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Granström MK, Roepstorff L, Pettersson K, Ljungvall I, Dimopoulou M, Peck C, Bergström A. Evaluation of forelimb gait variation overground at a walk in sound and lame dogs using a combination of diagnostic techniques. Acta Vet Scand 2024; 66:25. [PMID: 38902837 PMCID: PMC11191351 DOI: 10.1186/s13028-024-00746-w] [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: 01/03/2024] [Accepted: 05/31/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Kinetic and kinematic gait analysis is increasingly practised as a part of lameness evaluation in dogs. The aim of this study was to examine the normal short- and long-term variation in forelimb gait in sound control dogs (CD) at a walk using seven selected variables of objective kinetic and kinematic gait analyses. Also, to compare the findings in CD to a group of forelimb lame dogs with elbow osteoarthritis (OAD). An additional aim was to test a kinetic based graphic method for lameness detection; symmetry squares (SS). A prospective longitudinal study was carried out on client owned CD and OAD. Clinical and orthopaedic evaluations were performed to ensure soundness and detect and grade lameness. Seven kinetic and kinematic variables and SS were tested for lameness evaluation. The CD were divided into two subgroups, CD1 and CD2, and examined twice: CD1 with two months interval and CD2 with 3-4 h interval. The OAD group was evaluated once and compared to the CD groups' first examination. RESULTS Thirteen CD and 19 OAD were included. For CD1 and CD2, there were no significant differences in any examined variable between examination occasions. Total peak force/impulse symmetry and fore-hind peak force/impulse symmetry differed significantly between OAD and CD. Symmetry squares had a 74% agreement to subjective orthopaedic evaluations. CONCLUSIONS In CD, no difference in the examined variables was seen between examination occasions. Four out of seven objective variables differed significantly between CD and OAD. The graphic SS method might have diagnostic potential for lameness detection, making it possible to detect a shift from lame to non-lame limbs. Potentially, this might be especially helpful in bilaterally lame dogs, which often represent a clinical challenge in lameness evaluation.
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Affiliation(s)
- Miriam Kjörk Granström
- University Animal Hospital, Swedish University of Agricultural Sciences, Ultunaallén 5A, Uppsala, SE-75007, Sweden.
| | - Lars Roepstorff
- Department of Anatomy, Physiology and Biochemistry, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, P.O. Box 7070, Uppsala, SE-75007, Sweden
| | - Kjerstin Pettersson
- University Animal Hospital, Swedish University of Agricultural Sciences, Ultunaallén 5A, Uppsala, SE-75007, Sweden
| | - Ingrid Ljungvall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, P.O. Box 7070, Uppsala, SE-75007, Sweden
| | - Maria Dimopoulou
- University Animal Hospital, Swedish University of Agricultural Sciences, Ultunaallén 5A, Uppsala, SE-75007, Sweden
| | - Charlie Peck
- University Animal Hospital, Swedish University of Agricultural Sciences, Ultunaallén 5A, Uppsala, SE-75007, Sweden
| | - Annika Bergström
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, P.O. Box 7070, Uppsala, SE-75007, Sweden
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Khuna L, Soison T, Plukwongchuen T, Tangadulrat N. Reliability and concurrent validity of 30-s and 5-time sit-to-stand tests in older adults with knee osteoarthritis. Clin Rheumatol 2024; 43:2035-2045. [PMID: 38634965 DOI: 10.1007/s10067-024-06969-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/28/2024] [Accepted: 04/14/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Sit-to-stand (STS) movement is fundamental in daily life. STS tasks have been used to assess lower limb muscle strength, balance control, and functional abilities in various populations, but limited information is available on their use in older individuals with knee osteoarthritis. OBJECTIVE We here examined the intra-rater, inter-rater, and test-retest reliability of the 30-s and 5-time STS tests, and calculated the standard error of measurement (SEM) and minimal detectable change (MDC). Moreover, we explored the concurrent validity of these tests by analysing their correlation with knee muscle strength, pain, stiffness, and physical function in older adults with knee osteoarthritis. METHOD This cross-sectional study included 60 older participants diagnosed with knee osteoarthritis. Baseline demographic information and data on pain, stiffness, and physical function using the modified Western Ontario and McMaster Universities Osteoarthritis (WOMAC) were obtained. Participants performed the 30-s and 5-time STS tests as well as knee muscle strength assessment using a hand-held dynamometer. After 1 week, 30 participants were reassessed to evaluate test-retest reliability. RESULTS The 30-s and 5-time STS tests had excellent intra-, inter-, and test-retest reliability (intraclass correlation coefficients: 0.990-1.000, 0.996-0.999, and 0.841-0.853, respectively) with a large SEM and MDC. Both STS tests significantly correlated with knee extensor and flexor strength and all modified WOMAC domains (Pearson's correlation coefficients: 0.28-0.61, p < 0.05). CONCLUSION The 30-s and 5-time STS tests are reliable assessment tools and correlate with knee muscle strength, pain, stiffness, and physical function in older adults with knee osteoarthritis. Key Points • The 30-s and 5-time STS test can serve as surrogate measures in various aspects of knee health, including muscle strength, pain levels, stiffness, and overall physical function, in older adults with knee osteoarthritis. • Both these STS tests are dependable tools, accessible for both experienced and inexperienced assessors to administer effectively.
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Affiliation(s)
- Lalita Khuna
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
| | - Tussaneeporn Soison
- Physical Therapy Unit, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Theardkhwan Plukwongchuen
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Napaporn Tangadulrat
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Silva MDC, Woodward AP, Fearon AM, Perriman DM, Spencer TJ, Couldrick JM, Scarvell JM. Minimal clinically important change of knee flexion in people with knee osteoarthritis after non-surgical interventions using a meta-analytical approach. Syst Rev 2024; 13:50. [PMID: 38303000 PMCID: PMC10832130 DOI: 10.1186/s13643-023-02393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/17/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Minimal clinically important change (MCIC) represents the minimum patient-perceived improvement in an outcome after treatment, in an individual or within a group over time. This study aimed to determine MCIC of knee flexion in people with knee OA after non-surgical interventions using a meta-analytical approach. METHODS Four databases (MEDLINE, Cochrane, Web of Science and CINAHL) were searched for studies of randomised clinical trials of non-surgical interventions with intervention duration of ≤ 3 months that reported change in (Δ) (mean change between baseline and immediately after the intervention) knee flexion with Δ pain or Δ function measured using tools that have established MCIC values. The risk of bias in the included studies was assessed using version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Bayesian meta-analytic models were used to determine relationships between Δ flexion with Δ pain and Δ function after non-surgical interventions and MCIC of knee flexion. RESULTS Seventy-two studies (k = 72, n = 5174) were eligible. Meta-analyses included 140 intervention arms (k = 61, n = 4516) that reported Δ flexion with Δ pain using the visual analog scale (pain-VAS) and Δ function using the Western Ontario and McMaster Universities Osteoarthritis Index function subscale (function-WOMAC). Linear relationships between Δ pain at rest-VAS (0-100 mm) with Δ flexion were - 0.29 (- 0.44; - 0.15) (β: posterior median (CrI: credible interval)). Relationships between Δ pain during activity VAS and Δ flexion were - 0.29 (- 0.41, - 0.18), and Δ pain-general VAS and Δ flexion were - 0.33 (- 0.42, - 0.23). The relationship between Δ function-WOMAC (out of 100) and Δ flexion was - 0.15 (- 0.25, - 0.07). Increased Δ flexion was associated with decreased Δ pain-VAS and increased Δ function-WOMAC. The point estimates for MCIC of knee flexion ranged from 3.8 to 6.4°. CONCLUSIONS The estimated knee flexion MCIC values from this study are the first to be reported using a novel meta-analytical method. The novel meta-analytical method may be useful to estimate MCIC for other measures where anchor questions are problematic. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022323927.
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Affiliation(s)
- M Denika C Silva
- Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia.
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australia.
- Department of Physiotherapy, General Sir John Kotelawala Defence University, Werahera, Colombo, Sri Lanka.
| | - Andrew P Woodward
- Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Angela M Fearon
- Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australia
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Diana M Perriman
- Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australia
- College of Medicine and Health Sciences, Australian National University, Canberra, Australia
| | - Trevor J Spencer
- Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australia
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Jacqui M Couldrick
- Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australia
| | - Jennie M Scarvell
- Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australia
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Camillieri S. The five times sit-to-stand test predicts same-day discharge for outpatients undergoing total joint arthroplasty. INTERNATIONAL ORTHOPAEDICS 2024; 48:351-356. [PMID: 37775574 DOI: 10.1007/s00264-023-05994-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE To examine whether a patient's pre-operatively administered five times sit-to-stand (FTSTS) test score, when used alone or when combined with previously established predictors, relates to same-day discharge (SDD) after total knee or hip arthroplasty. METHODS This study utilized a multivariate, retrospective, observational design. Electronic medical record data for included participants were used to analyze the relationship between the patient factors (including the novel FTSTS variable) and the SDD outcome. Univariate and multiple variable regression modeling was undertaken to understand the strength of the relationship between the independent variables with the dependent variable. Receiver operating curve (ROC) analysis was performed to determine the area under the curve (AUC) for the novel model. Cut score analysis was performed to establish the score which has the greatest utility for stratifying patients based upon their likelihood of achieving SDD. RESULTS All independent variables related to the SDD outcome with varying effect sizes. The dichotomized FTSTS score related to the SDD outcome with medium effect (Exp(B) = 2.56). The score of 13.6 s was established as the point where the test was most highly sensitive and specific. The combined model including all included patient characteristics had a classification accuracy of 64.7% and an area under the curve score of .724. CONCLUSION The FTSTS score had higher predictive accuracy than all other stand-alone patient characteristics for the SDD outcome.
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Affiliation(s)
- Susan Camillieri
- Department of Rehabilitation Medicine, RUSK Rehabilitation at NYU Langone Health, NYU Langone Orthopedic Hospital, 301 E. 17Th Street, 5Th Floor, Office 508, New York, NY, 10003, USA.
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Alpay K, Sahin M. Effects of basic body awareness therapy on pain, balance, muscle strength and functionality in knee osteoarthritis: a randomised preliminary trial. Disabil Rehabil 2023; 45:4373-4380. [PMID: 36444879 DOI: 10.1080/09638288.2022.2151650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 11/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to investigate the effects of basic body awareness therapy (BBAT) on pain, balance, muscle strength, and functionality in knee OA. METHODS Forty patients (mean age: 55.20 ± 6.40 years) with knee OA were randomly assigned to experimental and control groups. Both groups participated in a home-based exercise programme. The home-based exercise programme was performed daily for 6 weeks. In addition to the home-based programme, patients in the experimental group participated in BBAT 3 days a week for 6 weeks. The visual analogue scale, fall risk assessment, single-leg stability test, knee extension muscle strength, five times sit-to-stand test, joint range of motion assessment, Western Ontario and McMaster Universities Osteoarthritis Index, 6-minute walk test, and stair climb test were performed at baseline and after 6 weeks. RESULTS All outcomes in the experimental group significantly improved after 6 weeks (p < 0.05). There were significant differences between the two groups in terms of the experimental group in muscle strength (p = 0.018, η2= 0.191), five times sit-to-stand test (p < 0.001, η2= 0.510), and the stair climbing test (p = 0.012, η2=0.212). CONCLUSION This study showed that BBAT, in addition to a home-based exercise programme, can improve muscle strength and functionality in patients with knee OA. CLINICAL TRIAL REGISTRATION NUMBER NCT04165187.
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Affiliation(s)
- Kubra Alpay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey
- Health Sciences Institute, Istanbul Medipol University, Istanbul, Turkey
| | - Mustafa Sahin
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Murao M, Nankaku M, Kawano T, Goto K, Kuroda Y, Kawai T, Ikeguchi R, Matsuda S. Reproducibility, criterion-related validity, and minimal clinically important difference of the stair negotiation test after total Hip arthroplasty. Physiother Theory Pract 2023; 39:2438-2445. [PMID: 35581533 DOI: 10.1080/09593985.2022.2078255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 03/10/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the reproducibility, criterion-related validity, and minimal clinically important difference (MCID) of the stair negotiation test (SNT) after total hip arthroplasty (THA). METHODS Sixty patients who underwent THA were included in this study. They performed the SNT and rated their difficulty in stair negotiation (question 7 of the Oxford Hip Score [OHSQ7]) before and 6 months after surgery. The SNT determined the time taken by a patient to ascend, turn around, and descend the stairs (15 cm × 4 steps) and was measured twice each time. As a measure of reproducibility, the intraclass correlation coefficient (ICC1,1) was calculated using the preoperative SNT. As an index of criterion-related validity, Spearman's rank correlation coefficient was used to evaluate the relationship between the better score of two trials in the preoperative SNT and the OHSQ7. The MCID of the SNT was calculated using the distribution-based method and the anchor-based method. The change in the OHSQ7 between before and after surgery was used as an anchor in the latter method. RESULTS The ICC1,1 of the SNT was 0.97. The SNT was significantly correlated with the OHSQ7 (r = 0.40, p < .05). Moreover, the anchor-based MCID of the SNT was 1.98 seconds. CONCLUSION The SNT is an objective assessable test of stair negotiation ability in post-THA patients that has good reproducibility and moderate criterion-related validity. Changes in the SNT beyond the MCID (1.98 seconds) represent clinically important changes in stair negotiation ability.
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Affiliation(s)
- Masanobu Murao
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Takumi Kawano
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Knox PJ, Simon CB, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. Construct validity of movement-evoked pain operational definitions in older adults with chronic low back pain. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:985-992. [PMID: 36944266 PMCID: PMC10391587 DOI: 10.1093/pm/pnad034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Movement-evoked pain (MeP) may predispose the geriatric chronic low back pain (LBP) population to health decline. As there are differing operational definitions for MeP, the question remains as to whether these different definitions have similar associations with health outcomes in older adults with chronic LBP. DESIGN Cross-sectional analysis of an observational study. SETTING Clinical research laboratory. SUBJECTS 226 older adults with chronic LBP. METHODS This secondary analysis used baseline data from a prospective cohort study (n = 250). LBP intensity was collected before and after the repeated chair rise test, stair climbing test, and 6-minute walk test; MeP change scores (ie, sum of pretest pain subtracted from posttest pain) and aggregated posttest pain (ie, sum of posttest pain) variables were calculated. LBP-related disability and self-efficacy were measured by the Quebec Back Pain Disability Scale (QBPDS) and Low Back Activity Confidence Scale (LOBACS), respectively. Physical function was measured with the Health ABC Performance Battery. Robust regression with HC3 standard errors was used to evaluate adjusted associations between both MeP variables and disability, self-efficacy, and physical function. RESULTS Greater aggregated posttest MeP was independently associated with worse disability (b = 0.593, t = 2.913, P = .004), self-efficacy (b = -0.870, t = -3.110, P = .002), and physical function (b = -0.017, t = -2.007, P = .039). MeP change scores were not associated with any outcome (all P > .050). CONCLUSIONS Aggregate posttest MeP was linked to poorer health outcomes in older adults with chronic LBP, but MeP change scores were not. Future studies should consider that the construct validity of MeP paradigms partially depends on the chosen operational definition.
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Affiliation(s)
- Patrick J Knox
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Corey B Simon
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, NC 27710, United States
| | - Ryan T Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE 19713, United States
- Biostatistics Core, University of Delaware, Newark, DE 19713, United States
| | - Jenifer M Pugliese
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Jaclyn M Sions
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
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Di Stasi S, Chaudhari AMW, Renshaw S, Wei L, Ward L, Arhos EK, Poulose BK. ABVENTURE-P pilot trial of physical therapy versus standard of care following ventral hernia repair: Protocol for a randomized controlled trial. PLoS One 2023; 18:e0289038. [PMID: 37498821 PMCID: PMC10374060 DOI: 10.1371/journal.pone.0289038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/30/2023] [Indexed: 07/29/2023] Open
Abstract
Hernia disease is one of the most common reasons patients seek surgical treatment, yet nearly 1 in 4 patients seeking ventral hernia repair in the United States suffer from chronic pain, disability, and diminished physical activity. The relationships between the anterior abdominal wall, lower back, diaphragm, and pelvic floor are critical in providing function and quality of life, yet management of hernia disease has been limited to surgical restoration of anatomy without taking into consideration the functional relationships of the abdominal core. Therefore, the primary goal of this study is to evaluate the feasibility of implementing physical therapy targeted to improving stability and function in this population. A secondary goal is to estimate whether pre-operative abdominal core function predicts responsiveness to physical therapy. This study is a registry-based randomized controlled trial (NCT05142618: Pilot Trial of Abdominal Core Rehabilitation To Improve Outcomes After Ventral Hernia Repair (ABVENTURE-P)). All participants will be randomized to one of two post-operative treatment arms: standard of care plus up to 16 sessions of physical therapy, or standard of care alone. Primary timepoints include pre-operative (baseline) and ten weeks after surgery, with intermediate or secondary timepoints 30 days, 6 months, and 1 year post-operative. At each timepoint, participants will undergo functional and patient-reported outcome testing. We will also collect data on retention rate and treatment adherence. An intention to treat approach is planned for all analyses, using all participants who were randomized and have available data at the 10-week timepoint. This is a pilot and feasibility trial, hence our goals are to establish safety and initial efficacy of the PT intervention, retention and adherence to both PT and control arms, whether pre-operative abdominal core function predicts responsiveness to PT, and to collect a large enough sample to power a future definitive multi-center randomized controlled trial.
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Affiliation(s)
- Stephanie Di Stasi
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, Ohio, United States of America
- Sports Medicine Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Ajit M. W. Chaudhari
- Sports Medicine Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, Ohio, United States of America
| | - Savannah Renshaw
- Center for Abdominal Core Health, Division of General and Gastrointestinal Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Lai Wei
- Department of Biomedical Informatics, Center for Biostatistics, Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Laura Ward
- Outpatient Rehabilitation Services, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Elanna K. Arhos
- Sports Medicine Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, Ohio, United States of America
| | - Benjamin K. Poulose
- Center for Abdominal Core Health, Division of General and Gastrointestinal Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
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Zeng D, Ling XY, Fang ZL, Lu YF. Optimal exercise to improve physical ability and performance in older adults with sarcopenia: a systematic review and network meta-analysis. Geriatr Nurs 2023; 52:199-207. [PMID: 37400288 DOI: 10.1016/j.gerinurse.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The study aimed to pool and analyze the effects of different forms of exercise on muscle strength (handgrip strength [HGS]), and physical performance (timed up and go test [TUGT], gait speed [GS] and chair stand test [CS]) in older adults with sarcopenia. METHODS The effect sizes of all studies retrieved and included by the four databases were analyzed using the network meta-analysis and expressed as standardized mean differences (SMD) and the corresponding 95% confidence intervals (CI). RESULTS Twenty studies were included in this study with 1347 older adults with sarcopenia. Compared with control and other intervention groups, resistance training (RT) improved HGS [SMD=3.8, 95% CI (1.3, 6.0), p<0.05] and TUGT [SMD = -1.99, 95% CI (-2.82, -1.16), p<0.05] significantly. comprehensive training (CT) [SMD = -2.04, 95% CI (-3.05, -1.06), Pp<0.05] and Comprehensive training under self-management (CT_SM) [SMD = -2.01, 95% CI (-3.24, -0.78), p<0.05] improved TUGT significantly. CONCLUSION In older adults with sarcopenia, RT could improve HGS and TUGT, CT and CT_SM could improve TUGT. There were no significant changes in CS and GS with any of the exercise training modes.
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Affiliation(s)
- Dan Zeng
- School of Sport Medicine and Physical Therapy, Beijing Sport University, Xinxi Road, No. 48, Haidian District, Beijing 100084, China
| | - Xiao-Yu Ling
- School of Sport Medicine and Physical Therapy, Beijing Sport University, Xinxi Road, No. 48, Haidian District, Beijing 100084, China
| | - Zi-Long Fang
- School of Sport Medicine and Physical Therapy, Beijing Sport University, Xinxi Road, No. 48, Haidian District, Beijing 100084, China.
| | - Yi-Fan Lu
- School of Sport Medicine and Physical Therapy, Beijing Sport University, Xinxi Road, No. 48, Haidian District, Beijing 100084, China; Key Laboratory of Sports Stress and Adaptation of General Administration of Sport, Beijing Sport University, Xinxi Road, No. 48, Haidian District, Beijing 100084, China
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Wijnen A, Seeber GH, Dietz G, Dijkstra B, Dekker JS, Vermeulen KM, Slager GEC, Hessel A, Lazovic D, Bulstra SK, Stevens M. Effectiveness of rehabilitation for working-age patients after a total hip arthroplasty: a comparison of usual care between the Netherlands and Germany. BMC Musculoskelet Disord 2023; 24:525. [PMID: 37370054 DOI: 10.1186/s12891-023-06654-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Postoperative rehabilitation after primary total hip arthroplasty (p-THA) differs between the Netherlands and Germany. Aim is to compare clinical effectiveness and to get a first impression of cost effectiveness of Dutch versus German usual care after p-THA. METHODS A transnational prospective controlled observational trial. Clinical effectiveness was assessed with self-reported questionnaires and functional tests. Measurements were taken preoperatively and 4 weeks, 12 weeks, and 6 months postoperatively. For cost effectiveness, long-term economic aspects were assessed from a societal perspective. RESULTS 124 working-age patients finished the measurements. German usual care leads to a significantly larger proportion (65.6% versus 47.5%) of satisfied patients 12 weeks postoperatively and significantly better self-reported function and Five Times Sit-to-Stand Test (FTSST) results. German usual care is generally 45% more expensive than Dutch usual care, and 20% more expensive for working-age patients. A scenario analysis assumed that German patients work the same number of hours as the Dutch, and that productivity costs are the same. This analysis revealed German care is still more expensive but the difference decreased to 8%. CONCLUSIONS German rehabilitation is clinically advantageous yet more expensive, although comparisons are less straightforward as the socioeconomic context differs between the two countries. TRIAL REGISTRATION The study is registered in the German Registry of Clinical Trials (DRKS00011345, 18/11/2016).
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Affiliation(s)
- Annet Wijnen
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Gesine H Seeber
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Günter Dietz
- Clinic for Orthopedic and Rheumatological Rehabilitation, Reha-Zentrum Am Meer Bad Zwischenahn, Bad Zwischenahn, Germany
- Praxis Für Orthopädie, Bad Zwischenahn, Germany
| | - Baukje Dijkstra
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Johan S Dekker
- Department of Orthopedics, Ommelander Ziekenhuis Groningen, Scheemda, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geranda E C Slager
- Department of Physical Therapy, School of Health Care Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Aike Hessel
- Deutsche Rentenversicherung Oldenburg, Bremen, Germany
| | - Djordje Lazovic
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Sjoerd K Bulstra
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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11
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Stasi S, Sarantis M, Papathanasiou G, Evaggelou-Sossidis G, Stamou M, Tzefronis D, Macheras G. Stair Climbing Ability and Identification of the Nine Stairs Ascent and Descent Test Cut-Off Points in Hip Osteoarthritis Patients: A Retrospective Study. Cureus 2023; 15:e41095. [PMID: 37519506 PMCID: PMC10380059 DOI: 10.7759/cureus.41095] [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] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Objectives As the prevalence and incidence of hip osteoarthritis (hip OA) continue to rise, measuring the impact of hip OA severity on a patient's functionality is essential. Stair walking is a particularly relevant task to assess hip OA patients, as difficulty with stair ascent is one of the driving factors in deciding to undergo a total hip arthroplasty. Although stairs tests often arise in post-arthroplasty measures, there is a lack of reported stairs performance time in hip OA patients. Therefore, this retrospective study aimed to report the stair performance time of hip OA patients categorized by disease severity and determine cut-off points that differentiate between severity grades. Materials and methods The patient selection was based on the review of de-identified data from our research laboratory database. 254 hip OA patients (aged ≥ 50 years) were divided according to the Kellgren-Lawrence classification system into three groups: Grade 2 (n=68), Grade 3 (n=109), and Grade 4 (n= 68). The stair-walking ability was evaluated using the 9S-A/D test. The time taken to ascend and descend the stairs was measured separately, and the total time (9S-A/D) was also recorded. The one-way ANOVA model, Welch test, Games-Howell posthoc test, Chi-Square tests, and Two-Way ANOVA model were used for the statistical analysis of the data. The cut-off points were obtained by receiver operating curve (ROC) analysis. The statistical significance was set at p<0.05. Results Homogeneity was found between the three groups regarding demographic and clinical characteristics, except age and gender (p<0.001). The comparison of the variables (9S-ascent, 9S-descent, and 9S-A/D) between groups, adjusted for gender and age, showed significant differences: Grade 2 individuals had shorter performance times compared to those in Grade 3 and Grade 4 (p<0.005). Simultaneously, patients with Grade 3 hip OA have a shorter performance time than those with Grade 4 hip OA (p<0.005). Regarding ROC analysis of Grade 2 versus Grade 3: The AUCs of 9S-ascend, 9S-descent, and 9S-A/D were 0.742 (95%CI 0.67-0.81), 0.734 (95%CI 0.66-0.81), and 0.745 (95%CI 0.54-0.90), respectively (all p values <0.005). The cut-off points of 9S-ascend, 9S-descent, and 9S-A/D were 8.7 s (sensitivity 56%, specificity 88%), 7.1 s (sensitivity 58%, specificity 80%), and 16.25 s (sensitivity 54%, specificity 90%), respectively. Concerning ROC analysis of Grade 3 versus Grade 4: The AUCs of 9S-ascend, 9S-descent, and 9S-A/D were 0.702 (95%CI 0.62-0.78), 0.711 (95%CI 0.63-0.79), and 0.715 (95%CI 0.64-0.80), respectively (all p values <0.005). The cut-off points of 9S-ascend, 9S-descent, and 9S-A/D were 11.5 s (sensitivity 66%, specificity 65%), 8.3 s (sensitivity 71%, specificity 62%), and 19.05 s (sensitivity 71%, specificity 61%), respectively. Conclusions The study provides evidence that the progression of hip OA affected stair walking; the performance time of 9S-ascent, 9S-ascent, and 9S-A/D tests was significantly longer as the severity of hip OA worsened. ROC analysis results show tests' ability to distinguish the cut-off point between different hip OA grades. However, further research is required for the reporting and classification of stair performance time values in hip OA patients and to further investigate the ability of 9S-ascent, 9S-descent, and 9S-A/D tests to predict the grade of hip OA.
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Affiliation(s)
- Sophia Stasi
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
| | - Michail Sarantis
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
| | - George Papathanasiou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
| | - George Evaggelou-Sossidis
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
| | - Magda Stamou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
| | - Dimitrios Tzefronis
- 7th Orthopaedic Department, Henry Dunant Hospital, Athens, GRC
- Department of Minimal Invasive Orthopaedic Surgery, Athens Medical Center, Athens, GRC
| | - George Macheras
- 7th Orthopaedic Department, Henry Dunant Hospital, Athens, GRC
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
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12
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Knox PJ, Simon CB, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. Movement-Evoked Pain Versus Widespread Pain: A Longitudinal Comparison in Older Adults With Chronic Low Back Pain From the Delaware Spine Studies. THE JOURNAL OF PAIN 2023; 24:980-990. [PMID: 36706887 PMCID: PMC10257757 DOI: 10.1016/j.jpain.2023.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/20/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
It is currently unknown which pain-related factors contribute to long-term disability and poorer perceived health among older adults with chronic low back pain (LBP). This investigation sought to examine the unique influence of movement-evoked pain (MeP) and widespread pain (WP) on longitudinal health outcomes (ie, gait speed, perceived disability, and self-efficacy) in 250 older adults with chronic LBP. MeP was elicited with 3 standardized functional tests, while presence of WP was derived from the McGill Pain Map. Robust regression with HC3 standard errors was used to examine associations between these baseline pain variables and health outcomes at 12-month follow-up. Covariates for these models included age, sex, body mass index, resting and recall LBP intensity, LBP duration, depression, pain catastrophizing, and baseline outcome (eg, baseline gait speed). Greater MeP was independently associated with worse 12-month LBP-related disability (b = .384, t = 2.013, P = .046) and poorer self-efficacy (b = -.562, t = -2.074, P = .039); but not gait speed (P > .05). In contrast, WP and resting and recall LBP intensity were not associated with any prospective health outcome after adjustment (all P > .05). Compared to WP and resting and recall LBP intensity, MeP is most strongly related to longitudinal health outcomes in older adults with chronic LBP. PERSPECTIVE: This article establishes novel independent associations between MeP and worse perceived disability and self-efficacy at 12-months in older adults with chronic LBP. MeP likely has biopsychosocial underpinnings and consequences and may therefore be an important determinant of health outcomes in LBP and other geriatric chronic pain populations.
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Affiliation(s)
- Patrick J Knox
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Corey B Simon
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, North Carolina
| | - Ryan T Pohlig
- Department of Epidemiology, University of Delaware, Newark, Delaware; Biostatistics Core, University of Delaware, Newark, Delaware
| | - Jenifer M Pugliese
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Jaclyn M Sions
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, Delaware.
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13
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Frade S, O’Neill S, Walsh S, Campbell C, Greene D, Bird SP, Cameron M. Telehealth-supervised exercise in systemic lupus erythematosus: A pilot study. Lupus 2023; 32:508-520. [PMID: 36803286 PMCID: PMC9944478 DOI: 10.1177/09612033231157073] [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] [Indexed: 02/22/2023]
Abstract
OBJECTIVES To explore the feasibility and effectiveness of telehealth-supervised exercise for adults with Systemic lupus erythematosus (SLE). METHODS This was a non-randomised controlled pilot trial comparing telehealth-supervised exercise (8 weeks, 2 days/week, 45 min, moderate intensity) plus usual care with usual care alone. Mixed methods were used to assess change in fatigue (FACIT-fatigue), quality of life (SF36), resting fatigue and pain (11-point scale), lower body strength (five-time sit-to-stand) and endurance (30 s sit-to-stand), upper body endurance (30 s arm curl), aerobic capacity (2 min step test), and experience (survey and interviews). Group comparison was performed statistically using a two-sample T-test or Mann-Whitney U-test. Where known, we used MCID or MCII, or assumed a change of 10%, to determine clinically meaningful change within groups over time. Interviews were analysed using reflexive thematic analysis. RESULTS Fifteen female adults with SLE were included (control group n = 7, exercise group n = 8). Statistically significant differences between groups, in favour of the exercise intervention, were noted for SF36 domain emotional well-being (p = 0.048) and resting fatigue (p = 0.012). There were clinically meaningful improvements over time for FACIT-fatigue (+6.3 ± 8.3, MCID >5.9), SF36 domains physical role functioning (+30%), emotional role functioning (+55%), energy/fatigue (+26%), emotional well-being (+19%), social functioning (+30%), resting pain (-32%), and upper body endurance (+23%) within the exercise group. Exercise attendance was high (98%, 110/112 sessions); participants strongly agreed (n = 5/7, 71%) or agreed (n = 2/7, 29%) they would do telehealth-supervised exercise again and were satisfied with the experience. Four themes emerged: (1) ease and efficiency of exercising from home, (2) value of live exercise instruction, (3) challenges of exercising at home, and (4) continuation of telehealth-supervised exercise sessions. CONCLUSION Key findings from this mixed-method investigation suggest that telehealth-supervised exercise was feasible for, and well-accepted by, adults with SLE and resulted in some modest health improvements. We recommend a follow-up RCT with more SLE participants.
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Affiliation(s)
- Stephanie Frade
- School of Health and Medical
Sciences, Faculty of Health and Engineering and Sciences, University of Southern
Queensland, Ipswich, Australia,Stephanie Frade, School of Health and
Wellbeing, University of Southern Queensland, 11 Salisbury Ave, Ipswich, QLD
4305, Australia.
| | - Sean O’Neill
- Department of Rheumatology Institute of Bone and Joint Research,
Kolling Institute, University of Sydney, Sydney, Australia
| | - Samantha Walsh
- School of Behavioural and Health
Sciences Australian Catholic
University, Strathfield, Australia
| | - Chloe Campbell
- School of Health and Medical
Sciences, Faculty of Health and Engineering and Sciences, University of Southern
Queensland, Ipswich, Australia
| | - David Greene
- School of Behavioural and Health
Sciences Australian Catholic
University, Strathfield, Australia
| | - Stephen P. Bird
- School of Health and Medical
Sciences, Faculty of Health and Engineering and Sciences, University of Southern
Queensland, Ipswich, Australia
| | - Melainie Cameron
- School of Health and Medical
Sciences, Faculty of Health and Engineering and Sciences, University of Southern
Queensland, Ipswich, Australia
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14
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de Melo TA, Silva Guimarães F, Lapa E Silva JR. The five times sit-to-stand test: safety, validity and reliability with critical care survivors's at ICU discharge. Arch Physiother 2022; 13:2. [PMID: 36597159 PMCID: PMC9809000 DOI: 10.1186/s40945-022-00156-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 10/29/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The Five Times Sit-to-Stand Test (FTSST) has been found reliable, safe and valid for measuring healthy adults' lower limb muscle strength and for determining balance control, fall risk, and exercise capacity among older examinees. We believe that the FTSST has the potential to be a straightforward, low cost and valuable tool for identifying muscle disability and functional status following critical illness. The aim of our study was to establish the applicability, safety, and psychometric qualities of FTSST in patients at Intensive Care Unit (ICU) discharge. METHODS In our study applicability was determined by assessing the percentage of patients who could perform the test at ICU discharge. Safety was assessed by examining data regarding any exacerbated haemodynamic and respiratory responses or adverse events associated with the test. For assessing FTSST reliability, intraclass correlation coefficients (ICCs), standard error of measurement (SEM) and Bland-Altman plot were used. For assessing concurrent validity handgrip strength, ICU length of stay, duration of invasive ventilation, Simplified Acute Physiology Score 3 (SAPS3) and age variables were used. For investigating predictive validity, correlations between the FTSST and measures of hospital length of stay and functional independence were evaluated. RESULTS Only 30% of ICU survivors (n = 261 out of 817) were eligible to perform the FTSST and 7% of patients who performed the test (n = 10 out of 142) presented adverse events. Both inter (ICC 0.92 CI95% 0.89-0.94) and intra-rater (ICC 0.95 CI95% 0.93-0.96) reliability were excellent and higher scores were associated with lower muscle strength, longer hospital stay and greater functional impairment at hospital discharge in adult survivors of critical diseases. CONCLUSION Our results suggest that the FTSST may be applicable only to high-functioning critical care survivors. In this specifical population, FTSST is a safe, easy to perform, valid and reliable measure that can be applied to fall risk and functional recovery management.
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Affiliation(s)
- Thiago Araújo de Melo
- School of Health Sciences - Brazil, Universidade Federal do Rio de Janeiro, Rua das Patativas, 449, Imbuí, Salvador, Bahia, Brazil.
| | - Fernando Silva Guimarães
- Physical Therapy Department, Federal University of Rio de Janeiro, Rua prof. Rodolpho Paulo Rocco, 255, oitavo andar, sala 3 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - José Roberto Lapa E Silva
- School of Medicine - Federal University of Rio de Janeiro, Rua Ferreira Pontes, 264/103, Andaraí, Rio de Janeiro, RJ, Brazil
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15
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Kawai T, Goto K, Kuroda Y, Okuzu Y, Matsuda S. Discrepancy in the Responsiveness to Hip Range of Motion Between Harris and Oxford Hip Scores. Arthroplast Today 2022; 13:157-164. [PMID: 35097171 PMCID: PMC8783107 DOI: 10.1016/j.artd.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/07/2021] [Accepted: 10/13/2021] [Indexed: 11/06/2022] Open
Abstract
Background The primary objectives of total hip arthroplasty (THA) include mobility improvement and pain relief; however, the correlation between hip range of motion (ROM) and function remains unclear. We aimed to explore how ROM affects hip functions after THA and compare the responsiveness of each component of the modified Harris Hip Score (mHHS) and Oxford Hip Score (OHS) to preoperative and postoperative ROM. Methods This prospective observational study involved 120 patients who underwent unilateral THA. Univariate regression analyses were performed using the University of California Los Angeles activity score and mHHS and OHS to determine the effects of preoperative and postoperative flex ROM on clinical scores at 12 months. Multivariate regressions were performed to adjust for the confounding effects of patient factors: age, sex, body mass index, and diagnosis. Results A larger preoperative flexion ROM was associated with a higher score in the mHHS socks component (standardized coefficient [SC] = 0.26, P = .0041) at 12 months; the effect on the OHS socks component was not significant (P = .34). A larger flexion ROM at 12 months was associated with higher scores in the mHHS support (SC = 0.21, P = .026), stairs (SC = 0.35, P = .0002), and socks (SC = 0.32, P = .0007) components but had no significant effect on any OHS component. The effects of ROM on University of California Los Angeles activity score were limited. Conclusions A discrepancy was noted in the responsiveness to ROM between the two major measurement tools; this difference might be because mHHS and OHS are surgeon- and patient-administered questionnaires, respectively. This discrepancy also suggests that the patients have higher satisfaction than that assumed by the surgeons.
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16
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Hart HF, Neogi T, LaValley M, White D, Zhang Y, Nevitt MC, Torner J, Lewis CE, Stefanik JJ. Relationship of Patellofemoral Osteoarthritis to Changes in Performance-based Physical Function Over 7 Years: The Multicenter Osteoarthritis Study. J Rheumatol 2022; 49:98-103. [PMID: 34470797 PMCID: PMC8724393 DOI: 10.3899/jrheum.210270] [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] [Accepted: 08/18/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the relationship of patellofemoral osteoarthritis (PFOA) to changes in performance-based function over 7 years. METHODS There were 2666 participants (62.2 ± 8.0 yrs, BMI 30.6 ± 5.9 kg/m2, 60% female) from the Multicenter Osteoarthritis Study with knee radiographs at baseline who completed repeated chair stands and a 20-meter walk test (20MWT) at baseline, 2.5, 5, and 7 years. Generalized linear models assessed the relation of radiographic PFOA and radiographic PFOA with frequent knee pain to longitudinal changes in performance-based function. Analyses were adjusted for age, sex, BMI, tibiofemoral OA, and injury/surgery. RESULTS Linear models demonstrated a significant group-by-time interaction for the repeated chair stands (P = 0.04) and the 20MWT (P < 0.0001). Those with radiographic PFOA took 1.01 seconds longer on the repeated chair stands (P = 0.02) and 1.69 seconds longer on the 20MWT (P < 0.0001) at 7 years compared with baseline. When examining the relation of radiographic PFOA with frequent knee pain to performance-based function, there was a significant group-by-time interaction for repeated chair stands (P = 0.05) and the 20MWT (P < 0.0001). Those with radiographic PFOA with frequent knee pain increased their time on the repeated chair stands by 1.12 seconds (P = 0.04) and on the 20MWT by 1.91 seconds (P < 0.0001) over 7 years. CONCLUSION Individuals with radiographic PFOA and those with radiographic PFOA with frequent knee pain have worsening of performance-based function over time. This knowledge may present opportunities to plan for early treatment strategies for PFOA to limit functional decline over time.
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Affiliation(s)
- Harvi F Hart
- H.F. Hart, PhD, Faculty of Health Sciences and Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Tuhina Neogi
- T. Neogi, MD, PhD, Division of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michael LaValley
- M. LaValley, PhD, Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Daniel White
- D. White, PT, PhD, Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Yuqing Zhang
- Y. Zhang, DSc, Department of Rheumatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael C Nevitt
- M.C. Nevitt, PhD, MPH, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - James Torner
- J. Torner, PhD, Department of Epidemiology, The University of Iowa, Iowa City, Iowa, USA
| | - Cora E Lewis
- C.E. Lewis, MD, MSPH, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joshua J Stefanik
- J.J. Stefanik, PT, PhD, Division of Rheumatology, Boston University School of Medicine, and Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, USA.
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17
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Knox PJ, Simon CB, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. A Standardized Assessment of Movement-evoked Pain Ratings Is Associated With Functional Outcomes in Older Adults With Chronic Low Back Pain. Clin J Pain 2021; 38:241-249. [PMID: 34954729 PMCID: PMC8917081 DOI: 10.1097/ajp.0000000000001016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/06/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Despite high prevalence estimates, chronic low back pain (CLBP) remains poorly understood among older adults. Movement-evoked pain (MeP) is an understudied factor in this population that may importantly contribute to disability. This study investigated whether a novel MeP paradigm contributed to self-reported and performance-based function in older adults with CLBP. MATERIALS AND METHODS This secondary analysis includes baseline data from 230 older adults with CLBP in the context of a prospective cohort study. The Repeated Chair Rise Test, Six Minute Walk Test, and Stair Climbing Test were used to elicit pain posttest LBP ratings were aggregated to yield the MeP variable. Self-reported and performance-based function were measured by the Late Life Function and Disability Index (LLFDI) scaled function score and Timed Up-and-Go Test (TUG), respectively. Robust regression with HC3 standard errors was used to model adjusted associations between MeP and both functional outcomes; age, sex, body mass index, and pain characteristics (ie, intensity, quality, and duration) were utilized as covariates. RESULTS MeP was present in 81.3% of participants, with an average rating of 5.09 (SD=5.4). Greater aggregated posttest MeP was associated with decreased LLFDI scores (b=-0.30, t=-2.81, P=0.005) and poorer TUG performance (b=0.081, t=2.35, P=0.020), independent of covariates. LBP intensity, quality and duration were not associated with the LLFDI or TUG, (all P>0.05). DISCUSSION Aggregated posttest MeP independently contributed to worse self-reported and performance-based function among older adults with CLBP. To understand long-term consequences of MeP, future studies should examine longitudinal associations between MeP and function in this population.
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Affiliation(s)
- Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Ryan T. Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE
- Biostatistics Core, University of Delaware, Newark, DE
| | | | - Peter C. Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Jaclyn M. Sions
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Gregory E. Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE
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18
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Master H, Thoma LM, Dunlop DD, Christiansen MB, Voinier D, White DK. Joint Association of Moderate-to-vigorous Intensity Physical Activity and Sedentary Behavior With Incident Functional Limitation: Data From the Osteoarthritis Initiative. J Rheumatol 2021; 48:1458-1464. [PMID: 33526619 PMCID: PMC8325705 DOI: 10.3899/jrheum.201250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the joint association of moderate-to-vigorous intensity physical activity (MVPA) and sedentary behavior with the risk of developing functional limitation 4 years later in adults with knee osteoarthritis (OA). METHODS Using 48-month (baseline) accelerometry data from the Osteoarthritis Initiative, we classified participants as Active-Low Sedentary (≥ 1 10-min bout/week of MVPA, lowest tertile for standardized sedentary time), Active-High Sedentary (≥ 1 10-min bout/week of MVPA, top 2 tertiles for standardized sedentary time), Inactive-Low Sedentary (zero 10-min bouts/week of MVPA, lowest tertile for standardized sedentary time), and Inactive-High Sedentary (zero 10-minute bouts/week of MVPA, top 2 tertiles for standardized sedentary time) groups. Functional limitation was defined as > 12 seconds for the 5-repetition sit-to-stand test (5XSST) and < 1.22 m/s gait speed during the 20-meter walk test. To investigate the association of exposure groups with risk of developing functional limitation 4 years later, we calculated adjusted risk ratios (aRR; adjusted for potential confounders). RESULTS Of 1091 and 1133 participants without baseline functional limitation, based on the 5XSST and 20-meter walk test, respectively, 15% and 21% developed functional limitation 4 years later. The Inactive-Low Sedentary and Inactive-High Sedentary groups had increased risk of developing functional limitations compared to the Active-Low Sedentary and Active-High Sedentary groups. The Inactive-Low Sedentary group had 72% (aRR 1.72, 95% CI 1.00-2.94) and 52% (aRR 1.52, 95% CI 1.03-2.25) more risk of developing functional limitation based on the 5XSST and 20-meter walk test, respectively, compared to the Active-Low Sedentary group. CONCLUSION Regardless of sedentary category, being inactive (zero 10-min bouts/week in MVPA) may increase the risk of developing functional limitation in adults with knee OA.
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Affiliation(s)
- Hiral Master
- H. Master, PT, PhD, MPH, Department of Physical Therapy, College of Health Sciences, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, and Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Louise M Thoma
- L.M. Thoma, PT, DPT, PhD, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dorothy D Dunlop
- D.D. Dunlop, PhD, Department of Medicine, and Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | - Dana Voinier
- D. Voinier, PT, DPT, D.K. White, PT, ScD, Department of Physical Therapy, College of Health Sciences, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA
| | - Daniel K White
- D. Voinier, PT, DPT, D.K. White, PT, ScD, Department of Physical Therapy, College of Health Sciences, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA.
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Johnson AJ, Wilson AT, Laffitte Nodarse C, Montesino-Goicolea S, Valdes-Hernandez PA, Somerville J, Peraza JA, Fillingim RB, Bialosky J, Cruz-Almeida Y. Age Differences in Multimodal Quantitative Sensory Testing and Associations With Brain Volume. Innov Aging 2021; 5:igab033. [PMID: 34616958 PMCID: PMC8489433 DOI: 10.1093/geroni/igab033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Somatosensory function is critical for successful aging. Prior studies have shown declines in somatosensory function with age; however, this may be affected by testing site, modality, and biobehavioral factors. While somatosensory function declines are associated with peripheral nervous system degradation, little is known regarding correlates with the central nervous system and brain structure in particular. The objectives of this study were to examine age-related declines in somatosensory function using innocuous and noxious stimuli, across 2 anatomical testing sites, with considerations for affect and cognitive function, and associations between somatosensory function and brain structure in older adults. RESEARCH DESIGN AND METHODS A cross-sectional analysis included 84 "younger" (n = 22, age range: 19-24 years) and "older" (n = 62, age range: 60-94 years) healthy adults who participated in the Neuromodulatory Examination of Pain and Mobility Across the Lifespan study. Participants were assessed on measures of somatosensory function (quantitative sensory testing), at 2 sites (metatarsal and thenar) using standardized procedures, and completed cognitive and psychological function measures and structural magnetic resonance imaging. RESULTS Significant age × test site interaction effects were observed for warmth detection (p = .018,η p 2 = 0.10) and heat pain thresholds (p = .014,η p 2 = 0.12). Main age effects were observed for mechanical, vibratory, cold, and warmth detection thresholds (ps < .05), with older adults displaying a loss of sensory function. Significant associations between somatosensory function and brain gray matter structure emerged in the right occipital region, the right temporal region, and the left pericallosum. DISCUSSION AND IMPLICATIONS Our findings indicate healthy older adults display alterations in sensory responses to innocuous and noxious stimuli compared to younger adults and, furthermore, these alterations are uniquely affected by anatomical site. These findings suggest a nonuniform decline in somatosensation in older adults, which may represent peripheral and central nervous system alterations part of aging processes.
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Affiliation(s)
- Alisa J Johnson
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Abigail T Wilson
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Brooks Rehabilitation–College of Public Health and Health Professions Research Collaboration, Gainesville, Florida, USA
| | - Chavier Laffitte Nodarse
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
| | - Soamy Montesino-Goicolea
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
| | - Pedro A Valdes-Hernandez
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Jessie Somerville
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
| | - Julio A Peraza
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Joel Bialosky
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
- Brooks Rehabilitation–College of Public Health and Health Professions Research Collaboration, Gainesville, Florida, USA
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry & Behavioral Sciences, College of Dentistry, University of Florida, Gainesville, Florida, USA
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Heinrich KM, Crawford DA, Langford CR, Kehler A, Andrews V. High-Intensity Functional Training Shows Promise for Improving Physical Functioning and Activity in Community-Dwelling Older Adults: A Pilot Study. J Geriatr Phys Ther 2021; 44:9-17. [PMID: 31626033 DOI: 10.1519/jpt.0000000000000251] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Healthy aging allows older adults to remain active in their communities; however, sedentary behaviors can lead to physical deconditioning and decreased physical function. Structured exercise programs are recommended to facilitate activity engagement and prevent muscle atrophy due to aging to facilitate older adults' abilities to complete activities of daily living. In particular, high-intensity functional training (HIFT) is a multicomponent group exercise program that has previously been shown to increase physical function for middle-age cancer survivors. This study examined the preliminary feasibility and effectiveness of HIFT for improving physical function and participation in physical activity for community-dwelling older adults. METHODS The 8-week pilot study included two 60-minute HIFT sessions per week. Participants (n = 8) were 75% female with a mean age of 71 (6) years. Study initiation, adherence, and acceptability were assessed to determine feasibility. Effectiveness was assessed via 5 physical function measures conducted during sessions 1 and 16 and included the Timed Up and Go, lift and carry test, chair stand test, a repeated stair climb test, and the 6-minute walk test. Participants also self-reported confidence and difficulty for activities of daily living via the Outpatient Physical Therapy Improvement in Movement Assessment Log and physical activity participation via the Community Health Activities Model Program for Seniors questionnaire. RESULTS AND DISCUSSION The study recruitment rate was 88.9% and 87.5% of participants adhered. Intervention acceptability was promising, as 4 participants reported liking multiple aspects of the intervention (eg, coaching/supervision and similar age peers). Intervention effectiveness was promising with significant improvement in 1 of 5 physical function measures, although clinical effects were most likely trivial. Participants reported increased participation in both leisure and structured physical activities. CONCLUSIONS HIFT appeared feasible and showed promise for counteracting the loss of physical function and sedentary behaviors associated with aging. Results should be confirmed in a longer, fully powered study.
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Affiliation(s)
- Katie M Heinrich
- Functional Intensity Training Laboratory, Department of Kinesiology, Kansas State University, Manhattan
| | - Derek A Crawford
- School of Nutrition, Kinesiology, and Psychological Science, University of Central Missouri, Warrensburg
| | - Cheyenne R Langford
- Functional Intensity Training Laboratory, Department of Kinesiology, Kansas State University, Manhattan
| | - Ainslie Kehler
- Functional Intensity Training Laboratory, Department of Kinesiology, Kansas State University, Manhattan
| | - Victor Andrews
- Functional Intensity Training Laboratory, Department of Kinesiology, Kansas State University, Manhattan
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Farazdaghi M, Kordi Yoosefinejad A, Abdollahian N, Rahimi M, Motealleh A. Dry needling trigger points around knee and hip joints improves function in patients with mild to moderate knee osteoarthritis. J Bodyw Mov Ther 2021; 27:597-604. [PMID: 34391293 DOI: 10.1016/j.jbmt.2021.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/28/2021] [Accepted: 04/18/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Dry needling may be an effective method to alleviate pain and improve range of motion. Controversial results have been found in previous studies using dry needling in knee problems. So, the aim of current study is to exert dry needling technique on unilateral muscles around the hip and knee joints and evaluate its effects on knee osteoarthritic patients. METHOD For this double-blind randomized clinical trial, 40 female patients with mild to moderate knee osteoarthritis (aged 45-70 years old) were recruited. They entered the study if they had any trigger points around the hip or knee joints of the examined side and randomized into two groups. Pain, sensitivity of trigger points, balance and function measured by visual analogue scale, algometer, Y-balance test, timed up and go, self-paced walk tests beside KOOS questionnaire respectively before and after intervention. The intervention group received 3 sessions of dry needling on marked trigger points while the sham group received sham treatment consisting of only the plastic cover of a needle. Both groups reexamined 2 weeks after primary evaluation. RESULTS Comparing results before and after implementing dry needling revealed significant improvements in all measured variables in treatment group whereas, pain and timed up and go increased and peak pain pressure decreased in sham group. Between group comparison revealed significant differences in all variables. CONCLUSION Using 3 sessions of dry needling can increase functional activity, sensitivity and balance and decrease pain in patients with knee osteoarthritis in short term.
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Affiliation(s)
| | - Amin Kordi Yoosefinejad
- Department of Physical Therapy, School of Rehabilitation Sciences, University, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najmeh Abdollahian
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahvash Rahimi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Motealleh
- Department of Physical Therapy, School of Rehabilitation Sciences, University, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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22
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Dodds RM, Murray JC, Granic A, Hurst C, Uwimpuhwe G, Richardson S, Brayne C, Matthews FE, Sayer AA. Prevalence and factors associated with poor performance in the 5-chair stand test: findings from the Cognitive Function and Ageing Study II and proposed Newcastle protocol for use in the assessment of sarcopenia. J Cachexia Sarcopenia Muscle 2021; 12:308-318. [PMID: 33463015 PMCID: PMC8061374 DOI: 10.1002/jcsm.12660] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/08/2020] [Accepted: 11/24/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Poor performance in the 5-chair stand test (5-CST) indicates reduced lower limb muscle strength. The 5-CST has been recommended for use in the initial assessment of sarcopenia, the accelerated loss of muscle strength and mass. In order to facilitate the use of the 5-CST in sarcopenia assessment, our aims were to (i) describe the prevalence and factors associated with poor performance in the 5-CST, (ii) examine the relationship between the 5-CST and gait speed, and (iii) propose a protocol for using the 5-CST. METHODS The population-based study Cognitive Function and Ageing Study II recruited people aged 65 years and over from defined geographical localities in Cambridgeshire, Newcastle, and Nottingham. The study collected data for assessment of functional ability during home visits, including the 5-CST and gait speed. We used multinomial logistic regression to assess the associations between factors including the SARC-F questionnaire and the category of 5-CST performance: fast (<12 s), intermediate (12-15 s), slow (>15 s), or unable, with slow/unable classed as poor performance. We reviewed previous studies on the protocol used to carry out the 5-CST. RESULTS A total of 7190 participants aged 65+ from the three diverse localities of Cognitive Function and Ageing Study II were included (54.1% female). The proportion of those with poor performance in the 5-CST increased with age, from 34.3% at age 65-69 to 89.7% at age 90+. Factors independently associated with poor performance included positive responses to the SARC-F questionnaire, physical inactivity, depression, impaired cognition, and multimorbidity (all P < 0.005). Most people with poor performance also had slow gait speed (57.8%) or were unable to complete the gait speed test (18.4%). We found variation in the 5-CST protocol used, for example, timing until a participant stood up for the fifth time or until they sat down afterwards. CONCLUSIONS Poor performance in the 5-CST is increasingly common with age and is associated with a cluster of other factors that characterize risk for poor ageing such as physical inactivity, impaired cognition, and multimorbidity. We recommend a low threshold for performing the 5-CST in clinical settings and provide a protocol for its use.
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Affiliation(s)
- Richard Matthew Dodds
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - James C Murray
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - Antoneta Granic
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - Christopher Hurst
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - Germaine Uwimpuhwe
- Department of Anthropology, Durham University, Durham, UK.,Durham Research Methods Centre, Durham University, Durham, UK
| | - Sarah Richardson
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - Carol Brayne
- Cambridge Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
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Khruakhorn S, Chiwarakranon S. Effects of hydrotherapy and land-based exercise on mobility and quality of life in patients with knee osteoarthritis: a randomized control trial. J Phys Ther Sci 2021; 33:375-383. [PMID: 33935364 PMCID: PMC8079887 DOI: 10.1589/jpts.33.375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/30/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To determine the effects of hydrotherapy and land-based exercises on functional mobility and quality of life among patients with knee osteoarthritis. [Participants and Methods] We conducted a randomized controlled trial with knee osteoarthritis patients randomly allocated into land-based (n=17) and hydrotherapy groups (n=17). The Time-Up and Go (TUG), Five Times Sit-to-Stand (5STS), Stair Climbing Test (SCT), and Quality of Life by questionnaires including the Modified Western Ontario and McMaster Universities Osteoarthritis Index questionnaire Thai version (Thai WOMAC) were assessed at baseline and 6 weeks. The World Health Organization Quality of Life BREF Thai version (WHOQOL-BREF-THAI) questionnaire were assessed at baseline and six weeks and 6 months. [Results] There was no significant difference in outcomes between the groups after 6-weeks and 6-months of follow-up. After 6 weeks, Thai WOMAC score improved in both groups. Only 5STS was improved in the land-based group, while the hydrotherapy group showed significant TUG, 5STS, and SCT improvement. Furthermore, only hydrotherapy showed significant improvement in WHOQOL-BREF-THAI scores in the mental, social, quality of health, and total domains after six months. [Conclusion] Both exercises equally improved functional mobility and quality of life. Hydrotherapy and land-based exercise could improve functional mobility and quality of life in patients with knee osteoarthritis.
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Affiliation(s)
- Santhanee Khruakhorn
- Department of Physical Therapy, Faculty of Allied Health
Sciences, Thammasat University Rangsit Campus: 99 Moo.18 Phahonyothin Road, Khlong Nueng,
Khlong Luang, Pathum Thani 12120, Thailand
| | - Sanon Chiwarakranon
- Department of Physical Therapy, Faculty of Allied Health
Sciences, Thammasat University Rangsit Campus: 99 Moo.18 Phahonyothin Road, Khlong Nueng,
Khlong Luang, Pathum Thani 12120, Thailand
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Abstract
Hip fracture is a leading cause of profound morbidity in individuals aged 65 years and older, ranking in the top 10 causes of loss of disability-adjusted life-years for older adults. Worldwide, the number of people with hip fracture is expected to rise significantly due to the aging population and other factors. Physical therapist management is recommended within medical, surgical, and multidisciplinary clinical practice guideline (CPGs) and is considered to be the standard of care in rehabilitation for people with hip fracture. The goal of this CPG was to review the evidence relevant to physical therapist management and to provide evidence-based recommendations for physical therapy diagnosis, prognosis, intervention, and assessment of outcome in adults with hip fracture. J Orthop Sports Phys Ther 2021;51(2):CPG1-CPG81. doi:10.2519/jospt.2021.0301.
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25
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Epskamp S, Dibley H, Ray E, Bond N, White J, Wilkinson A, Chapple CM. Range of motion as an outcome measure for knee osteoarthritis interventions in clinical trials: an integrated review. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2020.1867393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Samantha Epskamp
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Hayley Dibley
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Elizabeth Ray
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Nicole Bond
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Joshua White
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Amanda Wilkinson
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Cathy M. Chapple
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Vourganas I, Stankovic V, Stankovic L. Individualised Responsible Artificial Intelligence for Home-Based Rehabilitation. SENSORS (BASEL, SWITZERLAND) 2020; 21:E2. [PMID: 33374913 PMCID: PMC7792599 DOI: 10.3390/s21010002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 01/23/2023]
Abstract
Socioeconomic reasons post-COVID-19 demand unsupervised home-based rehabilitation and, specifically, artificial ambient intelligence with individualisation to support engagement and motivation. Artificial intelligence must also comply with accountability, responsibility, and transparency (ART) requirements for wider acceptability. This paper presents such a patient-centric individualised home-based rehabilitation support system. To this end, the Timed Up and Go (TUG) and Five Time Sit To Stand (FTSTS) tests evaluate daily living activity performance in the presence or development of comorbidities. We present a method for generating synthetic datasets complementing experimental observations and mitigating bias. We present an incremental hybrid machine learning algorithm combining ensemble learning and hybrid stacking using extreme gradient boosted decision trees and k-nearest neighbours to meet individualisation, interpretability, and ART design requirements while maintaining low computation footprint. The model reaches up to 100% accuracy for both FTSTS and TUG in predicting associated patient medical condition, and 100% or 83.13%, respectively, in predicting area of difficulty in the segments of the test. Our results show an improvement of 5% and 15% for FTSTS and TUG tests, respectively, over previous approaches that use intrusive means of monitoring such as cameras.
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Affiliation(s)
- Ioannis Vourganas
- Department of Electronic and Electrical Engineering, University of Strathclyde, Glasgow G1 1XW, UK; (V.S.); (L.S.)
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Physical Performance Tests Provide Distinct Information in Both Predicting and Assessing Patient-Reported Outcomes Following Lumbar Spine Surgery. Spine (Phila Pa 1976) 2020; 45:E1556-E1563. [PMID: 32890302 DOI: 10.1097/brs.0000000000003665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Secondary analysis of randomized controlled trial data. OBJECTIVE The aim of this study was to examine whether preoperative physical performance is an independent predictor of patient-reported disability and pain at 12 months after lumbar spine surgery. SUMMARY OF BACKGROUND DATA Patient-reported outcome measures (PROMs) are commonly used to assess clinical improvement after lumbar spine surgery. However, there is evidence in the orthopedic literature to suggest that PROMs should be supplemented with physical performance tests to accurately evaluate long-term outcomes. METHODS A total of 248 patients undergoing surgery for degenerative lumbar spine conditions were recruited from two institutions. Physical performance tests (5-Chair Stand and Timed Up and Go) and PROMs of disability (Oswestry Disability Index: ODI) and back and leg pain (Brief Pain Inventory) were assessed preoperatively and at 12 months after surgery. RESULTS Physical performance tests and PROMs significantly improved over 12 months following lumbar spine surgery (P < 0.01). Weak correlations were found between physical performance tests and disability and pain (ρ = 0.15 to 0.32, P < 0.05). Multivariable regression analyses controlling for age, education, preoperative outcome score, fusion, previous spine surgery, depressive symptoms, and randomization group found that preoperative 5-Chair Stand test was significantly associated with disability and back pain at 12-month follow-up. Each additional 10 seconds needed to complete the 5-Chair Stand test were associated with six-point increase in ODI (P = 0.047) and one-point increase in back pain (P = 0.028) scores. The physical performance tests identified an additional 14% to 19% of patients as achieving clinical improvement that were not captured by disability or pain questionnaires. CONCLUSION Results indicate that physical performance tests may provide distinct information in both predicting and assessing clinical outcomes in patients undergoing lumbar spine surgery. Our findings suggest that the 5-Chair Stand test may be a useful test to include within a comprehensive risk assessment before surgery and as an outcome measure at long-term follow-up. LEVEL OF EVIDENCE 3.
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Alasfour M, Almarwani M. The effect of innovative smartphone application on adherence to a home-based exercise programs for female older adults with knee osteoarthritis in Saudi Arabia: a randomized controlled trial. Disabil Rehabil 2020; 44:2420-2427. [PMID: 33103499 DOI: 10.1080/09638288.2020.1836268] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To examine the effects of an Arabic smartphone application on adherence to home exercise programs (HEPs) and the effectiveness of mobile-based HEPs on pain, physical function, and lower-limb muscle strength among older women with knee osteoarthritis (OA). MATERIALS AND METHODS This randomised control trial (ClinicalTrials.gov: (NCT04159883) enrolled 40 women aged ≥50 years with knee OA who were randomised into the app group (experimental; n = 20) receiving HEPs using an Arabic smartphone application called "My Dear Knee", whereas the paper group (control; n = 20) receiving HEPs as hand-outs. Both groups had the same exercise program. Outcome measures were self-reported adherence, changes in the Arabic Numeric Pain Rating Scale, the Arabic version of the reduced Western Ontario, McMaster Universities Osteoarthritis Index-Physical Function subscale, and Five-Times Sit-To-Stand Test scores. All participants were assessed at baseline, at week 3 and week 6. Using completer-only analyses, the repeated measures ANOVA was used to compare the means of the outcome measures between the two groups. RESULTS At the end of week 6, the app group reported greater adherence to HEPs (p = .002) and significant reduction in pain (p = .015). CONCLUSIONS A smartphone application with motivational and attractive features could enhance adherence to HEPs in this patient cohort.IMPLICATIONS FOR REHABILITATIONOlder adults with knee OA may face many obstacles that prevent or limit their adherence to the prescribed HEP.Smart device apps supported with attractive and motivational features could be an effective strategy to enhance adherence to HEPs among older adults with knee OA.Using such remote technology appears to overcome the barriers that may limit the ability of older women to receive supervised physical therapy in a clinical setting.
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Affiliation(s)
- Maryam Alasfour
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.,Department of Medical Rehabilitation, Physical Therapy Department, Ministry of health, Riyadh, Saudi Arabia
| | - Maha Almarwani
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Coleman G, Dobson F, Hinman RS, Bennell K, White DK. Measures of Physical Performance. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:452-485. [PMID: 33091270 DOI: 10.1002/acr.24373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Fiona Dobson
- University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Bennell
- University of Melbourne, Melbourne, Victoria, Australia
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Harkey MS, Price LL, Reid KF, Lo GH, Liu SH, Lapane KL, Dantas LO, McAlindon TE, Driban JB. Patient-specific reference values for objective physical function tests: data from the Osteoarthritis Initiative. Clin Rheumatol 2020; 39:1961-1970. [PMID: 32030634 PMCID: PMC7372536 DOI: 10.1007/s10067-020-04972-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION/OBJECTIVE We aimed to establish sex-specific reference values of objective physical function tests among individuals with or at risk for knee osteoarthritis (KOA) across subsets of age, radiographic KOA severity, and body mass index (BMI). METHOD We included Osteoarthritis Initiative participants with data for objective physical function tests, sex, age, BMI, and radiographic KOA severity (Kellgren-Lawrence [KL] grade) at baseline. Objective physical function was quantified with 20-m walk speed, chair-stand speed, 400-m walk time, and knee extension and flexion strength. We created participant characteristic subsets for sex, age, KL grade, and BMI. Reference values were created as percentiles from minimum to maximum in 10% increments for each combination of participant characteristic subsets. Previously established clinically important differences for 20-m walk speed and knee extension strength were used to highlight clinically relevant differences. RESULTS Objective physical function reference values tables and an interactive reference value table were created across all combinations of sex, age, KL grade, and BMI among 3860 individuals with or at risk for KOA. Clinically relevant differences exist for 20-m walk speed and knee extension strength between males and females across age groups, KL grades, and BMI categories. CONCLUSIONS Establishing an individual's relative level of objective physical function by comparing their performance to individuals with similar sex, age, KL grade, or BMI may help improve interpretation of physical function performance. The interactive reference value table will provide clinicians and researchers a clinically accessible avenue to use these reference values.Key Points• Since greater age, radiographic knee osteoarthritis severity, and body mass index are all associated with worse objective physical function, reference values should consider the complex inter-play among these patient characteristics.• This study provides objective physical function reference values among subsets of individuals across the spectrum of sex, age groups, radiographic knee osteoarthritis severity, and body mass index categories.• These reference values offer a more patient-centered approach for interpreting an individual's relative level of objective physical function by comparing them to a more homogeneous group of individuals with similar participant characteristics.• We have provided a clinically accessible interactive table that will enable clinicians and researchers to input their patient's data to quickly and efficiently determine a patient's relative objective physical function compared to individual's with similar characteristics.
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Affiliation(s)
- Matthew S Harkey
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111, USA.
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Kieran F Reid
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Grace H Lo
- Medical Care Line and Research Care Line, Houston Health Services Research and Development Center of Excellence Michael E. DeBakey VAMC, Houston, TX, USA
- Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, TX, USA
| | - Shao-Hsien Liu
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lucas Ogura Dantas
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111, USA
- Physical Therapy Department, Neuromuscular Plasticity Laboratory, Federal University of São Carlos, São Paulo, Brazil
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111, USA
| | - Jeffrey B Driban
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111, USA
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Wijnen A, Hoogland J, Munsterman T, Gerritsma CLE, Dijkstra B, Zijlstra WP, Dekker JS, Annegarn J, Ibarra F, Slager GE, Zijlstra W, Stevens M. Effectiveness of a Home-Based Rehabilitation Program After Total Hip Arthroplasty Driven by a Tablet App and Remote Coaching: Nonrandomized Controlled Trial Combining a Single-Arm Intervention Cohort With Historical Controls. JMIR Rehabil Assist Technol 2020; 7:e14139. [PMID: 32338621 PMCID: PMC7215512 DOI: 10.2196/14139] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 12/20/2019] [Accepted: 01/24/2020] [Indexed: 11/29/2022] Open
Abstract
Background Recent technological developments such as wearable sensors and tablets with a mobile internet connection hold promise for providing electronic health home-based programs with remote coaching for patients following total hip arthroplasty. It can be hypothesized that such a home-based rehabilitation program can offer an effective alternative to usual care. Objective The aim of this study was to determine the effectiveness of a home-based rehabilitation program driven by a tablet app and remote coaching for patients following total hip arthroplasty. Methods Existing data of two studies were combined, in which patients of a single-arm intervention study were matched with historical controls of an observational study. Patients aged 18-65 years who had undergone total hip arthroplasty as a treatment for primary or secondary osteoarthritis were included. The intervention consisted of a 12-week home-based rehabilitation program with video instructions on a tablet and remote coaching (intervention group). Patients were asked to do strengthening and walking exercises at least 5 days a week. Data of the intervention group were compared with those of patients who received usual care (control group). Effectiveness was measured at four moments (preoperatively, and 4 weeks, 12 weeks, and 6 months postoperatively) by means of functional tests (Timed Up & Go test and the Five Times Sit-to Stand Test) and self-reported questionnaires (Hip disability and Osteoarthritis Outcome Score [HOOS] and Short Form 36 [SF-36]). Each patient of the intervention group was matched with two patients of the control group. Patient characteristics were summarized with descriptive statistics. The 1:2 matching situation was analyzed with a conditional logistic regression. Effect sizes were calculated by Cohen d. Results Overall, 15 patients of the intervention group were included in this study, and 15 and 12 subjects from the control group were matched to the intervention group, respectively. The intervention group performed functional tests significantly faster at 12 weeks and 6 months postoperatively. The intervention group also scored significantly higher on the subscales “function in sport and recreational activities” and “hip-related quality of life” of HOOS, and on the subscale “physical role limitations” of SF-36 at 12 weeks and 6 months postoperatively. Large effect sizes were found on functional tests at 12 weeks and at 6 months (Cohen d=0.5-1.2), endorsed by effect sizes on the self-reported outcomes. Conclusions Our results clearly demonstrate larger effects in the intervention group compared to the historical controls. These results imply that a home-based rehabilitation program delivered by means of internet technology after total hip arthroplasty can be more effective than usual care. Trial Registration ClinicalTrials.gov NCT03846063; https://clinicaltrials.gov/ct2/show/NCT03846063 and German Registry of Clinical Trials DRKS00011345; https://tinyurl.com/yd32gmdo
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Affiliation(s)
- Annet Wijnen
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Jildou Hoogland
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Tjerk Munsterman
- Department of Physiotherapy, Martini Hospital Groningen, Groningen, Netherlands
| | - Carina LE Gerritsma
- Department of Orthopedics, Martini Hospital Groningen, Groningen, Netherlands
| | - Baukje Dijkstra
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Wierd P Zijlstra
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Johan S Dekker
- Department of Orthopedics, Ommelander Ziekenhuis Groep, Scheemda, Netherlands
| | - Janneke Annegarn
- Collaborative Care Solutions, Philips Research, Eindhoven, Netherlands
| | | | - Geranda Ec Slager
- Department of Physical Therapy, School of Health Care Studies, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Wiebren Zijlstra
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Concentric and Eccentric Resistance Training Comparison on Physical Function and Functional Pain Outcomes in Knee Osteoarthritis: A Randomized Controlled Trial. Am J Phys Med Rehabil 2020; 99:932-940. [PMID: 32324615 DOI: 10.1097/phm.0000000000001450] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to compare the effectiveness of concentrically focused resistance training to eccentrically focused resistance training on physical function and functional pain in knee osteoarthritis. DESIGN This is a randomized, single-blinded controlled 4-mo trial. Older adults with knee osteoarthritis (N = 88; 68.3 ± 6.4 yrs, 30.4 ± 6.9 kg/m, and 67.4% women) were randomized to eccentrically focused resistance training, concentrically focused resistance training, or no-exercise control. Main outcomes included chair rise time, stair climb time, 6-min walk test distance, temporal-spatial parameters of gait, community ambulation, and functional pain. RESULTS Leg muscle strength improved in both training groups compared with no-exercise control. There were no significant group × time interactions for any functional performance score (chair rise time, stair climb time, 6-min walk test distance, gait parameters, community ambulation). Compared with no-exercise control, functional pain scores were reduced for chair rise (-38.6% concentrically focused resistance training, -50.3% eccentrically focused resistance training vs. +10.0%) and stair climb (-51.6% concentrically focused resistance training, -41.3% eccentrically focused resistance training vs. +80.7%; all P < 0.05). Pain scores were reduced during the 6-min walk and in early recovery with concentrically focused resistance training compared with the remaining two groups (P < 0.05). CONCLUSIONS Either resistance exercise type improves activity-related knee osteoarthritis pain, but concentrically focused resistance training more effectively reduced severity of ambulatory pain and pain upon walking cessation.
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Monitoring the Clinical Response to an Innovative Transdermal Delivery System for Ibuprofen. Pharmaceutics 2019; 11:pharmaceutics11120664. [PMID: 31835344 PMCID: PMC6955711 DOI: 10.3390/pharmaceutics11120664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 12/19/2022] Open
Abstract
We present a phase 1 study that utilizes a crossover design that provides a rapid and relatively inexpensive methodology for evaluating a new transdermal product. The treatment for osteoarthritis (OA) aims to reduce pain and improve function. An innovative magnetophoresis technology has been developed that facilitates transdermal delivery of ibuprofen. The study used measures that were taken over a relatively short time period to monitor the pharmacodynamic response to ibuprofen. Each participant received magnetophoresis-enhanced transdermal ibuprofen or placebo in randomised order, with a five-day washout period. The participants were 24 volunteers with medically diagnosed, painful knee OA. The primary outcome measures were VAS rating of pain on movement and Western Ontario and McMaster Universities (WOMAC) pain and function scores. VAS for pain on movement (p < 0.001), WOMAC pain score (p = 0.004), and WOMAC function score (p = 0.004) were all significantly improved. There was a significant reduction in movement-related pain (p < 0.05) during the first patch application and for the remainder of the study period. The number needed to treat for a 50% reduction in movement related pain was 2.2. The study showed a rapid and significant analgesic effect in response to transdermal ibuprofen. A short trial of this nature can be used for informing the parameters that are required for a major randomised controlled trial.
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Hong S, Lee G. Effects of an Immersive Virtual Reality Environment on Muscle Strength, Proprioception, Balance, and Gait of a Middle-Aged Woman Who Had Total Knee Replacement: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1636-1642. [PMID: 31695020 PMCID: PMC6859930 DOI: 10.12659/ajcr.918521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The purpose of this case study was to apply a training program using virtual reality to a middle-aged woman who had total knee replacement surgery and to investigate its effects on her muscle strength, proprioception, balance, and gait ability. CASE REPORT The subject who participated in this study was a 62-year-old woman, who had been diagnosed with moderate osteoarthritis and had a total knee replacement. Post-operative treatment consisted of virtual reality training along with range of motion exercise of the knee joint, light quadriceps isometric exercise, and conventional physical therapy. This also included thermal and electric therapy for pain control conducted on 10 occasions (5 times a week for 2 weeks). Total treatment time, which included 30 min of conventional physical therapy, was 60 min. Measurement of the subject's lower extremity muscle strength after intervention decreased to 9.43 s, and the error in proprioception decreased to 1.5°. In addition, balance score increased to 56 points, and the time taken to measure gait ability decreased to 9.87 s. CONCLUSIONS The patient responded positively to rehabilitation using virtual reality, and her muscle strength, proprioception, balance, and gait ability improved. These results suggest that the application of rehabilitative training through virtual reality for total knee replacement patients warrants further study and consideration.
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Affiliation(s)
- Soungkyun Hong
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, South Korea
| | - GyuChang Lee
- Department of Physical Therapy, Kyungnam University, Changwon, South Korea
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Effectiveness of ultrasonographic skeletal muscle assessment in patients after total knee arthroplasty. Osteoporos Sarcopenia 2019; 5:94-101. [PMID: 31728427 PMCID: PMC6838742 DOI: 10.1016/j.afos.2019.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/17/2019] [Accepted: 09/06/2019] [Indexed: 12/29/2022] Open
Abstract
Objectives This study aimed to characterize the skeletal muscles of patients who underwent total knee arthroplasty (TKA) using ultrasonography in order to investigate the effectiveness of ultrasonographic skeletal muscle assessment after TKA. Methods This study included 50 TKA patients (TKA group) and 41 residents with osteoarthritis who have not received TKA (non-TKA group). Ultrasonography was used to assess the characteristics of several different muscles. Various postoperative outcomes were evaluated. Muscle thickness (MT) and echo intensity (EI) results were compared among operated knees in the TKA group, nonoperated knees in the TKA group, and more severely affected knees in the non-TKA group. For the TKA group, multiple regression was conducted to examine the association between skeletal muscle characteristics of operated knees and postoperative outcomes. Results The MTs of the vastus medialis, vastus intermedius, and rectus femoris (RF) were significantly smaller and the RF-EI was significantly greater for both operated and nonoperated knees in the TKA group compared with the non-TKA group (P < 0.017). Several parameters of physical function were significantly poorer in the TKA group than in the non-TKA group (P < 0.05). Multiple regression demonstrated that RF-MT was associated with knee range of motion, knee strength, and physical functional performance in the TKA group (P < 0.05). Conclusions The quantity and quality of skeletal muscles were lower in the TKA group than in the non-TKA group. Ultrasonography may be useful for assessing skeletal muscles in TKA patients because MT assessed with ultrasonography was associated with various parameters of physical function.
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Allen KD, Lo G, Abbate LM, Floegel TA, Lindquist JH, Coffman C, Oddone EZ, Taylor SS, Hall K. Composite measures of physical activity and pain associate better with functional assessments than pain alone in knee osteoarthritis. Clin Rheumatol 2019; 38:2241-2247. [PMID: 30929153 DOI: 10.1007/s10067-019-04530-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/05/2019] [Accepted: 03/20/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Recent research showed that physical activity (PA)-adjusted pain measures were more strongly associated with radiographic osteoarthritis (OA) severity than an unadjusted pain measure. This exploratory study examined whether PA-adjusted pain measures were more closely associated with other key OA-related measures, compared to unadjusted pain scores. METHOD Participants were 122 Veterans (mean age = 61.2 years, 88.5% male) with knee OA. Baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores were adjusted for accelerometer-derived daily: (1) step counts, (2) minutes of any activity, (3) minutes of moderate or greater intensity activity, (4) minutes of light intensity activity, and (5) energy expenditure. Partial correlations, adjusted for age, sex, and body mass index, estimated associations of unadjusted and PA-adjusted WOMAC pain scores with functional assessments (6-minute walk test, 8-foot walk test, chair stand test, satisfaction with physical function), fatigue (Brief Fatigue Inventory), and anxiety/depressive symptoms (single item). RESULTS Significant (p < 0.05) associations were found in 29 of 36 of models. For the four function-related assessments, step count and energy expenditure-adjusted WOMAC pain scores had stronger associations (partial rs = 0.24-0.48) than WOMAC pain score (partial rs = 0.19-0.25). For fatigue and anxiety/depressive symptoms, WOMAC pain score had stronger, positive associations than most PA-adjusted pain scores. Of the PA-adjusted measures, the strongest associations overall were observed for step count and energy expenditure. CONCLUSION PA-adjusted pain scores may have particular value for OA studies involving functional assessments, whereas unadjusted WOMAC pain scores are more closely associated with psychological symptoms. This has implications for measurement in clinical OA studies. TRIAL REGISTRATION NCT01058304 KEY POINTS: • Among patents with osteoarthritis, physical activity-adjusted pain measures (particularly those adjusted for step count and energy expenditure) were more strongly associated with measures of physical function, compared to unadjusted pain scores, whereas unadjusted pain score was more strongly associated with a measure of psychological symptoms. • In clinical osteoarthritis research, the most appropriate or sensitive symptom measure (pain vs. physical activity-adjusted pain) may depend on the type of intervention or outcome being studied.
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Affiliation(s)
- Kelli D Allen
- Thurston Arthritis Research Center, University of North Carolina, 3300 Thurston Bld., CB# 7280, Chapel Hill, NC, 27599-7280, USA. .,Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA. .,Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA.
| | - Grace Lo
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Medical Care Line and Research Care Line, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Medical Center, Houston, TX, USA
| | - Lauren M Abbate
- Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO, USA.,Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Jennifer H Lindquist
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Cynthia Coffman
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Eugene Z Oddone
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Shannon Stark Taylor
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA.,Greenville Health System, Greenville, SC, USA
| | - Katherine Hall
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Center for Aging and Human Development, Duke University, Durham, NC, USA.,Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, USA
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Melo TAD, Duarte ACM, Bezerra TS, França F, Soares NS, Brito D. The Five Times Sit-to-Stand Test: safety and reliability with older intensive care unit patients at discharge. Rev Bras Ter Intensiva 2019; 31:27-33. [PMID: 30892478 PMCID: PMC6443310 DOI: 10.5935/0103-507x.20190006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/30/2018] [Indexed: 11/30/2022] Open
Abstract
Objective Assess the Five Times Sit-to-Stand Test safety and clinimetric properties in
older patients hospitalized in an intensive care unit. Methods Test safety was assessed according to the incidence of adverse events and
through hemodynamic and respiratory data. Additionally, reliability
properties were investigated using the intraclass correlation coefficients,
standard error of measurement, standard error percentage change,
Altman-Bland plot and a survival agreement plot. Results The overall suitability of the Five Times Sit-to-Stand Test was found to be
low, with 29.8% meeting the inclusion criteria. Only 44% of the hospitalized
patients who met the inclusion criteria performed the test, with no need for
discontinuation in any patient. Heart rate (79.7 ± 10.2bpm/86.6
± 9.7bpm; p = 0.001) and systolic blood pressure (118 ±
21.4mmHg/129 ± 21.5mmHg; p = 0.031) were the only variables that
presented a significant statistical increase, with no evidence of
exacerbated response to the test. Additionally, no adverse events were
reported from participating and both test-retest and interrater reliability
were high (intraclass correlation coefficient ≥ 0.99). Conclusion The Five Times Sit-to-Stand Test was proven to be safe and to have excellent
reliability. Its clinical use, however, may be restricted to
high-functioning older adults in hospital settings.
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Affiliation(s)
| | | | | | | | - Neila Silva Soares
- Escola de Ciências da Saúde, Universidade Salvador - Salvador (BA), Brasil
| | - Debora Brito
- Centro Universitário Estácio - Salvador (BA), Brasil
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Christensen JC, Paxton RJ, Baym C, Forster JE, Dayton MR, Hogan CA, Stevens-Lapsley JE. Benefits of direct patient discharge to outpatient physical therapy after total knee arthroplasty. Disabil Rehabil 2019; 42:660-666. [PMID: 30616406 DOI: 10.1080/09638288.2018.1505968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To investigate the effectiveness of home health physical therapy followed by outpatient physical therapy as compared to patients discharged directly to outpatient physical therapy in improving functional performance, strength/activation and residual knee pain outcomes among patients who received a total knee arthroplasty.Materials and methods: A secondary analysis of longitudinal data in which patients with total knee arthroplasty underwent home health physical therapy or were discharged directly to outpatient physical therapy. Main outcome measures included the stair climb test, timed up and go, 6-min walk test, quadriceps and hamstring strength, quadriceps activation and residual knee pain.Results: Patients referred to home health physical therapy prior to outpatient physical therapy demonstrated significantly greater declines in stair climb test (10.3; 95% CI [6.5, 14.1]; t = 5.41; p < 0.0001), timed up and go (2.0; 95% CI [1.0, 3.0]; t = 4.10; p < 0.0001), 6-min walk (53.8; 95% CI [29.4, 78.2]; t = 4.35; p < 0.0001), quadriceps strength (21.7%; 95% CI [19.3%, 24.9%]; t = 2.53; p = 0.01), hamstring strength (44.7%; 95% CI [43.4%, 45.7%], t = 3.17; p = 0.002) and higher residual knee pain (0.53; 95% CI [0.04, 1.03]; t = 2.17; p = 0.03) 1 month after total knee arthroplasty compared to those referred directly to outpatient physical therapy.Conclusions: These findings suggest that patients discharged directly to outpatient physical therapy had a more rapid recovery 1 month after total knee arthroplasty. Additional research is needed to investigate the potential causal relation between care pathways and clinical outcomes following total knee arthroplasty.Implications for rehabilitationTotal knee arthroplasty, typically performed to alleviate end-stage knee osteoarthritis, is the most commonly performed elective surgery in the United States.Despite improvement in pain, objective measurements of functional performance and strength often remain at preoperative levels one year after total knee arthroplasty.Patients discharged directly to higher intensity outpatient physical therapy have a more rapid recovery after total knee arthroplasty compared with those patients who received two weeks of home health prior to undergoing outpatient physical therapy.
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Affiliation(s)
- Jesse C Christensen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Roger J Paxton
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.,Department of Clinical Research, Children's Hospital Colorado, Aurora, CO, USA
| | - Carol Baym
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Michael R Dayton
- Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Craig A Hogan
- Department of Orthopedics, University of Colorado, Aurora, CO, USA
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Amano T, Suzuki N. Minimal Detectable Change for Motor Function Tests in Patients with Knee Osteoarthritis. Prog Rehabil Med 2018; 3:20180022. [PMID: 32789247 PMCID: PMC7365206 DOI: 10.2490/prm.20180022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/03/2018] [Indexed: 11/20/2022] Open
Abstract
Objective: Improvement in a subject’s motor function is clinically evaluated by comparing
measurements of the motor function tests taken before and after an intervention.
Consequently, it is important to increase the accuracy of the determination of the
intervention effect by confirming the minimal detectable change (MDC), which is an index
representing the limits of measurement errors in motor function tests. This study aimed
to examine the MDC of the five-time sit-to-stand test (FTSST) and the 5-m walk test
(5mWT) in patients with knee osteoarthritis (OA). Methods: In this cross-sectional study, 83 patients (63 women and 20 men, mean age: 73.7±8.0
years) with knee OA were subjected to two trials of the FTSST and 5mWT. The maximum
walking speed was calculated using the walking time in the 5mWT, and the intraclass
correlation coefficients (ICCs) were determined. Results: The ICCs (1,1) of the FTSST, the walking time in the 5mWT, and the walking speed were
0.90, 0.83, and 0.81, respectively. The MDC95 for the FTSST time, walking
time in the 5mWT, and walking speed were 1.71 s, 0.99 s, and 0.36 m/s, respectively.
Conclusion: If the observed changes in the motor function tests exceed 1.71 s for FTSST time, 0.99
s for walking time in the 5mWT, or 0.36 m/s for walking speed, then an improvement in
function is indicated. Such an improvement would reflect the effectiveness of the
intervention. These findings may aid in clinical decision making when using motor
function tests in patients with knee OA.
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Affiliation(s)
- Tetsuya Amano
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, Hamamatsu, Japan
| | - Nobuharu Suzuki
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, Hamamatsu, Japan
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Inai T, Takabayashi T, Edama M, Kubo M. Effect of hip joint angle at seat-off on hip joint contact force during sit-to-stand movement: a computer simulation study. Biomed Eng Online 2018; 17:177. [PMID: 30497482 PMCID: PMC6267796 DOI: 10.1186/s12938-018-0610-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/24/2018] [Indexed: 03/16/2023] Open
Abstract
Background Sit-to-stand movements are a necessary part of daily life, and excessive mechanical stress on the articular cartilage has been reported to encourage the progression of osteoarthritis. Although a change in hip joint angle at seat-off may affect hip joint contact force during a sit-to-stand movement, the effect is unclear. This study aimed to examine the effect of the hip joint angle at seat-off on the hip joint contact force during a sit-to-stand movement by using a computer simulation. Methods A musculoskeletal model was created for the computer simulation, and eight muscles were attached to each lower limb. Various sit-to-stand movements were generated using parameters (e.g., seat height and time from seat-off to standing posture) reported by previous studies. The hip joint contact force for each sit-to-stand movement was calculated. Furthermore, the effect of the hip joint angle at seat-off on the hip joint contact force during the sit-to-stand movement was examined. In this study, as the changes to the musculoskeletal model parameters affect the hip joint contact force, a sensitivity analysis was conducted. Results and conclusions The hip joint contact force during the sit-to-stand movement increased approximately linearly as the hip flexion angle at the seat-off increased. Moreover, the normal sit-to-stand movement and the sit-to-stand movement yielding a minimum hip joint contact force were approximately equivalent. The effect of the changes to the musculoskeletal model parameters on the main findings of this study was minimal. Thus, the main findings are robust and may help prevent the progression of hip osteoarthritis by decreasing mechanical stress, which will be explored in future studies. Electronic supplementary material The online version of this article (10.1186/s12938-018-0610-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Takuma Inai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan. .,Department of Rehabilitation, Oguma Orthopedics Clinic, 5-8-9 Koshin, Nishi-ku, Niigata City, Niigata, 950-2023, Japan.
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Masayoshi Kubo
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan
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Cudejko T, van der Esch M, van den Noort JC, Rijnhart JJM, van der Leeden M, Roorda LD, Lems W, Waddington G, Harlaar J, Dekker J. Decreased Pain and Improved Dynamic Knee Instability Mediate the Beneficial Effect of Wearing a Soft Knee Brace on Activity Limitations in Patients With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2018; 71:1036-1043. [PMID: 30099859 PMCID: PMC6771793 DOI: 10.1002/acr.23722] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/07/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate whether improvement of proprioception, pain, or dynamic knee instability mediates the effect of wearing a soft knee brace on activity limitations in patients with knee osteoarthritis (OA). METHODS We conducted an analysis of data for 44 patients with knee OA who were enrolled in a laboratory-based trial evaluating the effect of wearing a commercially available soft knee brace. Activity limitations were assessed with the 10-meter walk test and the Get Up and Go test. Knee joint proprioception was assessed by an active joint position sense test; pain was assessed on a numeric rating scale (NRS) (range 0-10); pressure pain threshold (PPT) was assessed with a hand-held pressure algometer; dynamic knee instability was expressed by the perturbation response, i.e., a measure reflecting a deviation in mean knee varus-valgus angle after a controlled mechanical perturbation on a treadmill, with respect to level walking. Mediation analysis was conducted using the product of coefficients approach. Confidence intervals were calculated with a bootstrap procedure. RESULTS A decrease in pain (scored on an NRS) and a decrease in dynamic knee instability mediated the effect of wearing a soft knee brace on the reduction of activity limitations (P < 0.05), while changes in proprioception and PPT did not mediate this effect (P > 0.05). CONCLUSION This study shows that decreased pain and reduced dynamic knee instability are pathways by which wearing a soft knee brace decreases activity limitations in patients with knee OA.
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Affiliation(s)
- Tomasz Cudejko
- VU Medical Center, Amsterdam Movement Sciences and Amsterdam Rehabilitation Research Center Reade, Amsterdam, The Netherlands
| | | | - Josien C van den Noort
- VU Medical Center, Amsterdam Movement Sciences and Musculoskeletal Imaging Quantification Center, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Marike van der Leeden
- VU Medical Center, Amsterdam Movement Sciences and Amsterdam Rehabilitation Research Center Reade, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center Reade, Amsterdam, The Netherlands
| | - Willem Lems
- Jan van Breemen Research Institute, Reade and Amsterdam Rheumatology and Immunology Centre, Amsterdam, The Netherlands
| | - Gordon Waddington
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Jaap Harlaar
- VU University Medical Center, Amsterdam Movement Sciences and Amsterdam and Delft University of Technology, Delft, The Netherlands
| | - Joost Dekker
- VU Medical Center, Amsterdam Movement Sciences and VU University Medical Center, Amsterdam, The Netherlands
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Localized muscle vibration reverses quadriceps muscle hypotrophy and improves physical function: a clinical and electrophysiological study. Int J Rehabil Res 2018; 40:339-346. [PMID: 28723717 DOI: 10.1097/mrr.0000000000000242] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Quadriceps weakness has been associated with knee osteoarthritis (OA). High-frequency localized muscle vibration (LMV) has been proposed recently for quadriceps strengthening in patients with knee OA. The purpose of this study was (a) to investigate the clinical effectiveness of high-frequency LMV on quadriceps muscle in patients with knee OA and (b) to disentangle, by means of surface electromyography (sEMG), the underlying mechanism. Thirty patients, aged between 40 and 65 years, and clinically diagnosed with knee OA were included in this randomized, controlled, single-blinded pilot study. Participants were randomly assigned to two groups: a study group treated with LMV, specifically set for muscle strengthening (150 Hz), by means of a commercial device VIBRA, and a control group treated with neuromuscular electrical stimulation. Clinical outcome was measured using the Western Ontario and McMaster Universities Osteoarthritis Index, Visual Analogue Scale, knee range of motion, Timed Up and Go test, and Stair climbing test. To assess changes in muscle activation and fatigue a subgroup of 20 patients was studied with the use of sEMG during a sustained isometric contraction. The LMV group showed a significant change in Western Ontario and McMaster Universities Osteoarthritis Index score, Visual Analogue Scale score, Timed Up and Go test, Stair Climbing Test, and knee flexion. These improvements were not significant in patients treated with neuromuscular electrical stimulation. sEMG analysis suggested an increased involvement of type II muscle fibers in the group treated with LMV. In conclusion, the present study supports the effectiveness of local vibration in muscle function and clinical improvement of patients with knee OA.
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Hyytiäinen HK, Mölsä SH, Junnila JJT, Laitinen-Vapaavuori OM, Hielm-Björkman AK. Developing a testing battery for measuring dogs' stifle functionality: the Finnish Canine Stifle Index (FCSI). Vet Rec 2018; 183:324. [PMID: 29779002 PMCID: PMC6166606 DOI: 10.1136/vr.104588] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/29/2017] [Accepted: 04/07/2018] [Indexed: 11/05/2022]
Abstract
This study aimed at developing a quantitative testing battery for dogs’ stifle functionality, as, unlike in human medicine, currently none is available in the veterinary field. Forty-three dogs with surgically treated unilateral cranial cruciate ligament rupture and 21 dogs with no known musculoskeletal problems were included. Eight previously studied tests: compensation in sitting and lying positions, symmetry of thrust in hindlimbs when rising from lying and sitting, static weight bearing, stifle flexion and extension and muscle mass symmetry, were summed into the Finnish Canine Stifle Index (FCSI). Sensitivities and specificities of the dichotomised FCSI score were calculated against orthopaedic examination, radiological and force platform analysis and a conclusive assessment (combination of previous). One-way analysis of variance (ANOVA)was used to evaluate FCSI score differences between the groups. Cronbach’s alpha for internal consistency was calculated. The range of the index score was 0–263, with a proposed cut-off value of 60 between ‘adequate’ and ‘compromised’ functional performance. In comparison to the conclusive assessment, the sensitivity and specificity of the FCSI were 90 per cent and 90.5 per cent, respectively. Cronbach’s alpha for internal reliability of the FCSI score was 0.727. An estimate of the surgically treated and control dogs’ FCSI scores were 105 (95 per cent CI 93 to 116) and 20 (95 per cent CI 4 to 37), respectively. The difference between the groups was significant (P<0.001).
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Affiliation(s)
- Heli K Hyytiäinen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Sari H Mölsä
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | | | - Outi M Laitinen-Vapaavuori
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Anna K Hielm-Björkman
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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Master H, Thoma LM, Christiansen MB, Polakowski E, Schmitt LA, White DK. Minimum Performance on Clinical Tests of Physical Function to Predict Walking 6,000 Steps/Day in Knee Osteoarthritis: An Observational Study. Arthritis Care Res (Hoboken) 2018; 70:1005-1011. [PMID: 29045051 DOI: 10.1002/acr.23448] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/10/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Evidence of physical function difficulties, such as difficulty rising from a chair, may limit daily walking for people with knee osteoarthritis (OA). The purpose of this study was to identify minimum performance thresholds on clinical tests of physical function predictive to walking ≥6,000 steps/day. This benchmark is known to discriminate people with knee OA who develop functional limitation over time from those who do not. METHODS Using data from the Osteoarthritis Initiative, we quantified daily walking as average steps/day from an accelerometer (Actigraph GT1M) worn for ≥10 hours/day over 1 week. Physical function was quantified using 3 performance-based clinical tests: 5 times sit-to-stand test, walking speed (tested over 20 meters), and 400-meter walk test. To identify minimum performance thresholds for daily walking, we calculated physical function values corresponding to high specificity (80-95%) to predict walking ≥6,000 steps/day. RESULTS Among 1,925 participants (mean ± SD age 65.1 ± 9.1 years, mean ± SD body mass index 28.4 ± 4.8 kg/m2 , and 55% female) with valid accelerometer data, 54.9% walked ≥6,000 steps/day. High specificity thresholds of physical function for walking ≥6,000 steps/day ranged 11.4-14.0 seconds on the 5 times sit-to-stand test, 1.13-1.26 meters/second for walking speed, or 315-349 seconds on the 400-meter walk test. CONCLUSION Not meeting these minimum performance thresholds on clinical tests of physical function may indicate inadequate physical ability to walk ≥6,000 steps/day for people with knee OA. Rehabilitation may be indicated to address underlying impairments limiting physical function.
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Inai T, Takabayashi T, Edama M, Kubo M. Relationship between movement time and hip moment impulse in the sagittal plane during sit-to-stand movement: a combined experimental and computer simulation study. Biomed Eng Online 2018; 17:48. [PMID: 29703194 PMCID: PMC5923195 DOI: 10.1186/s12938-018-0486-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/23/2018] [Indexed: 11/18/2022] Open
Abstract
Background The association between repetitive hip moment impulse and the progression of hip osteoarthritis is a recently recognized area of study. A sit-to-stand movement is essential for daily life and requires hip extension moment. Although a change in the sit-to-stand movement time may influence the hip moment impulse in the sagittal plane, this effect has not been examined. The purpose of this study was to clarify the relationship between sit-to-stand movement time and hip moment impulse in the sagittal plane. Methods Twenty subjects performed the sit-to-stand movement at a self-selected natural speed. The hip, knee, and ankle joint angles obtained from experimental trials were used to perform two computer simulations. In the first simulation, the actual sit-to-stand movement time obtained from the experiment was entered. In the second simulation, sit-to-stand movement times ranging from 0.5 to 4.0 s at intervals of 0.25 s were entered. Hip joint moments and hip moment impulses in the sagittal plane during sit-to-stand movements were calculated for both computer simulations. Results and conclusions The reliability of the simulation model was confirmed, as indicated by the similarities in the hip joint moment waveforms (r = 0.99) and the hip moment impulses in the sagittal plane between the first computer simulation and the experiment. In the second computer simulation, the hip moment impulse in the sagittal plane decreased with a decrease in the sit-to-stand movement time, although the peak hip extension moment increased with a decrease in the movement time. These findings clarify the association between the sit-to-stand movement time and hip moment impulse in the sagittal plane and may contribute to the prevention of the progression of hip osteoarthritis.
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Affiliation(s)
- Takuma Inai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, Niigata, 950-3198, Japan. .,Department of Rehabilitation, Oguma Orthopedics Clinic, 5-8-9 Koshin, Nishi-ku, Niigata, Niigata, 950-2023, Japan.
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, Niigata, 950-3198, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, Niigata, 950-3198, Japan
| | - Masayoshi Kubo
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, Niigata, 950-3198, Japan
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Abstract
OBJECTIVES To characterize the type and magnitude of lower extremity physical performance deficits in military service members who have undergone rehabilitation after limb salvage or transtibial amputation. DESIGN Cross-sectional prospective. SETTING Level I trauma military medical and rehabilitation center. PATIENTS/PARTICIPANTS Service members with lower extremity trauma resulting in limb salvage (n = 20) or unilateral transtibial amputation (n = 14) compared with uninjured actively training service members (n = 123). INTERVENTION Control participants and individuals with amputation were tested during a single session. Participants with limb salvage were tested with and without the use of a custom carbon fiber orthosis. MAIN OUTCOME MEASUREMENTS Physical performance as measured using four-square step, sit-to-stand 5 times, and timed stair ascent tests. Secondary outcomes included the associations between these lower extremity activity measures to determine the interrelationship of activity limitations. RESULTS The ability of service members to rapidly ascend stairs, a demanding lower limb mobility task, is limited after amputation and limb salvage. However, performance on an agility test similar to the four-square step test approximated normative levels. Differences between individuals with amputation or limb salvage were less than 1 second for all tests and were not statistically significant. Correlations were observed among the physical performance measures in the tested patient populations, particularly between the sit-to-stand and timed stair ascent tests. CONCLUSIONS Severe limb trauma significantly affects performance, particularly during tasks requiring lower extremity strength and power. Individuals with amputation or limb salvage who were provided a custom carbon fiber orthosis and intensive rehabilitation had similar performance. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Medina-Mirapeix F, Vivo-Fernández I, López-Cañizares J, García-Vidal JA, Benítez-Martínez JC, Del Baño-Aledo ME. Five times sit-to-stand test in subjects with total knee replacement: Reliability and relationship with functional mobility tests. Gait Posture 2018; 59:258-260. [PMID: 29102855 DOI: 10.1016/j.gaitpost.2017.10.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 10/07/2017] [Accepted: 10/29/2017] [Indexed: 02/02/2023]
Abstract
The objective was to determine the inter-observer and test/retest reliability of the "Five-repetition sit-to-stand" (5STS) test in patients with total knee replacement (TKR). To explore correlation between 5STS and two mobility tests. A reliability study was conducted among 24 (mean age 72.13, S.D. 10.67; 50% were women) outpatients with TKR. They were recruited from a traumatology unit of a public hospital via convenience sampling. A physiotherapist and trauma physician assessed each patient at the same time. The same physiotherapist realized a 5STS second measurement 45-60min after the first one. Reliability was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots. Pearson coefficient was calculated to assess the correlation between 5STS, time up to go test (TUG) and four meters gait speed (4MGS). ICC for inter-observer and test-retest reliability of the 5STS were 0.998 (95% confidence interval [CI], 0.995-0.999) and 0.982 (95% CI, 0.959-0.992). Bland-Altman plot inter-observer showed limits between -0.82 and 1.06 with a mean of 0.11 and no heteroscedasticity within the data. Bland-Altman plot for test-retest showed the limits between 1.76 and 4.16, a mean of 1.20 and heteroscedasticity within the data. Pearson correlation coefficient revealed significant correlation between 5STS and TUG (r=0.7, p<0.001) and 4MGS (r=-0.583, p=0.003). This study demonstrates excellent inter-observer and test-retest reliability when it is used in people with TKR, and also significant correlation with other functional mobility tests. These findings support the use of 5STS as outcome measure in TKR population.
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Cudejko T, van der Esch M, van der Leeden M, van den Noort JC, Roorda LD, Lems W, Twisk J, Steultjens M, Woodburn J, Harlaar J, Dekker J. The immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence in patients with knee osteoarthritis. Arthritis Res Ther 2017; 19:260. [PMID: 29191237 PMCID: PMC5709997 DOI: 10.1186/s13075-017-1456-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/18/2017] [Indexed: 01/12/2023] Open
Abstract
Background We aimed to (i) evaluate the immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence, and (ii) to assess the difference in effect between a non-tight and a tight soft brace in patients with knee osteoarthritis (OA). Methods Forty-four patients with knee OA and self-reported knee instability participated in the single-session, laboratory, experimental study. A within-subject design was used, comparing a soft brace with no brace, and comparing a non-tight with a tight soft brace. The outcome measures were pain, self-reported knee instability and knee confidence during level and perturbed walking on the treadmill and activity limitations (10-m walk test and the get up and go (GUG) test). Linear mixed-effect model analysis for continuous outcomes and logistic generalized estimating equations for categorical outcomes were used to evaluate the effect of wearing a soft brace. Results Wearing a soft brace significantly reduced pain during level walking (B − 0.60, P = 0.001) and perturbed walking (B − 0.80, P < 0.001), reduced the time to complete the 10-m walk (B − 0.23, P < 0.001) and the GUG tests (B − 0.23, P = 0.004), reduced self-reported knee instability during level walking (OR 0.41, P = 0.002) and perturbed walking (OR 0.36, P < 0.001), and reduced lack of confidence in the knees during level walking (OR 0.45, P < 0.001) and perturbed walking (OR 0.56, P < 0.001), compared with not wearing a soft brace. There was no difference in effects between a non-tight and tight brace, except for the 10-m walk test. Wearing a tight brace significantly reduced the time to complete the 10-m walk test in comparison with wearing a non-tight brace (B − 0.11, P = 0.03). Conclusion The results of this study indicate that a soft brace is an efficacious intervention targeting pain, activity limitations, self-reported knee instability, and knee confidence in the immediate term in patients with knee OA. Further studies are needed evaluating the mode of action based on exerted pressure, and on the generalization to functioning in daily life. Trial registration trialregister.nl, NTR6363. Retrospectively registered on 15 May 2017.
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Affiliation(s)
- Tomasz Cudejko
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Centre Reade, Dr. J. van Breemenstraat 2, 1056 AB Amsterdam, P.O. Box 58271, 1040 HG, Amsterdam, The Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Centre Reade, Dr. J. van Breemenstraat 2, 1056 AB Amsterdam, P.O. Box 58271, 1040 HG, Amsterdam, The Netherlands.
| | - Marike van der Leeden
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Centre Reade, Dr. J. van Breemenstraat 2, 1056 AB Amsterdam, P.O. Box 58271, 1040 HG, Amsterdam, The Netherlands
| | - Josien C van den Noort
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Musculoskeletal Imaging Quantification Center (MIQC), Academic Medical Center, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Centre Reade, Dr. J. van Breemenstraat 2, 1056 AB Amsterdam, P.O. Box 58271, 1040 HG, Amsterdam, The Netherlands
| | - Willem Lems
- Amsterdam Rheumatology & Immunology Center, Amsterdam Medical Center, Reade, VU University Medical Center, Amsterdam, The Netherlands.,Jan van Breemen Research Institute, Reade, Amsterdam, The Netherlands
| | - Jos Twisk
- Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Steultjens
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - James Woodburn
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Delft University of Technology, Delft, The Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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Collado-Mateo D, Domínguez-Muñoz FJ, Olivares PR, Adsuar JC, Gusi N. Stair negotiation in women with fibromyalgia: A descriptive correlational study. Medicine (Baltimore) 2017; 96:e8364. [PMID: 29069023 PMCID: PMC5671856 DOI: 10.1097/md.0000000000008364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Walking up and down stairs is a common and important activity of daily living. Women with fibromyalgia often show a reduced ability to perform this task.The objective of this study was to evaluate the test-retest reliability of stair negotiation tasks and to assess the impact of fibromyalgia symptoms on the ability to negotiate stairs.Forty-two women with fibromyalgia participated in this descriptive correlational study. The relevance of the stair negotiation (both walking up and down) was evaluated by assessing its association with the revised version of the fibromyalgia impact questionnaire (FIQ-R) and other health-related variables. Test-retest reliability was also analyzed. The main outcome measures were time spent walking up and down stairs and impact of fibromyalgia, quality of life, number of falls, weight, and lower limb strength and endurance.The intraclass correlation coefficient (ICC) for stair descent was 0.929 whereas that for ascent was 0.972. The score in these tests correlated significantly with the total score for the FIQ-R and the score for many of dimensions and symptoms: that is, physical function, overall impact of fibromyalgia, pain, energy, stiffness, restorative sleep, tenderness, self-perceived balance problems, and sensitivity.Given the importance of the stair negotiation as activity of daily living and the high reliability, both stair ascent and descent tasks may be useful as outcome measures in studies on patients with fibromyalgia.
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Affiliation(s)
| | | | | | - José C. Adsuar
- Faculty of Sport Science, University of Extremadura, Spain
| | - Narcis Gusi
- Faculty of Sport Science, University of Extremadura, Spain
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Functioning Without Cartilage: Older People With Radiographic Knee Osteoarthritis Who Self-Report No Functional Limitations Do Score Lower on a Performance Battery. J Aging Phys Act 2017; 25:570-575. [PMID: 28181834 DOI: 10.1123/japa.2016-0112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The majority of the older population shows signs of radiographic knee osteoarthritis. However, many remain without functional complaints for a long period. This study aims to find early functional changes associated with stages of radiographic knee osteoarthritis. A group of older people without self-reported complaints was divided in two groups: knee osteoarthritis (K&L = 2-4, N = 29) and control (K&L = 0-1, N = 31). Muscle function was assessed with voluntary and electrically-stimulated isometric knee contractions, including a fatigue test. Physical functioning was assessed with a 6-min walk test (6MWT), a stair climb test (SCT), and a short performance battery. There were no differences in muscle function parameters, 6MWT, and SCT between groups. A clinically relevant lower score on the performance battery was found in participants with knee osteoarthritis. In conclusion, even when older people indicate to have no functional limitations, a decline in functional outcome can be measured with a physical performance battery.
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