:245-251. [PMID: 34530311 DOI: 10.1016/j.gaitpost.2021.09.164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Turning is a component of gait that requires planning for movement of multiple body segments and the sophisticated integration of sensory information from the vestibular, visual, and somatosensory systems. These aspects of turning have led to growing interest to quantify turning in clinical populations to characterize deficits or identify disease progression. However, turning may be affected by environmental differences, and the degree to which turning assessments are comparable across research or clinical sites has not yet been evaluated. RESEARCH QUESTION The aim of this study was to determine the extent to which peak turning speeds are equivalent between two sites for a variety of mobility tasks. METHODS Data were collected at two different sites using separate healthy young adult participants (n = 47 participants total), but recruited using identical inclusion and exclusion criteria. Participants at each site completed three turning tasks: a one-minute walk (1 MW) along a six-meter walkway, a modified Illinois Agility Test (mIAT), and a custom clinical turning course (CCTC). Peak yaw turning speeds were extracted from wearable inertial sensors on the head, trunk, and pelvis. Between-site differences and two one-sided tests (TOST) were used to determine equivalence between sites, based on a minimum effect size reported between individuals with mild traumatic brain injury and healthy control subjects. RESULTS No outcomes were different between sites, and equivalence was determined for 6/21 of the outcomes. These findings suggest that some turning tasks and outcome measures may be better suited for multi-site studies. The equivalence results are also dependent on the minimum effect size of interest; nearly all outcomes were equivalent across sites when larger minimum effect sizes of interest were used. SIGNIFICANCE Together, these results suggest some tasks and outcome measures may be better suited for multi-site studies and literature-based comparisons.
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Affiliation(s)
- Lucy Parrington
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | | | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, United States
| | - Mark E Lester
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, United States; Department of Physical Therapy, Texas State University, Round Rock, TX, United States
| | - Leland E Dibble
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States.
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Master H, Neogi T, LaValley M, Thoma LM, Zhang Y, Voinier D, Christiansen MB, White DK. Does the 1-year Decline in Walking Speed Predict Mortality Risk Beyond Current Walking Speed in Adults With Knee Osteoarthritis? J Rheumatol 2020; 48:279-285. [PMID: 33259329 DOI: 10.3899/jrheum.200259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate whether walking speed at 1 timepoint, decline over the past 12 months, or both predict mortality risk over 11 years in adults with, or at risk of, knee osteoarthritis (OA). METHODS Using the data from the Osteoarthritis Initiative, we defined slow versus adequate walking speed as walking < 1.22 versus ≥ 1.22 m/s on a 20m walk test during the 12-month follow-up visit. We defined meaningful decline (yes/no) as slowing ≥ 0.08 m/s over the past year. At the 12-month visit, we classified adequate sustainers as those with adequate walking speed and no meaningful decline, slow sustainers as slow walking speed and no meaningful decline, adequate decliners as adequate walking speed and meaningful decline, and slow decliners as slow walking speed and meaningful decline. Mortality was recorded over 11 years. To examine the association of walking speed with mortality, HR and 95% CI were calculated using Cox regression, adjusted for potential confounders. RESULTS Of 4229 participants in the analytic sample (58% female, age 62 ± 9 yrs, BMI 29 ± 5 kg/m2), 6% (n = 270) died over 11 years. Slow sustainers and slow decliners had 2-times increased mortality risk compared to adequate sustainers (HR 1.96, 95% CI 1.44-2.66 for slow sustainers, and HR 2.08, 95% CI 1.46-2.96 for slow decliners). Adequate decliners had 0.43 times the mortality risk compared with adequate sustainers (HR 0.57, 95% CI 0.32-1.01). CONCLUSION In adults with, or at risk of, knee OA, walking slower than 1.22 m/s in the present increased mortality risk, regardless of decline over the previous year.
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Affiliation(s)
- Hiral Master
- H. Master, PT, PhD, MPH, Department of Physical Therapy, College of Health Sciences, University of Delaware, Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, and Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tuhina Neogi
- T. Neogi, MD, PhD, Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael LaValley
- M. LaValley, PhD, School of Public Health, Boston University, Boston, Massachusetts
| | - Louise M Thoma
- L.M. Thoma, PT, PhD, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yuqing Zhang
- Y. Zhang, PhD, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dana Voinier
- D. Voinier, PT, DPT, M.B. Christiansen, PT, PhD, D.K. White, PT, ScD, MSc, Department of Physical Therapy, College of Health Sciences, University of Delaware and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
| | - Meredith B Christiansen
- D. Voinier, PT, DPT, M.B. Christiansen, PT, PhD, D.K. White, PT, ScD, MSc, Department of Physical Therapy, College of Health Sciences, University of Delaware and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
| | - Daniel K White
- D. Voinier, PT, DPT, M.B. Christiansen, PT, PhD, D.K. White, PT, ScD, MSc, Department of Physical Therapy, College of Health Sciences, University of Delaware and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA.
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Master H, Coleman G, Dobson F, Bennell K, Hinman RS, Jakiela JT, White DK. A Narrative Review on Measurement Properties of Fixed-distance Walk Tests Up to 40 Meters for Adults With Knee Osteoarthritis. J Rheumatol 2020; 48:638-647. [PMID: 33060316 DOI: 10.3899/jrheum.200771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
Abstract
Knee osteoarthritis (OA) is a serious disease and has no cure to date. Knee OA is a leading cause of functional limitation (e.g., difficulty walking). Walking speed is 1 method of quantifying difficulty with walking and should be assessed in clinical practice for adults with knee OA because it has prognostic value and is modifiable. Specifically, slow walking speed is associated with increased risk of adverse health outcomes, including all-cause mortality in adults with knee OA and can be modified by engaging in physical activity or exercise. However, at present, there is little consensus on the distance and instructions used to conduct the walk test. Distance is often selected based on space availability, and instruction varies, from asking the participants to walk at a comfortable pace versus as fast as possible. Therefore, the purpose of this narrative review is to summarize the measurement properties, strengths, and limitations of a fixed-distance walk test ≤ 40 meters in adults with knee OA. Good measurement properties in terms of reliability and validity were observed across the different testing protocols for fixed-distance walk test (i.e., any distance ≤ 40 m and fast- or self-paced). Therefore, clinicians and researchers can select a testing protocol that can safely and consistently be performed over time, as well as provide a practice trial to acclimatize the patients to the fixed-distance walk test.
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Affiliation(s)
- Hiral Master
- H. Master, PT, PhD, MPH, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, and Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware
| | - Grace Coleman
- G. Coleman, BS, SPT, Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware
| | - Fiona Dobson
- F. Dobson, PT, PhD, K. Bennell, PT, PhD, R.S. Hinman, PT, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Kim Bennell
- F. Dobson, PT, PhD, K. Bennell, PT, PhD, R.S. Hinman, PT, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Rana S Hinman
- F. Dobson, PT, PhD, K. Bennell, PT, PhD, R.S. Hinman, PT, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Jason T Jakiela
- J.T. Jakiela, MS, D.K. White, PT, ScD, MSc, Department of Physical Therapy, College of Health Sciences, University of Delaware, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
| | - Daniel K White
- J.T. Jakiela, MS, D.K. White, PT, ScD, MSc, Department of Physical Therapy, College of Health Sciences, University of Delaware, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA.
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Friesen KB, Zhang Z, Monaghan PG, Oliver GD, Roper JA. All eyes on you: how researcher presence changes the way you walk. Sci Rep 2020; 10:17159. [PMID: 33051502 PMCID: PMC7554041 DOI: 10.1038/s41598-020-73734-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/21/2020] [Indexed: 12/30/2022] Open
Abstract
Most human movement research takes place within controlled laboratories where researchers observe participant movement. Because a majority of daily activity is performed without observation, we hypothesized movement within a laboratory would vary when there was a small, large or absence of research group. We also hypothesized that personality type would influence movement during observation. Participants completed a personality questionnaire, then walked in a laboratory during three different conditions: no research group (no researchers), small research group (2 researchers), and large research group (6-10 researchers). Results revealed spatiotemporal parameters were altered between conditions, however personality type did not influence changes in movement. As the number of researchers increased, gait speed, cadence, and stride length increased, and step duration decreased. Gait speed increased by .03 m/s from the no research group to the small research group, by .06 m/s from the no research group to the large research group, and by .03 m/s from the small to large research group (all p values < .001). Understanding how researcher observation modifies movement is important and affects the replicability of results, as well as the interpretation of laboratory-based movement studies to activities of daily living in real world settings.
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Stuck AK, Bachmann M, Füllemann P, Josephson KR, Stuck AE. Effect of testing procedures on gait speed measurement: A systematic review. PLoS One 2020; 15:e0234200. [PMID: 32479543 PMCID: PMC7263604 DOI: 10.1371/journal.pone.0234200] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although gait speed is a widely used measure in older people, testing methods are highly variable. We conducted a systematic review to investigate the influence of testing procedures on resulting gait speed. METHODS We followed the PRISMA checklist for this systematic review. Two independent reviewers screened Pubmed and Embase for publications on pairwise comparisons of testing procedures of usual gait speed. Descriptives were abstracted from the included publications using a predefined extraction tool by two independent reviewers. We defined the cut-off for the minimal clinically imporant diffence in gait speed as 0.1 m/sec. RESULTS Of a total of 2109 records identified for screening, 29 reports on 53 pairwise comparisons were analyzed. The median (range) difference in gait speed for dynamic versus static start was 0.06 (-0.02 to 0.35) m/sec (14 reports); for longer versus shorter test distance 0.04 (-0.05 to 0.23) m/sec (14 reports); for automatic versus manual timing 0.00 (-0.05 to 0.07) m/sec (12 reports), for hard versus soft surfaces -0.11 (-0.18 to 0.08) m/sec (six reports), and electronic walkways versus usual walk test 0.04 (-0.08 to 0.14) m/sec (seven reports), respectively. No report compared the effect of finishing procedures. CONCLUSIONS The type of starting procedure, the length of the test distance, and the surface of the walkway may have a clinically relevant impact on measured gait speed. Manual timing resulted in statistically significant differences of measured gait speed as compared to automatic timing, but was below the level of clinical importance. These results emphasize that it is key to use a strictly standardized method for obtaining a reliable and valid measurement of gait speed.
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Affiliation(s)
- Anna K. Stuck
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Madeleine Bachmann
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pia Füllemann
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Karen R. Josephson
- Geriatric Research Education & Clinical Center, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
| | - Andreas E. Stuck
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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