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de Sire A, Marotta N, Spanó R, Fasano S, Sgro M, Lippi L, Invernizzi M, Ammendolia A. Efficacy of proprioceptive neuromuscular facilitation on functioning in patients with bilateral hip osteoarthritis: A pilot randomized controlled trial. J Back Musculoskelet Rehabil 2024; 37:445-457. [PMID: 37955078 DOI: 10.3233/bmr-230148] [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] [Indexed: 11/14/2023]
Abstract
BACKGROUND Hip osteoarthritis (OA) is a chronic progressive disease that impresses a noticeable burden to society and healthcare systems. Physical exercise constitutes the first-line hip OA treatment approach, nevertheless, there is currently no gold standard method to treat this disease. OBJECTIVE To evaluate the efficacy of proprioceptive neuromuscular facilitation (PNF) on functioning in patients with hip OA. METHOD A pilot randomized controlled trial (RCT) was carried out on patients with painful bilateral hip OA with a body mass index (BMI) < 30 kg/m2. After the randomization, the experimental group was treated with PNF protocol and the control group with conventional physical therapy (10 sessions of manual therapy, 5 sessions/week for 2 weeks). The Harris Hip Score (HHS) was the primary outcome, whereas we assessed as secondary outcomes: pain, range of motion, and muscle strength of hip, physical performance, and quality of life. RESULTS Twenty patients (40 hips) were enrolled and randomized into two groups: PNF group (mean age: 70.7 ± 8.07; BMI: 25.1 ± 3.07; 7 females and 3 males) and control group (mean age: 74.9 ± 10.72; BMI: 26.8 ± 3.78; 6 females and 4 males). The results showed a statistically significant improvement of HHS in the study group (T1: 90.6 ± 5.63) than in the control group (T1: 77.3 ± 10.9) (between-group p value < 0.001). Three months after the treatment we have statistically significant maintenance in the PNF group (T2:89.6±6.32, within-group ΔT0-T2 p< 0.01) while the control group did not maintain the improvements recorded at T1 (T2: 71.4 ± 15.8). CONCLUSION The results of this pilot RCT showed that incorporating PNF exercises into the rehabilitation program yielded notable enhancements in improving lower limb function, strength and ROM in hip OA patients. Nonetheless, further prospective studies including wider sample size are needed to implement scientific knowledge on this physical therapy approach, in patients with hip osteoarthritis.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Nicola Marotta
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Riccardo Spanó
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- S. Anna Institute, Crotone, Italy
| | - Stefano Fasano
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Maria Sgro
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Lorenzo Lippi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Kaufmann M, Nüesch C, Clauss M, Pagenstert G, Eckardt A, Ilchmann T, Stoffel K, Mündermann A, Ismailidis P. Functional assessment of total hip arthroplasty using inertial measurement units: Improvement in gait kinematics and association with patient-reported outcome measures. J Orthop Res 2023; 41:759-770. [PMID: 35880355 DOI: 10.1002/jor.25421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 07/08/2022] [Accepted: 07/23/2022] [Indexed: 02/04/2023]
Abstract
Inertial measurement units (IMUs) are commonly used for gait assessment, yet their potential for quantifying improvements in gait function and patterns after total hip arthroplasty (THA) has not been fully explored. The primary aim of this study was to compare spatiotemporal parameters and sagittal plane kinematic patterns of patients with hip osteoarthritis (OA) before and after THA, and to asymptomatic controls. The secondary aim was to assess the association between dynamic hip range of motion (ROM) during walking and the Hip Osteoarthritis Outcome Scores (HOOS). Twenty-four patients with hip OA and 24 matched asymptomatic controls completed gait analyses using the RehaGait® sensor system. Patients were evaluated pre- and 1 year postoperatively, controls in a single visit. Differences in kinematic data were analyzed using statistical parametric mapping, and correlations between dynamic hip ROM and HOOS were calculated. Walking speed and stride length significantly increased (+0.08 m/s, p = 0.019; +0.06 m, p = 0.048) after THA but did not reach the level of asymptomatic controls (-0.11 m/s, p = 0.028; -0.14 m, p = 0.001). Preoperative hip and knee kinematics differed significantly from controls. After THA, they improved significantly and did not differ from controls. Dynamic hip flexion-extension ROM correlated positively with all HOOS subscores (r > 0.417; p ≤ 0.001). The change in HOOS symptoms in patients was explained by the combination of baseline HOOS symptoms and change in dynamic hip ROM (r2 = 0.748) suggesting that the additional information gained with IMU gait analysis helps to complement and objectify patient-reported outcome measures pre- and postoperatively and monitor treatment-related improvements.
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Affiliation(s)
- Mara Kaufmann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Center for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland.,Clarahof Clinic of Orthopaedic Surgery, Basel, Switzerland
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik, Birshof, Münchenstein, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik, Birshof, Münchenstein, Switzerland
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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Paterson KL, Bennell KL, Metcalf BR, Jones SE, Campbell PK, McManus F, Lamb KE, Hinman RS. Shoes for self-managing chronic hip Pain: the SCHIPP randomized clinical trial protocol. BMC Musculoskelet Disord 2023; 24:141. [PMID: 36814221 PMCID: PMC9948330 DOI: 10.1186/s12891-023-06235-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Chronic hip pain is common and disabling and is largely due to osteoarthritis (OA). Self-management is recommended by international OA clinical guidelines yet there are few effective treatment options. Footwear has been suggested as a self-management approach, given that foot motion influences hip forces. Currently, guidelines advocate 'stable supportive' shoes for people with OA, however this is based solely on expert opinion given no research has investigated whether these shoes are effective at reducing symptoms in people with OA-related chronic hip pain. Therefore, this randomized controlled trial (RCT) aims to determine if stable supportive footwear reduces hip pain during walking compared to flat flexible footwear in people with chronic hip pain consistent with OA. METHODS This trial is a 6-month, participant- and assessor-blinded, pragmatic, comparative effectiveness, superiority RCT conducted in Melbourne, Australia. We are recruiting 120 participants aged over 45 years with chronic hip pain consistent with OA from the community. Following baseline assessment, participants are randomized to receive either i) stable supportive shoes or ii) flat flexible shoes. Participants are permitted to choose two different pairs of shoes in their allocated group from a range of options that match prespecified shoe classification criteria. They are advised to wear either pair of study shoes daily for a minimum of 6 hours each day for 6 months. The primary outcome is the 6-month change in average hip pain on walking in the last week. Secondary outcomes include changes in other measures of hip pain, symptoms, function in daily living and sports and recreation, hip-related quality of life, pain at other sites, adverse events, and physical activity. Other measures include co-intervention use, adherence, shoe comfort, descriptive characteristics, footwear characteristics, and objective foot measures. DISCUSSION This RCT will determine whether stable supportive shoes reduce hip pain during walking more than flat flexible shoes in people with chronic hip pain. Outcomes will help to inform footwear recommendations in international clinical guidelines for OA-related chronic hip pain, which to date have been based solely on expert opinion because of an absence of RCTs. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry reference: ACTRN12621001532897.
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Affiliation(s)
- Kade L. Paterson
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Kim L. Bennell
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Ben R. Metcalf
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Sarah E. Jones
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Penny K. Campbell
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Fiona McManus
- grid.1008.90000 0001 2179 088XBiostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Karen E. Lamb
- grid.1008.90000 0001 2179 088XBiostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Rana S. Hinman
- grid.1008.90000 0001 2179 088XCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
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Olsen AL, Magnussen LH, Skjaerven LH, Assmus J, Sundal MA, Furnes O, Hallan G, Strand LI. Basic Body Awareness Therapy versus standard care in hip osteoarthritis. A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 27:e1930. [PMID: 34811841 DOI: 10.1002/pri.1930] [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: 02/21/2021] [Revised: 06/10/2021] [Accepted: 10/09/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Compensational movement patterns in hip osteoarthritis (HOA) are associated with hip dysfunction. Basic Body Awareness Therapy (BBAT) promotes functional movement quality and might, accordingly, be beneficial in HOA. OBJECTIVE To examine the outcomes of BBAT compared to standard care in people with HOA after first receiving patient education (PE). STUDY DESIGN A prospective, assessor-blinded, and block-randomized controlled trial. METHODS Community-living adults with HOA participating in PE were randomly allocated to an intervention group receiving BBAT in groups (12 sessions offered once a week), or a comparison group. Data at baseline (pretest) and at 6 months (posttest) were analyzed. Primary outcomes were pain during walking assessed by the Numeric Rating Scale (NRS) and function by the Hip Osteoarthritis Outcome Score, subscale ADL (HOOS A). Secondary outcomes addressed physical capacity, movement quality, and self-reported aspects of function and health. RESULTS At pretest, there were no significant differences in demographic and test data between the intervention (n = 51) and the comparison (n = 50) group. Forty-one intervention and 45 comparison participants completed the posttest. At posttest, no significant differences in change between groups were found on NRS (p = 0.694, effect size (ES) = 0.02) or HOOS A (p = 0.783, ES = 0.07). Among secondary outcomes, movement quality improved significantly more (p < 0.001, ES = 0.84) in the intervention group. Compliance with BBAT varied substantially. Per-protocol analysis showed changes in favor of the intervention group for self-efficacy (p = 0.049, ES = 0.36), health (p = 0.037, ES = 0.44), and function (p = 0.029, ES = 0.53) when only intervention participants who completed at least 10 sessions of BBAT were included. CONCLUSIONS BBAT was not found to be a more effective treatment modality than self-initiated standard care to reduce pain during walking and improve daily functioning in people with HOA. Movement quality was significantly more improved in participants receiving BBAT, and improvement in other health aspects was associated with sufficient therapy compliance.
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Affiliation(s)
- Aarid Liland Olsen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Liv Heide Magnussen
- Department of Health and Function, Western Norway University of Applied Sciences, Bergen, Norway
| | - Liv Helvik Skjaerven
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jörg Assmus
- Centre of Competence on Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Mary-Anne Sundal
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ove Furnes
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Geir Hallan
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Gimunová M, Vodička T, Bozděch M, Vespalec T. Changes in plantar pressure, contact area and contact time symmetry during the gait 4 weeks before and 12 and 24 weeks after unilateral total hip arthroplasty. Clin Biomech (Bristol, Avon) 2021; 89:105473. [PMID: 34482069 DOI: 10.1016/j.clinbiomech.2021.105473] [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: 02/19/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Foot to ground pressure changes in total hip arthroplasty patients' gait are not widely described, although they are sensitive to gait abnormalities and the distribution of plantar pressures may differ before and after the surgery. This study aimed to analyse longitudinally differences in plantar pressure during gait in total hip arthroplasty patients compared to healthy controls. METHODS Eighteen males participated in this study. Eight males, who underwent unilateral total hip arthroplasty, participated at the data collection three times: 4 weeks before the surgery, 12 and 24 weeks after, and ten healthy controls. All participants were asked to walk over Emed platform. To compare differences between the affected and unaffected limbs, Kolmogorov-Smirnov test was used. Kruskal-Wallis test was used to compare the difference between total hip arthroplasty patients and healthy controls. FINDINGS Statistically significant differences between the affected and unaffected limb were observed only during the preoperative measurement in peak pressure at MH4 area and in the contact area at MH4 and big toe. When comparing total hip arthroplasty patients and controls, a difference in the contact time at MH2, MH3 and MH4 areas 12 weeks after surgery and at MH2 and MH4 24 weeks after the surgery were observed. INTERPRETATION The shorter contact time at forefoot areas may indicate an alteration in the propulsive phase of the gait of both the affected limb and unaffected limb in total hip arthroplasty patients as a result of decreased terminal hip extension during the stance phase described in previous studies.
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Affiliation(s)
- Marta Gimunová
- Masaryk University, Faculty of Sport Studies, Kamenice 753/5, 625 00 Brno, Czech Republic.
| | - Tomáš Vodička
- Masaryk University, Faculty of Sport Studies, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Michal Bozděch
- Masaryk University, Faculty of Sport Studies, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Tomáš Vespalec
- Masaryk University, Faculty of Sport Studies, Kamenice 753/5, 625 00 Brno, Czech Republic
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Tateuchi H, Akiyama H, Goto K, So K, Kuroda Y, Ichihashi N. Strategies for increasing gait speed in patients with hip osteoarthritis: their clinical significance and effects on hip loading. Arthritis Res Ther 2021; 23:129. [PMID: 33910597 PMCID: PMC8080338 DOI: 10.1186/s13075-021-02514-x] [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: 07/28/2020] [Accepted: 04/19/2021] [Indexed: 01/24/2023] Open
Abstract
Background Changes in gait speed are required in various situations and can be achieved by changing stride length, cadence, or both. Differences in strategies for increasing gait speed may have different effects on hip joint and physical function. The purpose of this study was to determine the effects of strategies for increasing gait speed on hip pain, physical function, and changes in hip loading during gait in patients with hip osteoarthritis (OA). We hypothesized that patients who increase gait speed mainly by increasing cadence would have lesser hip pain, a higher physical function, and a lower rate of increase in hip moments with increasing gait speed. Methods Forty-seven patients with secondary hip OA (age, 48.3 ± 11.0 years) were included. Gait speed, stride length, cadence, and peak and impulse of the hip moments were measured during gait at self-selected normal and fast gait speeds. The patients were classified as types S (with mainly increasing stride length, n = 11 [23.4%]), C (with mainly increasing cadence, n = 23 [48.9%]), and SC (with increasing stride length and cadence, n = 13 [27.7%]) according to whether they used changes in stride length and/or cadence to transition from normal to fast gait. Hip pain, physical function, and hip moment changes during gait were compared between types. Results The physical function was higher in types C (38.0 ± 8.8, P = 0.018) and SC (40.6 ± 8.5, P = 0.015) than in type S (28.2 ± 7.8), even after adjustment for age and minimum joint space width. Hip pain was not significantly different between types. The robustness of these results was confirmed with sensitivity analysis. The rates of increases in peak external hip adduction (P = 0.003) and internal rotation moments (P = 0.009) were lower in type C than in type SC. Conclusions Type C tended to suppress the increase in hip moments during fast gait. Types C and SC, which included increased cadence, maintained higher physical function levels than type S. Encouraging the use of cadence-increasing strategy may be useful for reducing hip loading and maintaining physical function in patients with hip OA. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02514-x.
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Affiliation(s)
- Hiroshige Tateuchi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, School of Medicine, Gifu University, Gifu, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka So
- Department of Orthopaedic Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Coordination Pattern of the Thigh, Pelvic, and Lumbar Movements during the Gait of Patients with Hip Osteoarthritis. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:9545825. [PMID: 32774826 PMCID: PMC7396060 DOI: 10.1155/2020/9545825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022]
Abstract
There are limited reports on segment movement and their coordination pattern during gait in patients with hip osteoarthritis. To avoid the excessive stress toward the hip and relevant joints, it is important to investigate the coordination pattern between these segment movements, focusing on the time series data. This study aimed to quantify the coordination pattern of lumbar, pelvic, and thigh movements during gait in patients with hip osteoarthritis and in a control group. An inertial measurement unit was used to measure the lumbar, pelvic, and thigh angular velocities during gait of 11 patients with hip osteoarthritis and 11 controls. The vector coding technique was applied, and the coupling angle and the appearance rate of coordination pattern in each direction were calculated and compared with the control group. Compared with the control group, with respect to the lumbar/pelvic segment movements, the patients with hip osteoarthritis spent more rates in anti-phase and lower rates in in-phase lateral tilt movement. With respect to the pelvic/thigh segment movements, the patients with hip osteoarthritis spent more rates within the proximal- and in-phases for lateral tilt movement. Furthermore, patients with osteoarthritis spent lower rates in the distal-phase for anterior/posterior tilt and rotational movement. Patients with hip osteoarthritis could not move their pelvic and thigh segments separately, which indicates the stiffness of the hip joint. The rotational movement and lateral tilt movements, especially, were limited, which is known as Duchenne limp. To maintain the gait ability, it seems important to pay attention to these directional movements.
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Miura N, Nagai K, Tagomori K, Ikutomo H, Okamura K, Okuno T, Nakagawa N, Masuhara K. Plantar pressure distribution during standing in women with end-stage hip osteoarthritis. Gait Posture 2020; 76:39-43. [PMID: 31731132 DOI: 10.1016/j.gaitpost.2019.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 09/10/2019] [Accepted: 10/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with hip osteoarthritis (OA) experience abnormal movement patterns and reduced loading of the affected leg. The plantar contacts the ground and receives force from the ground. Plantar pressure distribution may differ in patients with hip OA compared to healthy adults and may influence physical functioning in these patients. RESEARCH QUESTION We investigated whether plantar pressure distribution during standing differed between patients with hip OA and healthy adults. We also analyzed the relationship between plantar pressure distribution and walking ability and the factors affecting plantar pressure distribution. METHODS Maximum plantar pressure distribution during standing for 20 seconds was investigated in patients with hip OA (n = 62; OA group) and in healthy adults (n = 53; Control group). Statistical comparisons between these groups were made using Fisher's exact test and residual analysis. In the OA group, leg length discrepancy, range of hip extension, leg loading, knee extensor strength, and 10 m walking time were assessed; multiple linear regression and logistic regression analyses were used to examine the relationships between these factors and maximum plantar pressure distribution. RESULTS Maximum plantar pressure distribution was different between the OA and control groups. In the OA group, maximum plantar pressure distribution was one of the significant predictors of 10 m walking time. Additionally, leg length discrepancy was a significant predictor of maximum plantar pressure distribution in this group. SIGNIFICANCE During standing, the proportion of patients for whom the maximum plantar pressure region was the heel tended to be lower in the group with hip OA compared to the healthy adults. Plantar pressure distribution may have an importance for evaluating walking ability in patients with hip OA. Correcting leg length discrepancy and loading under the heel could adjust plantar pressure distribution in patients with hip OA.
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Affiliation(s)
- Namika Miura
- Masuhara Clinic, 3-4-2, Tenmabashi, Kita-ku, Osaka 530-0042, Japan.
| | - Koutatsu Nagai
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe 650-8530, Japan
| | - Keiichi Tagomori
- Masuhara Clinic, 3-4-2, Tenmabashi, Kita-ku, Osaka 530-0042, Japan
| | - Hisashi Ikutomo
- Masuhara Clinic, 3-4-2, Tenmabashi, Kita-ku, Osaka 530-0042, Japan
| | - Kenichi Okamura
- Masuhara Clinic, 3-4-2, Tenmabashi, Kita-ku, Osaka 530-0042, Japan
| | - Takato Okuno
- Masuhara Clinic, 3-4-2, Tenmabashi, Kita-ku, Osaka 530-0042, Japan
| | | | - Kensaku Masuhara
- Masuhara Clinic, 3-4-2, Tenmabashi, Kita-ku, Osaka 530-0042, Japan
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Tazawa M, Kurosaki M, Inoue T, Ibe Y, Kobayashi H, Kitagawa T, Chikuda H, Wada N. Superior migration of the femoral head in patients with severe hip osteoarthritis influences the gait patterns of the coronal plane. Hip Int 2019; 29:446-451. [PMID: 30757914 DOI: 10.1177/1120700019827250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Patients with hip osteoarthritis (OA) show abnormal movement patterns, including the leaning of the trunk toward the affected limb (Duchenne limp). Patients with severe OA, especially those with OA due to hip dysplasia, show a lateral pelvic drop (Trendelenburg sign). AIM The aim of this preoperative study is to investigate the relationship between superior migration of the arthritic femoral head, pain, and hip abductor muscle strength, and to clarify the relationship between the coronal plane gait patterns with pain and hip abductor muscle strength. METHODS The subjects of this study were 18 patients with unilateral hip OA secondary to dysplasia. A radiographic analysis was performed on standardised anteroposterior pelvis films. The abductor muscle strength of the OA hip joint was measured with a handheld dynamometer. The tilt angle of the pelvis and trunk lean angle during gait were obtained using a 3-dimensional motion analysis system. Visual analogue scale (VAS) of pain was obtained after trial. RESULTS The 2 lateral pelvic angle patterns at the mid-stance of the affected limb during gait were detected. 1 is a pattern that was pelvic rise, and the other was a contralateral pelvic drop. Subjects with pelvic drop showed more superior femoral migration than that with pelvic rise (r = 0.69 p < 0.01). VAS of pain correlate significantly with coronal trunk angle on mid-stance of affected limb during gait (r = 0.761, p < 0.01). CONCLUSION The pelvic drop Trendelenburg sign was influenced by superior migration of the femoral head, whereas the trunk lean Duchenne limp was found to be affected by pain.
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Affiliation(s)
- Masayuki Tazawa
- 1 Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Minori Kurosaki
- 1 Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tomotaka Inoue
- 1 Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yoko Ibe
- 1 Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hiroki Kobayashi
- 2 Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takanori Kitagawa
- 2 Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hirotaka Chikuda
- 2 Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Naoki Wada
- 1 Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
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Bieler T, Siersma V, Magnusson SP, Kjaer M, Beyer N. Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2017; 23. [DOI: 10.1002/pri.1697] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/14/2017] [Accepted: 09/08/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Theresa Bieler
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
- Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital; University of Copenhagen and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen; Copenhagen Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - S. Peter Magnusson
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
- Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital; University of Copenhagen and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen; Copenhagen Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital; University of Copenhagen and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen; Copenhagen Denmark
| | - Nina Beyer
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
- Institute for Clinical Medicine; University of Copenhagen; Copenhagen Denmark
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Steinhilber B, Haupt G, Miller R, Janssen P, Krauss I. Exercise therapy in patients with hip osteoarthritis: Effect on hip muscle strength and safety aspects of exercise—results of a randomized controlled trial. Mod Rheumatol 2016; 27:493-502. [DOI: 10.1080/14397595.2016.1213940] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Benjamin Steinhilber
- Department of Sports Medicine, University Hospital, Tuebingen, Germany and
- Institute of Occupational Medicine, Social Medicine and Health Services Research, University Hospital, Tuebingen, Germany
| | - Georg Haupt
- Department of Sports Medicine, University Hospital, Tuebingen, Germany and
| | - Regina Miller
- Department of Sports Medicine, University Hospital, Tuebingen, Germany and
| | - Pia Janssen
- Department of Sports Medicine, University Hospital, Tuebingen, Germany and
| | - Inga Krauss
- Department of Sports Medicine, University Hospital, Tuebingen, Germany and
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12
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Rosenlund S, Holsgaard-Larsen A, Overgaard S, Jensen C. The Gait Deviation Index Is Associated with Hip Muscle Strength and Patient-Reported Outcome in Patients with Severe Hip Osteoarthritis-A Cross-Sectional Study. PLoS One 2016; 11:e0153177. [PMID: 27065007 PMCID: PMC4827823 DOI: 10.1371/journal.pone.0153177] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/24/2016] [Indexed: 11/19/2022] Open
Abstract
Background The Gait Deviation Index summarizes overall gait ‘quality’, based on kinematic data from a 3-dimensional gait analysis. However, it is unknown which clinical outcomes may affect the Gait Deviation Index in patients with primary hip osteoarthritis. The aim of this study was to investigate associations between Gait Deviation Index as a measure of gait ‘quality’ and hip muscle strength and between Gait Deviation Index and patient-reported outcomes in patients with primary hip osteoarthritis. Method Forty-seven patients (34 males), aged 61.1 ± 6.7 years, with BMI 27.3 ± 3.4 (kg/m2) and with severe primary hip osteoarthritis underwent 3-dimensional gait analysis. Mean Gait Deviation Index, pain after walking and maximal isometric hip muscle strength (flexor, extensor, and abductor) were recorded. All patients completed the ‘Physical Function Short-form of the Hip disability and Osteoarthritis Outcome Score (HOOS-Physical Function) and the Hip disability and Osteoarthritis Outcome Score subscales for pain (HOOS-Pain) and quality-of-life (HOOS-QOL). Results Mean Gait Deviation Index was positively associated with hip abduction strength (p<0.01, r = 0.40), hip flexion strength (p = 0.01, r = 0.37), HOOS-Physical Function (p<0.01, r = 0.41) HOOS-QOL (p<0.01, r = 0.41), and negatively associated with HOOS-Pain after walking (p<0.01, r = -0.45). Adjusting the analysis for walking speed did not affect the association. Conclusion Patients with the strongest hip abductor and hip flexor muscles had the best gait ‘quality’. Furthermore, patients with higher physical function, quality of life scores and lower pain levels demonstrated better gait ‘quality’. These findings indicate that interventions aimed at improving hip muscle strength and pain management may to a moderate degree improve the overall gait ‘quality’ in patients with primary hip OA.
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Affiliation(s)
- Signe Rosenlund
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Department of Orthopaedic Surgery and Traumatology, Køge Hospital, Køge, Denmark
- * E-mail:
| | - Anders Holsgaard-Larsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Carsten Jensen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
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13
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Walker JL, Harrison TC, Brown A, Thorpe RJ, Szanton SL. Factors associated with disability among middle-aged and older African American women with osteoarthritis. Disabil Health J 2016; 9:510-7. [PMID: 27052590 DOI: 10.1016/j.dhjo.2016.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 02/16/2016] [Accepted: 02/25/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Middle-aged and older African American women experience disproportionate rates of functional limitations and disability from osteoarthritis (OA) compared to other racial ethnic groups; however, little is known about what factors contribute to this disparity within African American women. OBJECTIVE To examine factors associated with physical function and disability among African American women ages 50-80 with OA using the disablement process model. METHODS This descriptive study included 120 African American women with OA from the Southwestern region of the United States. Regression techniques were used to model the correlates of physical function and disability and to test a mediation model. RESULTS BMI and pain severity were significantly related to functional limitations. Depressive symptoms mediated the relationship between racial discrimination and disability. CONCLUSION Biological, intra-individual, and extra-individual factors are related to disablement outcomes in this sample of African American women, which is consistent with theory suggesting the need for treatment coupled with environmental modifications. This study can inform the development of future bio-behavioral interventions.
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Affiliation(s)
| | | | - Adama Brown
- School of Nursing, The University of Texas at Austin, USA
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, USA; Center for Biobehavioral Health Disparities Research, Duke University, USA
| | - Sarah L Szanton
- School of Nursing, Johns Hopkins University, USA; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, USA
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14
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Ferrari R. A cross-sectional study of perceived injustice and disability in hip osteoarthritis. Eur J Rheumatol 2015; 2:47-51. [PMID: 27708925 DOI: 10.5152/eurjrheum.2015.0095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 10/29/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the correlation among severity of hip osteoarthritis, disability, and Perceived injustice. MATERIAL AND METHODS A cohort of 46 participants with unilateral hip osteoarthritis underwent hip range of motion measurements and completed the Injustice Experience Questionnaire (IEQ), the Hip Disability and Osteoarthritis Outcome Score (HOOS), and a Croft radiological grading of osteoarthritis severity. RESULTS The mean age of the cohort was 62.7±10.4 years, and the cohort included 27 females. The mean duration of symptoms was 46.9±20.6 months. The means of each of the five subscales of the HOOS were as follows: Pain, 62.3±9.4; Other Symptoms, 56.7±9.6; Function in Activities of Daily Living (ADL), 58.2±6.7; Function in Sport and Recreation (Sport/Rec), 58.1±6.7; and Hip-Related Quality of Life (QOL) 59.9±7.5. The combined mean hip range of motion (abduction, adduction, flexion, extension, external rotation, internal rotation) was 215.9±10.9 degrees. The mean IEQ score (Perceived injustice) was 12.0±1.7. Of the available factors, only QOL, hip range of motion, and the Croft radiological osteoarthritis grade predicted Perceived injustice scores, with an R-squared of 0.81 in multiple regression analysis. CONCLUSION In this cohort of patients with unilateral osteoarthritis, more severe disease (as measured by restricted range of motion and radiological severity) was highly correlated with higher levels of Perceived injustice. Perceived injustice may thus reflect an appropriate response to the severity of the disease and is thus more likely a result of the disease process and subsequent disability rather than a cause of disability.
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Affiliation(s)
- Robert Ferrari
- Department of Rehumatic Diseases, Heritage Medical Research Centre, University of Alberta Edmonton, Alberta, Canada
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Zeni J, Pozzi F, Abujaber S, Miller L. Relationship between physical impairments and movement patterns during gait in patients with end-stage hip osteoarthritis. J Orthop Res 2015; 33:382-9. [PMID: 25492583 PMCID: PMC4346450 DOI: 10.1002/jor.22772] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/20/2014] [Indexed: 02/04/2023]
Abstract
Patients with hip osteoarthritis demonstrate limited range of motion, muscle weakness, and altered biomechanics; however, few studies have evaluated the relationships between physical impairments and movement asymmetries. The purpose of this study was to identify the physical impairments related to movement abnormalities in patients awaiting total hip arthroplasty. We hypothesized that muscle weakness and pain would be related to greater movement asymmetries. Fifty-six subjects who were awaiting total hip arthroplasty were enrolled. Pain was assessed using a 0-10 scale, range of motion was assessed with the Harris Hip Score and isometric hip abductor strength was tested using a hand-held dynamometer. Trunk, pelvis and hip angles and moments in the frontal and sagittal planes were measured during walking using three dimensional motion analysis. During gait, subjects had 3.49 degrees less peak hip flexion and 8.82 degrees less extension angles (p < 0.001) and had 0.03 Nm/k*m less hip adduction moment on the affected side (p = 0.043). Weaker hip muscles were related to greater pelvis (r = -0.291) and trunk (r = -0.332) rotations in the frontal plane. These findings suggest that hip weakness drives abnormal movement patterns at the pelvis and trunk in patients with hip osteoarthritis to a greater degree than hip pain.
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Affiliation(s)
- Joseph Zeni
- Department of Physical Therapy, University of Delaware, Newark, DE, 19713,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, 19713
| | - Federico Pozzi
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, 19713
| | - Sumayah Abujaber
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, 19713,University of Jordan, Rehabilitation Science College, Amman, Jordan
| | - Laura Miller
- Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, 19102
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