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Nazary-Moghadam S, Abbasi Z, Sekandari R, Razi A, Zeinalzadeh A, Rostami S, Khabbaz Kababi MH. Kinesiotaping Is Not Better Than a Placebo: Kinesiotaping for Postural Control in Anterior Cruciate Ligament-Reconstructed Patients-A Randomized Controlled Trial. J Sport Rehabil 2024; 33:245-251. [PMID: 38531351 DOI: 10.1123/jsr.2023-0185] [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: 06/13/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE The primary aim of this study was to investigate the immediate and delayed effects of kinesiotape (KT) on postural control and patient-reported outcome measures under challenging conditions in individuals with anterior cruciate ligament reconstructions. METHODS Thirty-two anterior cruciate ligament-reconstructed patients for whom 6 months had passed since their operation were randomly assigned to either the KT (n = 16, aged 21.8 [5.5] y) or the placebo KT (n = 16, aged 24.0 [5.1] y) groups. Initially, both groups stood barefoot on a force platform while performing postural tasks in 4 randomized conditions (eyes open, eyes closed, cognitive task, and foam). Before the experiment, patients would bring the 4 conditions, which were written on folded papers, one by one, and in this way, the order of conditions for the examiners was determined. The patients' evaluations were conducted immediately and 48 hours after KT application. Postural control measures, with area and displacement of the center of pressure (CoP) in anterior-posterior and medial-lateral directions, and mean total velocity displacement of CoP (MVELO CoP) served as dependent variables. In addition, the International Knee Documentation Committee score was measured pretreatment and 48 hours posttreatment. RESULTS Significant group-by-time interactions were observed for displacement of COP in medial-lateral direction (P = .002) and MVELO CoP (P = .034). MVELO CoP significantly decreased (mean difference = 0.60, P = .009) immediately after KT application compared with preapplication measures. In the placebo group, a statistically significant decrease in MVELO CoP (mean difference = 0.869, P = .001) was observed at 48 hours post-KT compared with preapplication values. International Knee Documentation Committee scores significantly improved at 48 hours post-KT application in both groups (P < .05). CONCLUSIONS Though observed at different time points, both KT (immediately after the intervention) and placebo KT (48 h after the intervention) were found to improve postural control measures. It appears that the changes in postural control may be more related to proprioceptive enhancement due to KT rather than the specific KT pattern.
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Affiliation(s)
- Salman Nazary-Moghadam
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Science, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Science, Mashhad, Iran
| | - Zahra Abbasi
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Science, Mashhad, Iran
| | - Reyhaneh Sekandari
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Science, Mashhad, Iran
| | - Amin Razi
- Orthopedic Research Center, Mashhad University of Medical Science, Mashhad, Iran
| | - Afsaneh Zeinalzadeh
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Science, Mashhad, Iran
| | - Somayyeh Rostami
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Science, Mashhad, Iran
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Batista NP, de Oliveira Silva D, Mochizuki L, Norte GE, Bazett-Jones DM. Clinic- and laboratory-based measures of postural control in patellofemoral pain: A systematic review with meta-analysis and evidence gap map. Gait Posture 2024; 109:189-200. [PMID: 38341930 DOI: 10.1016/j.gaitpost.2024.02.002] [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: 07/31/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a prevalent musculoskeletal disorder associated with functional impairments. Although postural control is commonly assessed in people with PFP, there are inconsistent results regarding potential postural control deficits in this population. RESEARCH QUESTION This review aims to evaluate whether postural control is impaired in people with patellofemoral pain (PFP) and the effectiveness of interventions on postural control measures. METHODS We searched six databases from their inception to May 5, 2023. We included studies assessing clinic- or laboratory-based postural control measures in people with PFP compared to pain-free controls, and intervention studies with PFP populations. We assessed risk of bias using the Joanna Briggs Institute critical appraisal checklists and the Cochrane Risk of Bias 2 tool. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We used random-effects meta-analyses considering subgroups based on type of task, measure, and intervention. RESULTS Fifty-three studies were included. Very low certainty evidence indicated that people with PFP have shorter anterior (SMD = 0.53, 95 %CI:0.16,0.90), posteromedial (SMD = 0.54, 95 %CI:0.04,1.03) and posterolateral (SMD = 0.59, 95 %CI:0.11,1.07) reach distance, and worse composite score (SMD = 0.46, 95 %CI:0.22,0.70). Very low to moderate certainty evidence indicated that people with PFP have worse anterior-posterior and overall stability indexes during single-leg stance (SMD = -0.71, 95 %CI:-1.29,-0.14; SMD = -0.63, 95 %CI:-0.94,-0.32) and overall stability index during double-leg stance (SMD = -0.39, 95 %CI:-0.78,-0.00), but no differences in center of pressure area during stair ascent (SMD = 0.32, 95 %CI:-2.72, 3.36). Low certainty evidence indicated that kinesio taping improved anterior reach distance (SMD = -0.49, 95 %CI:-0.89,-0.09), while no significant differences were observed between pre- and post-intervention outcomes for conventional rehabilitation and rigid taping. SIGNIFICANCE Clinicians should use clinic- (star excursion or Y-balance tests) and laboratory-based (stability indexes) measures to identify impairments of postural control in people with PFP. Low certainty of evidence suggests short-term improvement in postural control with kinesio taping.
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Affiliation(s)
- Natanael P Batista
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA.
| | - Danilo de Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
| | - Luis Mochizuki
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil.
| | - Grant E Norte
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA.
| | - David M Bazett-Jones
- School of Exercise and Rehabilitation Sciences, University of Toledo, Toledo, OH, USA.
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Orakifar N, Shahbazi F, Mofateh R, Seyedtabib M, Esfandiarpour F. Can a rigid antipronation foot orthosis change the effects of prolonged standing on postural control in men with patellofemoral pain? Prosthet Orthot Int 2023; 47:473-478. [PMID: 37068018 DOI: 10.1097/pxr.0000000000000225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/18/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Pronated foot posture is known as a contributing factor for patellofemoral pain (PFP) development. Patients with patellofemoral pain often experience poor postural control. Implementation of optimal management strategies for enhancing their postural performance is important. OBJECTIVES The aim of this study was to determine whether a rigid antipronation foot orthosis changes prolonged standing effects on postural control in men with PFP. STUDY DESIGN Case-control study. METHODS Twenty-eight men with PFP and pronated foot and 28 healthy men were enrolled in this study. Center-of-pressure parameters were measured during short trials (60 seconds) of single-leg standing before and immediately after prolonged standing (20 minutes) using force platform. In patients with PFP, postural control was examined on 2 separate days with and without rigid antipronation foot orthosis. RESULTS Findings showed that the pre-post differences of sway area (t(48) = -2.22, p = 0.03), mediolateral (ML) displacement (t (48) = -2.51, p = 0.01), and mean velocity (t(48) = -2.01, p = 0.04) were significantly greater in patients with PFP without foot orthosis compared with those in the healthy group. Significant intervention main effect ( p = 0.04) and time-by-intervention interaction ( p = 0.006) for sway area were shown. Significant intervention main effects were noted for ML displacement ( p = 0.007) and mean velocity ( p = 0.003). For these variables, significant time-by-intervention interactions were found. Further analysis showed greater values of ML displacement and mean velocity parameters before the prolonged standing in patients with PFP without foot orthosis compared with patients with PFP with orthosis. CONCLUSIONS Rigid antipronation foot orthosis can improve the postural performance after prolonged standing in young adult men with PFP.
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Affiliation(s)
- Neda Orakifar
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Shahbazi
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Razieh Mofateh
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Seyedtabib
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Nunes GS, Rodrigues DZ, Hörbe L, Prates I, Tessarin BM, Serrão FV, de Noronha M. Is Postural Control Affected in People with Patellofemoral Pain and Should it be Part of Rehabilitation? A Systematic Review with Meta-analysis. SPORTS MEDICINE - OPEN 2022; 8:144. [PMID: 36504326 PMCID: PMC9742077 DOI: 10.1186/s40798-022-00538-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Growing evidence supports that exercise therapy is effective for patellofemoral pain (PFP) rehabilitation. Nevertheless, the improvements have been reported not to be sustained in the long term, suggesting that the current protocols may not comprehend all required functional factors to provide a consistent recovery. A potential neglected factor in treatment protocols for PFP is postural control. However, it is unclear whether this population presents balance impairments or the influence of postural control on pain and function during rehabilitation programmes. OBJECTIVE To investigate whether (Q1) balance is impaired in people with PFP compared to controls, (Q2) conservative interventions are effective to improve balance in people with PFP, and (Q3) balance exercises are effective to improve pain and function in people with PFP. DATA SOURCES Medline, Embase, CINAHL, SPORTDiscus, Web of Science and Cochrane Library, supplemented by hand searching of reference lists, citations and relevant systematic reviews in the field. METHODS A systematic review with meta-analysis was conducted according to the Cochrane recommendations and reported according to the PRISMA statement recommendations. We included cross-sectional studies comparing balance between people with and without PFP; and randomised controlled trials verifying the effect of conservative intervention on balance and the effect of balance intervention on pain and function in people with PFP. The risk of bias was assessed using the Epidemiological Appraisal Instrument for cross-sectional studies and the Physiotherapy Evidence Database scale for randomised controlled trials. RESULTS From 15,436 records, 57 studies (Q1 = 28, Q2 = 23, Q3 = 14) met the eligibility criteria. Meta-analyses indicated that people with PFP have worse anteroposterior (very low grade evidence, standardised mean difference [SMD] = 1.03, 95% CI 0.40-1.66) and mediolateral (moderate grade evidence, SMD = 0.87, 95% CI 0.31-1.42) balance compared to controls. Moderate grade evidence indicated that overall balance is not affected in people with PFP (SMD = 0.38, 95% CI - 0.05-0.82). Low to very low grade evidence indicates that interventions are ineffective for mediolateral (SMD = 0.01, 95% CI - 0.51-0.53) and overall (SMD = 0.49, 95% CI - 0.14-1.11) balance improvements, and low grade evidence indicates that interventions are effective to improve anteroposterior balance (SMD = 0.64, 95% CI 0.04-1.23). Moderate to low grade evidence indicated that balance interventions are effective to reduce pain (SMD = 0.82, 95% CI 0.26-1.38) and improve function (SMD = 0.44, 95% CI 0.09-0.80) when measured using questionnaires; and very low grade evidence indicated no efficacy for function measured via functional tests (SMD = 0.73, 95% CI - 0.16-1.61). CONCLUSION People with PFP likely present balance deficits compared to asymptomatic people. There was insufficient evidence to support the efficacy of interventions to improve or modify balance in people with PFP. Also, there was insufficient evidence to support the efficacy of balance exercises to improve pain and function in people with PFP. Trial Registration The present systematic review was registered in PROSPERO (CRD42018091717).
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Affiliation(s)
- Guilherme S. Nunes
- grid.411239.c0000 0001 2284 6531Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS CEP 97105-900 Brazil
| | - Diênifer Zilmer Rodrigues
- grid.411239.c0000 0001 2284 6531Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS CEP 97105-900 Brazil
| | - Luiza Hörbe
- grid.411239.c0000 0001 2284 6531Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS CEP 97105-900 Brazil
| | - Izabela Prates
- grid.411239.c0000 0001 2284 6531Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Av. Roraima, 1000, Santa Maria, RS CEP 97105-900 Brazil
| | - Bruna M. Tessarin
- grid.411247.50000 0001 2163 588XDepartment of Physiotherapy, São Carlos Federal University, São Carlos, Brazil
| | - Fábio V. Serrão
- grid.411247.50000 0001 2163 588XDepartment of Physiotherapy, São Carlos Federal University, São Carlos, Brazil
| | - Marcos de Noronha
- grid.1018.80000 0001 2342 0938Rural Department of Allied Health, La Trobe University, Bendigo, VIC Australia
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Jellad A, Kalai A, Guedria M, Jguirim M, Elmhamdi S, Salah S, Frih ZBS. Combined Hip Abductor and External Rotator Strengthening and Hip Internal Rotator Stretching Improves Pain and Function in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial With Crossover Design. Orthop J Sports Med 2021; 9:2325967121989729. [PMID: 33912615 PMCID: PMC8050763 DOI: 10.1177/2325967121989729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Active rehabilitation has an important role in the management of
patellofemoral pain syndrome (PFPS). Although some studies have shown the
benefit of hip-muscle strengthening, the effect of combining hip-muscle
stretching with strengthening has not yet been defined. Purpose: To evaluate the effect of combined strengthening of the hip external rotators
and abductors and stretching of the hip internal rotators on pain and
function in patients with PFPS. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 109 patients with PFPS (75 female and 34 male; mean age, 31.6 ±
10.8 years) were first randomly assigned to protocol A (n = 67) of the A-B
arm (AB group; standard rehabilitation) or protocol B (n = 42) of the B-A
arm (BA group; standard rehabilitation with strengthening of the hip
external rotators and abductors and stretching of the hip internal
rotators). Each protocol consisted of 3 sessions a week for 4 weeks. After a
washout period, corresponding to a symptom-free period, rehabilitation
programs were crossed over. A visual analog scale (VAS) evaluating perceived
pain, the Functional Index Questionnaire (FIQ), and the Kujala score were
administered at baseline, the end of each rehabilitation protocol, and 12
weeks after the completion of the second protocol for each group. Results: Until the final follow-up, VAS, FIQ, and Kujala scores were significantly
improved in both the A-B and B-A arms (P < .05 for all).
Compared with protocol A, protocol B provided significant improvement in
terms of pain and function in both the BA (VAS and Kujala;
P < .001) and AB (VAS and Kujala; P
< .001) groups. Conclusion: Combined strengthening of the hip abductors and external rotators with
stretching of the hip internal rotators provided better outcomes, which were
maintained for at least 12 weeks, in terms of pain and function in patients
with PFPS.
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Affiliation(s)
- Anis Jellad
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Amine Kalai
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Mohamed Guedria
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Mahbouba Jguirim
- Department of Rheumatology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Elmhamdi
- Department of Preventive Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Salah
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Zohra Ben Salah Frih
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Zeinalzadeh A, Nazary-Moghadam S, Sayyed Hoseinian SH, Ebrahimzadeh MH, Imani E, Karimpour S. Intra- and Inter-Session Reliability of Methods for Measuring Reaction Time in Participants with and without Patellofemoral Pain Syndrome. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:102-109. [PMID: 33778122 DOI: 10.22038/abjs.2020.46213.2270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To evaluate the relative and absolute reliability of reaction time measuring methods during different conditions in participants with and without patellofemoral pain syndrome (PFPS). Methods 30 patients with PFPS and 30 healthy controls were recruited in the present study. The upper extremity reaction time, upper extremity error rate, involved and non-involved lower extremity braking reaction times, and involved and non-involved knee extension reaction times were measured. Each condition was repeated three times, 2 sessions with a 5-7 days interval. The intra-session reliability was evaluated in three-trial (A), second- and third-trial (B) modes. In addition, the inter-session reliability was evaluated in mode A, mode B, and best score (C) mode. Results The result of inter-session reliability of mode A showed that all measurements except upper extremity reaction time in PFPS group showed high to very high relative reliability (ICC: 0.74-0.94). In mode B, all measurements except non-involved knee extension reaction time in PFPS group showed high to very high relative reliability (ICC: 0.71-0.93). In mode C, all measurements showed high to very high relative reliability (ICC: 0.70-0.94) except upper extremity error rate and non-involved knee extension reaction time in PFPS group. The result of intra-session reliability showed that all measurements had high to very high relative reliability (ICC: 0.78-0.94) in mode A. In mode B, all measurements showed high to very high relative reliability (0.78-0.94). Conclusion The braking time seems more reliable than other reaction time tasks. In addition, the results showed that mode A is more reliable than other modes. The newly designed package is a reliable tool to measure the knee extension reaction time in patients with knee musculoskeletal disorders.
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Affiliation(s)
- Afsaneh Zeinalzadeh
- Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Salman Nazary-Moghadam
- Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Esmaeel Imani
- Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Karimpour
- Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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Porto C, Lemos T, Sá Ferreira A. Reliability and robustness of optimization properties for stabilization of the upright stance as determined using posturography. J Biomech 2020; 103:109686. [PMID: 32139097 DOI: 10.1016/j.jbiomech.2020.109686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 11/27/2022]
Abstract
Diagnostic value of static posturography depends on its methodological features, measurement properties, and on computational methods that extract meaningful information from the postural sway i.e. the center-of-pressure (CoP) displacements. In this study, we assessed the reliability and robustness of the postural system based on the optimization properties of the CoP signal: descending, local and global stability, and convergence. For the analysis, we used CoP data from 146 participants (104 [71%] female, age 46 ± 23 years, body mass index 23.6 ± 3.4 kg/m2) recorded while standing quietly on a foam surface without visual input. Reliability was estimated using the intraclass correlation coefficient from a single (ICC2,1) and averaged (ICC2,3) measurements. Robustness was assessed through main and interaction effects for the signal duration (60, 30 s), sampling frequency (100, 50 Hz), and lowpass filtering cutoff frequency (10, 5 Hz). The observed reliability depended on the use of average or single measurements as it was excellent for the stability property (ICC2,k ≥ 0.772); excellent-to-acceptable (ICC2,3 ≥ 0.540) or excellent-to-unacceptable (ICC2,1 ≥ 0.281) for the descending property; and excellent-to-unacceptable (ICC2,3 > 0.295; ICC2,1 > 0.122) for the convergence property. Robustness analysis showed large main effects of signal duration (ω2 ≤ 0.834, p < 0.001), sampling frequency (ω2 ≤ 0.526, p < 0.001), and the lowpass filter cutoff frequency (ω2 ≤ 0.523, p < 0.001) on the optimization properties; but all two-way and three-way effects varied from medium to trivial. Reliability is thus excellent to acceptable for deriving the descending, stability, and convergence properties from the average of three measurements. Those optimization properties are robust to the interaction but not the main effects of methodological sources of variation of posturography.
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Affiliation(s)
- Carla Porto
- Laboratory of Computational Simulation and Modeling in Rehabilitation, Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil
| | - Thiago Lemos
- Laboratory of Computational Simulation and Modeling in Rehabilitation, Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil
| | - Arthur Sá Ferreira
- Laboratory of Computational Simulation and Modeling in Rehabilitation, Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil.
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Reliability of Knee Flexion-Extension Lyapunov Exponent in People With and Without Anterior Cruciate Ligament Deficiency. J Sport Rehabil 2020; 29:253-256. [PMID: 31094623 DOI: 10.1123/jsr.2018-0468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/18/2019] [Accepted: 03/24/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The current study assessed the intrasession and intersession reliability of the knee flexion-extension Lyapunov exponent in patients with anterior cruciate ligament deficiency and healthy individuals. STUDY DESIGN University research laboratory. METHODS Kinematic data were collected in 14 patients with anterior cruciate ligament deficiency and 14 healthy individuals walked on a treadmill at a self-selected, low, and high speed, with and without cognitive load. The intraclass correlation coefficient, standard error of measurement, minimal metrically detectable change, and percentage of coefficient of variation were calculated to assess the reliability. RESULTS The knee flexion-extension Lyapunov exponent had high intrasession reliability, with intraclass correlation coefficients ranging from .83 to .98. In addition, the intersession intraclass correlation coefficient values of these measurements ranged from .35 to .85 regardless of group, gait speed, and dual tasking. In general, relative and absolute reliability were higher in the patients with anterior cruciate ligament deficiency than in the healthy individuals. CONCLUSIONS Although knee flexion-extension Lyapunov exponent demonstrates good intrasession reliability, its low intersession reliability indicates that changes of these measurements between different days should be interpreted with caution.
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Gait speed is more challenging than cognitive load on the stride-to-stride variability in individuals with anterior cruciate ligament deficiency. Knee 2019; 26:88-96. [PMID: 30473374 DOI: 10.1016/j.knee.2018.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 09/22/2018] [Accepted: 11/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several investigations have studied gait variability of individuals with anterior cruciate ligament (ACL) deficiency; however, the effect of dual-tasking on the gait variability of these individuals remained unclear. The aim of the present study was to determine the effect of gait speed and dual-tasking on knee flexion-extension variability in subjects with and without ACL deficiency. METHODS The knee flexion-extension Lyapunov exponent (LyE) was measured in 22 ACL-deficient (Mean±SD) (25.95 ± 4.69 years) and 22 healthy subjects (24.18 ± 3.32 years). They walked at three levels of gait speed in isolation or concurrently with a cognitive task. RESULTS Repeated-measure analyses of variance (ANOVAs) demonstrated that the interaction of group by gait speed was statistically significant. As the gait speed increased from low to high, the knee flexion-extension LyE significantly decreased for the subjects with ACL deficiency (effect size: 0.57, P = 0.01). The interaction of group by cognitive load was not statistically significant (P = 0.07). In addition, the ACL-deficient subjects had statistically slower reaction times than healthy subjects during the dual-task compared with the single-task condition. CONCLUSIONS The ACL-deficient and healthy individuals had a tendency to maintain safe gait. It seems that the ACL-deficient subjects sacrificed the cognitive task more than the healthy individuals to pay more attention toward gait. Additionally, it seems that the gait speed was more challenging than cognitive load on the stride-to-stride variability in the individuals with ACL deficiency.
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Capin JJ, Snyder-Mackler L. The current management of patients with patellofemoral pain from the physical therapist's perspective. ANNALS OF JOINT 2018; 3. [PMID: 31414069 DOI: 10.21037/aoj.2018.04.11] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patellofemoral pain (PFP) is a common diagnosis that includes an amalgam of conditions that are typically non-traumatic in origin and result in peripatellar and/or retropatellar knee pain. The purpose of this review is to provide an overview of the physical therapist's management, including the evaluation and treatment, of the patient with PFP. A thorough history is critical for appropriately diagnosing and optimally managing PFP; the history should include the date of symptom onset, mechanism of injury and/or antecedent events, location and quality of pain, exacerbating and alleviating symptoms, relevant past medical history, occupational demands, recreational activities, footwear, and patient goals. Physical examination should identify the patient's specific impairments, assessing range of motion (ROM), muscle length, effusion, resisted isometrics, strength, balance and postural control, special tests, movement quality, palpation, function, and patient reported outcome measures. Objective assessments should guide treatment, progression, and clinical decision-making. The rehabilitation program should be individually tailored, addressing the patient's specific impairments and functional limitations and achieving the patient's goals. Exercise therapy, including hip, knee, and core strengthening as well as stretching and aerobic exercise, are central to the successful management of PFP. Other complimentary treatments may include patellofemoral and tibiofemoral joint mobilizations, patellofemoral taping, neuromuscular training, and gait retraining. Appropriate progression of interventions should consider objective evaluations (e.g., effusion, soreness rules), systematic increases in loading, and the chronicity of symptoms. Although short-term changes or reductions in movement often are necessary in a protective capacity, the persistence of altered movement is a key characteristic of chronic pain, which may be managed in part through emphasis on function over symptoms, graded exposure, patient education, and perhaps referral. PFP etiology is largely movement related and a comprehensive conservative treatment using movement can be successful.
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Affiliation(s)
- Jacob John Capin
- Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA.,Physical Therapy, University of Delaware, Newark, Delaware, USA
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