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Brown-Taylor L, Harris-Hayes M, Foraker R, Vasileff WK, Glaws K, Di Stasi S. Treatment decisions after interdisciplinary evaluation for nonarthritic hip pain: A randomized controlled trial. PM R 2022; 14:297-308. [PMID: 34181823 PMCID: PMC8712617 DOI: 10.1002/pmrj.12661] [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: 07/31/2020] [Revised: 04/14/2021] [Accepted: 04/27/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Physical therapy and hip arthroscopy are two viable treatment options for patients with nonarthritic hip pain (NAHP); however, patients may experience considerable decisional conflict when making a treatment decision. Interdisciplinary evaluation with a physical therapist and surgeon may better inform the decision-making process and reduce decisional conflict. OBJECTIVE To identify the extent to which an interdisciplinary evaluation between a surgeon, physical therapist, and patient influences treatment plans and decisional conflict of persons with NAHP. DESIGN Randomized controlled trial. SETTING Hip preservation clinic. PARTICIPANTS Adults with primary NAHP. INTERVENTIONS Participants were randomized to receive a standard (surgeon) or interdisciplinary (surgeon+physical therapist) evaluation. Surgeon evaluations included patient interview, strength and range-of-motion examination, palpation, gross motor observation, and special testing. Interdisciplinary evaluations started with the surgeon evaluation, then a physical therapist evaluated movement impairments during sitting, sit-to-stand, standing, single-leg stance, single-leg squat, and walking. All evaluations concluded with treatment planning with the respective provider(s). OUTCOME MEASURES Treatment plan and decisional conflict were collected pre- and postevaluation. Inclusion of physical therapy in participants' postevaluation treatment plans and postevaluation decisional conflict were compared between groups using chi-square tests and Mann-Whitney U tests, respectively. RESULTS Seventy-eight participants (39 in each group) met all eligibility criteria and were included in all analyses. Sixty-six percent of participants who received an interdisciplinary evaluation included physical therapy in their postevaluation treatment plan, compared to 48% of participants who received a standard evaluation (p = .10). Participants who received an interdisciplinary evaluation reported 6.3 points lower decisional conflict regarding their postevaluation plan (100-point scale; p = .04). The interdisciplinary and standard groups reduced decisional conflict on average 24.8 ± 18.9 and 23.6 ± 14.6 points, respectively. CONCLUSIONS Adding a physical therapist to a surgical clinic increased interest in physical therapy treatment, but this increase was not statistically significant. The interdisciplinary group displayed lower postevaluation decisional conflict; however, both groups displayed similar reductions in decisional conflict from pre- to postevaluation. This study also demonstrated the feasibility of an interdisciplinary evaluation in a hip preservation clinic.
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Affiliation(s)
- Lindsey Brown-Taylor
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH,Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH,Health and Rehabilitation Sciences Doctoral Program, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | - Marcie Harris-Hayes
- Program in Physical Therapy and Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Randi Foraker
- Institute for Informatics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - W Kelton Vasileff
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH,Department of Orthopaedics, The Ohio State University, Columbus, OH
| | - Kathryn Glaws
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH,Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
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Brown-Taylor L, Pendley C, Glaws K, Vasileff WK, Ryan J, Harris-Hayes M, Di Stasi SL. Associations Between Movement Impairments and Function, Treatment Recommendations, and Treatment Plans for People With Femoroacetabular Impingement Syndrome. Phys Ther 2021; 101:pzab157. [PMID: 34555167 PMCID: PMC8459885 DOI: 10.1093/ptj/pzab157] [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: 06/25/2020] [Revised: 02/18/2021] [Accepted: 05/06/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to describe movement impairments for persons with femoroacetabular impingement syndrome and their association with function, treatment recommendations, and treatment plans. METHODS This report is a secondary, observational analysis of a clinical trial dataset in which participants received an interdisciplinary evaluation from a surgeon and physical therapist. The therapist documented frontal and sagittal plane movement impairments across 6 functional tasks. Associations between number of impairments in each plane and function (33-item International Hip Outcome Tool [iHOT33]) were evaluated using Pearson or Spearman correlations. Joint provider recommendations (physical therapist and surgeon) and participant-reported treatment plans were dichotomized based on the inclusion of physical therapy or not. Logistic regressions were used to examine the effects of (1) iHOT33, total movement impairments, and previous physical therapist treatment on joint provider recommendation and (2) these same variables along with joint provider recommendation on participant treatment plan; prevalence ratios and 95% CIs were reported for significant contributors. RESULTS Thirty-nine participants demonstrated an average iHOT33 of 35.0 (SD = 19.5) and presented with a median 5 frontal and 3 sagittal plane impairments. More frontal plane impairments were associated with worse iHOT33 scores. Twenty-seven participants received a joint provider recommendation that included physical therapy; no significant contributors to these recommendations were identified. Twenty-four of the 27 participants with a physical therapist recommendation included physical therapy in their treatment plan. Two additional participants did not receive a physical therapist recommendation but included physical therapy in their plan. Joint provider recommendation was the only significant contributor to the participant-reported plan (prevalence ratio = 7.06; 95% CI = 3.25-7.97). CONCLUSION Persons with femoroacetabular impingement syndrome displayed clinically observable movement impairments that were associated with worse function. Joint provider recommendations strongly influenced participants' treatment plans to pursue physical therapy. IMPACT Physical therapists contribute new information to surgical examinations regarding movement. Joint recommendations from the physical therapist and the surgeon can influence patients' decisions to pursue physical therapy.
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Affiliation(s)
- Lindsey Brown-Taylor
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Veterans Affairs, Salt Lake City, Utah, USA
| | - Chase Pendley
- Registered Physical Therapist Inc., Sandy, Utah, USA
| | - Kathryn Glaws
- University of Colorado Sports Medicine and Performance Center, Aurora, Colorado, USA
| | - W Kelton Vasileff
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - John Ryan
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Marcie Harris-Hayes
- Program in Physical Therapy and Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Stephanie L Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
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Roach KE, Pedoia V, Lee JJ, Popovic T, Link TM, Majumdar S, Souza RB. Multivariate functional principal component analysis identifies waveform features of gait biomechanics related to early-to-moderate hip osteoarthritis. J Orthop Res 2021; 39:1722-1731. [PMID: 33615524 PMCID: PMC8180534 DOI: 10.1002/jor.24901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
Clinicians often examine movement patterns to design hip osteoarthritis (OA) interventions, yet traditional biomechanical analyses only report a single timepoint. Multivariate principal component analysis (MFPCA) analyzes the entire waveform (i.e., movement pattern), which clinicians observe to direct treatment. This study investigated hip OA indicators, by (1) employing MFPCA to characterize variance across the hip, knee, and ankle angles in healthy and early-to-moderate hip OA participants; and (2) investigating relationships between these waveform features and hip cartilage health. Bilateral hip magnetic resonance images from 72 participants with Kellgren-Lawrence grades ranging from 0 to 3 were used to calculate mean T 1ρ and T 2 relaxation times in the femoral and acetabular cartilage. MFPCA was performed on lower-limb gait biomechanics and used to identify primary modes of variation, which were related to T 1ρ and T 2 relaxation times. Here, a MFPC = mode of variation = waveform feature. In the femoral cartilage, transverse plane MFPCs 3 and 5 and body mass index (BMI) was related to T 1ρ , while MFPC 2 and BMI were related to T 2 relaxation times. In the acetabular cartilage, sagittal plane MFPC 1 and BMI were related to T 1ρ , while BMI was related to T 2 relaxation times. Greater internal rotation was related to increased T 1ρ and T 2 relaxation times in the femoral cartilage, while the greater extension was related to increased T 1ρ relaxation times in the acetabular cartilage. This study established a data-driven framework to assess relationships between multi-joint biomechanics and quantitative assessments of cartilage health and identified waveform features that could be evaluated in future hip OA intervention studies.
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Affiliation(s)
- Koren E. Roach
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, USA
| | - Valentina Pedoia
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, USA
| | - Jinhee J. Lee
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, USA
| | - Tijana Popovic
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, USA
| | - Thomas M. Link
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, USA
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, USA
| | - Richard B. Souza
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, USA,Department of Physical Therapy and Rehabilitation Science, University of California – San Francisco, San Francisco, CA, USA
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Schroeder C, Zavala L, Opstedal L, Becker J. Recovery of Lower Extremity Function in the Initial Year Following Periacetabular Osteotomy: A Single Subject Analysis. Physiother Theory Pract 2020; 38:1233-1244. [PMID: 33094678 DOI: 10.1080/09593985.2020.1833388] [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] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known regarding how lower extremity joint function recovers in the 6 months following periacetabular osteotomy (PAO) for activities other than walking. PURPOSE Assess patient-reported outcomes, hip strength, lower extremity joint moments, and moment distributions during sit-to-stand in a female athlete during the one-year period following PAO. METHODS Patient-reported outcomes (i.e. hip and groin outcome score; HAGOS), hip strength, and lower extremity joint moments and contributions to peak support moment during the sit-to-stand were assessed pre-operatively and at 6 weeks, 12 weeks, 6 months, and 13 months following PAO. RESULTS HAGOS scores returned to normative ranges, however overall quality of life scores remained low. By 13-month muscle strength recovered to baseline values. Following surgery, peak support and hip extensor moments were higher on the non-surgical limb, but the contributions of hip, knee, and ankle to peak support moment did not change. On the surgical limb, while peak support moments were lower, the hip contributed less, and the knee contributed more. These asymmetric loading patterns gradually normalized over 1 yea-. CONCLUSIONS Asymmetric loading following PAO should be considered when developing rehabilitation plans following this surgery.
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Affiliation(s)
- Cailyn Schroeder
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
| | - Linnea Zavala
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
| | | | - James Becker
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
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Biomechanics during cross-body lunging in individuals with and without painful cam and/or pincer morphology. Clin Biomech (Bristol, Avon) 2020; 76:105030. [PMID: 32416407 DOI: 10.1016/j.clinbiomech.2020.105030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/16/2019] [Accepted: 05/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Femoroacetabular impingement is a patho-mechanical hip condition that can lead to restrictions in hip motion, particularly in end-range hip flexion, adduction and/or internal rotation. Radiographic evidence of femoroacetabular impingement - cam and/or pincer morphology - is prevalent in the general and athletic populations. There is, however, a lack of studies that have analyzed the performance of sport-specific movements in people possessing these morphologies. Therefore, the purpose of this study was to compare cross-body lunge biomechanics between individuals with and without painful cam and/or pincer morphology. METHODS This was an exploratory, cross-sectional study where nine participants with cam and/or pincer morphology and symptoms, thirteen participants with asymptomatic cam and/or pincer morphology, and eleven pain-free controls performed the cross-body lunge during a single session. Trunk, pelvis, hip, knee and ankle kinematics, as well as hip, knee and ankle kinetics and vertical ground reaction forces were examined. FINDINGS Overall, the groups performed the movement similarly, with most variables statistically similar between groups. However, pelvis sagittal plane excursion throughout the entire cross-body lunge was significantly larger in those with cam and/or pincer morphology and symptoms compared to those with asymptomatic cam and/or pincer morphology (P = .046, effect size = 0.98). INTERPRETATION The results of this study show that cross-body lunge performance is similar across individuals with and without painful cam and/or pincer morphology. However, future research should aim to better understand pelvis biomechanics during sporting activities, as pelvis sagittal plane excursion may have important implications in rehabilitation and sport performance.
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Mendis MD, Wilson SJ, Hayes DA, Hides JA. Hip muscle atrophy in patients with acetabular labral joint pathology. Clin Anat 2020; 33:538-544. [DOI: 10.1002/ca.23429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/30/2019] [Indexed: 12/15/2022]
Affiliation(s)
- M. Dilani Mendis
- School of Allied Health SciencesGriffith University Brisbane Queensland Australia
- Physiotherapy DepartmentMater Health Services South Brisbane Queensland Australia
| | - Stephen J. Wilson
- School of Information Technology and Electrical EngineeringThe University of Queensland Brisbane Queensland Australia
| | - David A. Hayes
- Brisbane Orthopaedic & Sports Medicine Centre Brisbane Queensland Australia
| | - Julie A. Hides
- School of Allied Health SciencesGriffith University Brisbane Queensland Australia
- Mater Back Stability Research ClinicMater Health Services South Brisbane Queensland Australia
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Brown-Taylor L, Wilson J, McNally M, Perry J, Jackson RD, Hewett TE, Ryan J, Knopp MV, Payne JE, Di Stasi S. Altered gait mechanics are associated with severity of chondropathy after hip arthroscopy for femoroacetabular impingement syndrome. Gait Posture 2020; 77:175-181. [PMID: 32044697 PMCID: PMC7138257 DOI: 10.1016/j.gaitpost.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Suboptimal patient-reported function and movement impairments often persist after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Individuals with FAIS with preoperative cartilage pathology (ie. chondropathy) demonstrate distinct movement patterns and have worse post-operative outcomes. It is unknown whether the presence of chondropathy after surgery negatively affects movement and function. RESEARCH QUESTION Do sagittal plane gait mechanics differ based on chondropathy severity following arthroscopy for FAIS? METHODS A cross-sectional walking gait analysis was performed for 25 participants post-arthroscopy (2.48 ± 1.38y) and 12 healthy controls (HCs). Peak total support moment (TSM) and relative contributions of the hip, knee, and ankle were calculated during loading response. The Hip Osteoarthritis MRI Scoring System was used to categorize the FAIS group into no-mild or moderate-severe chondropathy groups based on 3 T magnetic resonance imaging of their surgical hip. The interactions of group by limb were evaluated for kinetic variables, covaried by gait speed. RESULTS Groups did not differ based on age, BMI and sex distribution (P ≥ 0.14). 13 participants with FAIS presented with moderate-severe chondropathy and 12 presented with no-mild chondropathy. Participants with moderate-severe chondropathy walked significantly slower than both other groups (P = 0.006) and demonstrated lower peak TSM than those with no-mild chondropathy (P = 0.002). Participants with no-mild chondropathy demonstrated lower hip (61.5 %) and greater ankle (17.7 %) contributions to the TSM on the involved limb compared to the moderate-severe group (hip:73.4 %, P = 0.07; ankle:10.5 %, P = 0.007). SIGNIFICANCE Slower gait speed alone did not explain the lower TSM strategy in participants with moderate-severe chondropathy. Interestingly, the joint contribution strategy of this group was not different than HCs. Participants with no-mild chondropathy demonstrated a TSM strategy that shifted the demand away from their hip and toward their ankle. Given the small sample size, and large variability in joint strategies, future work needs to examine whether these alterations in gait strategy, with or without advanced chondropathy, impact patient function.
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Affiliation(s)
- Lindsey Brown-Taylor
- Health and Rehabilitation Sciences Doctoral Program, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Suite 228, Columbus, OH 43210, United States; Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Suite 516, Columbus, OH 43210, United States; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Suite 3200, Columbus, OH 43202, United States.
| | - Jordan Wilson
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Suite 3200, Columbus, OH 43202, United States; College of Medicine, The Ohio State University, 370 W 9th Avenue, Columbus, OH 43210, United States
| | - Michael McNally
- Health and Rehabilitation Sciences Doctoral Program, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Suite 228, Columbus, OH 43210, United States; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Suite 3200, Columbus, OH 43202, United States
| | - Jennifer Perry
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Suite 3200, Columbus, OH 43202, United States
| | - Rebecca D Jackson
- College of Medicine, The Ohio State University, 370 W 9th Avenue, Columbus, OH 43210, United States; Center for Clinical and Translational Science, The Ohio State University, 376 W 10th Avenue, Suite 260, Columbus, OH 43210, United States; Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, McCampbell Hall, 5th Floor, 1581 Dodd Drive, Columbus, OH 43210, United States
| | - Timothy E Hewett
- Orthopaedics Biomechanics Laboratories and Sports Medicine Research Center, Mayo Clinic, Guggenheim Building 1-21, 200 First St. SW, Rochester, MN 55905, United States
| | - John Ryan
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Suite 3200, Columbus, OH 43202, United States; Department of Orthopaedics, The Ohio State University, 725 Prior Hall, 376 W 10th Avenue, Columbus, OH 43210, United States
| | - Michael V Knopp
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12thAvenue, Columbus, OH 43210, United States
| | - Jason E Payne
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12thAvenue, Columbus, OH 43210, United States
| | - Stephanie Di Stasi
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Suite 516, Columbus, OH 43210, United States; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Suite 3200, Columbus, OH 43202, United States
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Petrella M, Serrão PRMDS, Selistre LFA, Lessi GC, Gonçalves GH, Mattiello SM. Individual joint contributions to the total support moment during the sit-to-stand task differentiate mild and moderate knee osteoarthritis. Clin Biomech (Bristol, Avon) 2019; 70:52-58. [PMID: 31401530 DOI: 10.1016/j.clinbiomech.2019.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Knee osteoarthritis tends to modify the kinematics and kinetics of the sit-to-stand task. However, it is not clear whether the different degrees of knee osteoarthritis differentiate regarding these aspects. The objective was to identify if the trunk flexion, lower limb kinetics, total support moment, and individual joint contributions to the total support moment during the sit-to-stand task are different between patients with mild and moderate knee osteoarthritis. METHODS Sixty-two participants were grouped as follows: moderate knee osteoarthritis (n = 16), mild knee osteoarthritis (n = 25), and controls (n = 21). The participants performed a sit-to-stand task, which was analyzed using a 3D-motion system and a force plate. FINDINGS The three phases of the sit-to-stand task were analyzed. During Phase1, the moderate osteoarthritis group decreased the total support moment (P = 0.012). During Phase2, the moderate osteoarthritis group showed higher trunk flexion (P = 0.023) and lower internal hip and knee extension moments (P ≤ 0.001 and P ≤ 0.040, respectively) when compared to controls. Also in Phase2, both the mild and moderate groups used lower total support moment (P = 0.019, and P ≤ 0.001, respectively). When compared to the controls and mild osteoarthritis group, those with moderate osteoarthritis presented higher hip joint contribution to the total support moment (P ≤ 0.001 and P = 0.006, respectively) as well as lower knee joint contribution (P ≤ 0.003 and P = 0,013, respectively). INTERPRETATION Those with moderate osteoarthritis showed modified sit-to-stand movement pattern. While in Phase3 a higher contribution of the hip joint to the total support moment was observed, during previous phases the individuals were able to decrease the load on the knee without influencing the lower limb load distribution.
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Affiliation(s)
- Marina Petrella
- Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luis, km 235, São Carlos, SP CEP:13565-905, Brazil.
| | | | - Luiz Fernando Approbato Selistre
- Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luis, km 235, São Carlos, SP CEP:13565-905, Brazil
| | - Giovanna Camparis Lessi
- Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luis, km 235, São Carlos, SP CEP:13565-905, Brazil
| | - Glaucia Helena Gonçalves
- Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luis, km 235, São Carlos, SP CEP:13565-905, Brazil
| | - Stela Márcia Mattiello
- Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luis, km 235, São Carlos, SP CEP:13565-905, Brazil.
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Brown L, Harris-Hayes M, Foraker R, Glaws K, Vasileff WK, Di Stasi S. A randomized controlled trial protocol for an interdisciplinary evaluation of non-arthritic hip disease. EUROPEAN JOURNAL FOR PERSON CENTERED HEALTHCARE 2019; 7:133-141. [PMID: 31217989 PMCID: PMC6583806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Non-arthritic hip disease (NAHD) is a clinical condition often accompanied by painful movement. Current literature is lacking regarding how movement abnormalities are evaluated and treated in this population, which may be key to identifying which patients may respond to non-operative versus operative treatment. Combining the expertise of a hip arthroscopist and physical therapist may better inform treatment decisions for persons with NAHD. The primary objective of this study is to identify the extent to which an interdisciplinary evaluation between a physical therapist and surgeon influences treatment decisions of persons presenting to a hip preservation clinic. RATIONALE FOR STUDY DESIGN A prospective, randomized controlled trial provides the ability to identify cause and effect of this new evaluation type. METHODS Ninety-six adults with unilateral, NAHD presenting to a hip preservation clinic for initial evaluation will be randomized to receive either a standard evaluation with a surgeon or an interdisciplinary evaluation by a physical therapist and surgeon. Regardless of group, the surgeon conducts a standard-care examination. For participants in the interdisciplinary group, the physical therapist conducts an assessment of 6 postures and movements to identify asymmetrical, abnormal, or painful strategies. Treatment selection(s) and decisional conflict will be compared between groups after the evaluations. DISCUSSION Persons with NAHD may experience considerable decisional conflict because of prolonged duration of symptoms and minimal evidence to compare operative and non-operative treatment for this population. The findings of this study have the potential to improve patient experience and produce more informed and supported treatment decisions for persons considering surgical treatment for NAHD.
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Affiliation(s)
- Lindsey Brown
- PhD Candidate, Health and Rehabilitation Sciences Doctoral Program, School of Health and Rehabilitation Sciences, The Ohio State University & Graduate Research Associate, Sports Medicine Research Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Marcie Harris-Hayes
- Associate Professor, Program in Physical Therapy and Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Randi Foraker
- Associate Professor, Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA
| | - Kathryn Glaws
- Physical Therapist, Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - W. Kelton Vasileff
- Orthopaedic Surgeon, Sports Medicine Research Institute, The Ohio State University Wexner Medical Center & Assistant Professor, Department of Orthopaedics, The Ohio State University, Columbus, OH, USA
| | - Stephanie Di Stasi
- Assistant Professor, Division of Physical Therapy, School of Health and Rehabilitation Sciences; Health and Rehabilitation Sciences Doctoral Program, School of Health and Rehabilitation Sciences, The Ohio State University & Research Scientist, Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Inter-joint coordination of kinematics and kinetics before and after total hip arthroplasty compared to asymptomatic subjects. J Biomech 2018; 72:180-186. [DOI: 10.1016/j.jbiomech.2018.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 11/22/2022]
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Kinematic Differences During Single-Leg Step-Down Between Individuals With Femoroacetabular Impingement Syndrome and Individuals Without Hip Pain. J Orthop Sports Phys Ther 2018; 48:270-279. [PMID: 29510652 PMCID: PMC6570579 DOI: 10.2519/jospt.2018.7794] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study, case-control design. Background Despite recognition that femoroacetabular impingement syndrome (FAIS) is a movement-related disorder, few studies have examined dynamic unilateral tasks in individuals with FAIS. Objectives To determine whether movements of the pelvis and lower extremities in individuals with FAIS differ from those in individuals without hip pain during a single-leg step-down, and to analyze kinematic differences between male and female participants within groups. Methods Individuals with FAIS and individuals without hip pain performed a single-leg step-down while kinematic data were collected. Kinematics were evaluated at 60° of knee flexion. A linear regression analysis assessed the main effects of group, sex, and side, and the interaction of sex by group. Results Twenty individuals with FAIS and 40 individuals without hip pain participated. Individuals with FAIS performed the step-down with greater hip flexion (4.9°; 95% confidence interval [CI]: 0.5°, 9.2°) and anterior pelvic tilt (4.1°; 95% CI: 0.9°, 7.3°) than individuals without hip pain. Across groups, female participants performed the task with more hip flexion (6.1°; 95% CI: 1.7°, 10.4°), hip adduction (4.8°; 95% CI: 2.2°, 7.4°), anterior pelvic tilt (5.8°; 95% CI: 2.6°, 9.0°), pelvic drop (1.4°; 95% CI: 0.3°, 2.5°), and thigh adduction (2.7°; 95% CI: 1.3°, 4.2°) than male participants. Conclusion The results of this study suggest that individuals with FAIS have alterations in pelvic motion during a dynamic unilateral task. The noted altered movement patterns in the FAIS group may contribute to the development of hip pain and may be due to impairments that are modifiable through rehabilitation. J Orthop Sports Phys Ther 2018;48(4):270-279. Epub 6 Mar 2018. doi:10.2519/jospt.2018.7794.
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King MG, Lawrenson PR, Semciw AI, Middleton KJ, Crossley KM. Lower limb biomechanics in femoroacetabular impingement syndrome: a systematic review and meta-analysis. Br J Sports Med 2018; 52:566-580. [DOI: 10.1136/bjsports-2017-097839] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 11/06/2017] [Accepted: 12/18/2017] [Indexed: 12/18/2022]
Abstract
Objective(1) Identify differences in hip and pelvic biomechanics in patients with femoroacetabular impingement syndrome (FAIS) compared with controls during everyday activities (eg, walking, squatting); and (2) evaluate the effects of interventions on hip and pelvic biomechanics during everyday activities.DesignSystematic review.Data sourcesMedline, CINAHL, EMBASE, Scopus and SPORTDiscus until February 2017.MethodsPrimary aim: studies that investigated hip or pelvic kinematics and/or joint torques of everyday activities in patients with FAIS compared with the asymptomatic contralateral limb or a control group. Secondary aim: studies that evaluated effects of conservative or surgical interventions on patients with FAIS using pre-post or controlled clinical trial designs. Biomechanical data must have been collected using three-dimensional motion capture devices. Reporting quality was assessed using the Epidemiological Appraisal Instrument and data were pooled (standardised mean difference (SMD), 95% CI) where populations and primary outcomes were similar.ResultsFourteen studies were included (11 cross-sectional and three pre/post intervention), varying between low and moderate reporting quality. Patients with FAIS walked with a lower: peak hip extension angle (SMD −0.40, 95% CI −0.71 to −0.09), peak internal rotation angle (−0.67, 95% CI −1.19 to −0.16) and external rotation joint torque (−0.71, 95% CI −1.07 to −0.35), and squatted to a lesser depth with no difference in hip flexion range. Pre/post intervention data were limited in number and quality, and to surgical cohorts.ConclusionThis review suggests that patients with FAIS may demonstrate hip biomechanical impairments during walking and squatting, with minimal literature available to comment on other tasks.Clinical relevanceThe information presented in the review provides insight into the biomechanical differences associated with FAIS; however, the between-group differences were small to moderate. This information may aid in the development of management strategies for people with the condition.PROSPEROregistration numberCRD42016038677.
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Pedoia V, Samaan MA, Inamdar G, Gallo MC, Souza RB, Majumdar S. Study of the interactions between proximal femur 3d bone shape, cartilage health, and biomechanics in patients with hip Osteoarthritis. J Orthop Res 2018; 36:330-341. [PMID: 28688198 PMCID: PMC5962017 DOI: 10.1002/jor.23649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/05/2017] [Indexed: 02/04/2023]
Abstract
In this study quantitative MRI and gait analysis were used to investigate the relationships between proximal femur 3D bone shape, cartilage morphology, cartilage biochemical composition, and joint biomechanics in subject with hip Osteoarthritis (OA). Eighty subjects underwent unilateral hip MR-imaging: T1ρ and T2 relaxation times were extracted through voxel based relaxometry and bone shape was assessed with 3D MRI-based statistical shape modeling. In addition, 3D gait analysis was performed in seventy-six of the studied subjects. Associations between shape, cartilage lesion presence, severity, and cartilage T1ρ and T2 were analyzed with linear regression and statistical parametric mapping. An ad hoc analysis was performed to investigate biomechanics and shape associations. Our results showed that subjects with a higher neck shaft angle in the coronal plane (higher mode 1, coxa valga), thicker femoral neck and a less spherical femoral head (higher mode 5, pistol grip) exhibited more severe acetabular and femoral cartilage abnormalities, showing different interactions with demographics factors. Subjects with coxa valga also demonstrated a prolongation of T1ρ and T2. Subjects with pistol grip deformity exhibited reduced hip internal rotation angles and subjects with coxa valga exhibited higher peak hip adduction moment and moment impulse. The results of this study establish a clear relationship between 3D proximal femur shape variations and markers of hip joint degeneration-morphological, compositional, well as insight on the possible interactions with demographics and biomechanics, suggesting that 3D MRI-based bone shape maybe a promising biomarker of early hip joint degeneration. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:330-341, 2018.
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Affiliation(s)
- Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA
| | - Michael A. Samaan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA
| | - Gaurav Inamdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA
| | - Matthew C. Gallo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA
| | - Richard B. Souza
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, CA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA
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Adusumilli G, Joseph SE, Samaan MA, Schultz B, Popovic T, Souza RB, Majumdar S. iPhone Sensors in Tracking Outcome Variables of the 30-Second Chair Stand Test and Stair Climb Test to Evaluate Disability: Cross-Sectional Pilot Study. JMIR Mhealth Uhealth 2017; 5:e166. [PMID: 29079549 PMCID: PMC5681723 DOI: 10.2196/mhealth.8656] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 08/29/2017] [Accepted: 09/16/2017] [Indexed: 11/16/2022] Open
Abstract
Background Performance tests are important to characterize patient disabilities and functional changes. The Osteoarthritis Research Society International and others recommend the 30-second Chair Stand Test and Stair Climb Test, among others, as core tests that capture two distinct types of disability during activities of daily living. However, these two tests are limited by current protocols of testing in clinics. There is a need for an alternative that allows remote testing of functional capabilities during these tests in the osteoarthritis patient population. Objective Objectives are to (1) develop an app for testing the functionality of an iPhone’s accelerometer and gravity sensor and (2) conduct a pilot study objectively evaluating the criterion validity and test-retest reliability of outcome variables obtained from these sensors during the 30-second Chair Stand Test and Stair Climb Test. Methods An iOS app was developed with data collection capabilities from the built-in iPhone accelerometer and gravity sensor tools and linked to Google Firebase. A total of 24 subjects performed the 30-second Chair Stand Test with an iPhone accelerometer collecting data and an external rater manually counting sit-to-stand repetitions. A total of 21 subjects performed the Stair Climb Test with an iPhone gravity sensor turned on and an external rater timing the duration of the test on a stopwatch. App data from Firebase were converted into graphical data and exported into MATLAB for data filtering. Multiple iterations of a data processing algorithm were used to increase robustness and accuracy. MATLAB-generated outcome variables were compared to the manually determined outcome variables of each test. Pearson’s correlation coefficients (PCCs), Bland-Altman plots, intraclass correlation coefficients (ICCs), standard errors of measurement, and repeatability coefficients were generated to evaluate criterion validity, agreement, and test-retest reliability of iPhone sensor data against gold-standard manual measurements. Results App accelerometer data during the 30-second Chair Stand Test (PCC=.890) and gravity sensor data during the Stair Climb Test (PCC=.865) were highly correlated to gold-standard manual measurements. Greater than 95% of values on Bland-Altman plots comparing the manual data to the app data fell within the 95% limits of agreement. Strong intraclass correlation was found for trials of the 30-second Chair Stand Test (ICC=.968) and Stair Climb Test (ICC=.902). Standard errors of measurement for both tests were found to be within acceptable thresholds for MATLAB. Repeatability coefficients for the 30-second Chair Stand Test and Stair Climb Test were 0.629 and 1.20, respectively. Conclusions App-based performance testing of the 30-second Chair Stand Test and Stair Climb Test is valid and reliable, suggesting its applicability to future, larger-scale studies in the osteoarthritis patient population.
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Affiliation(s)
- Gautam Adusumilli
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Solomon Eben Joseph
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Michael A Samaan
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Brooke Schultz
- Human Performance Center, Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Tijana Popovic
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Richard B Souza
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Imaging, University of California San Francisco, San Francisco, CA, United States.,Human Performance Center, Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, United States
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Imaging, University of California San Francisco, San Francisco, CA, United States
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