Effects of Tai Chi on partial anterior cruciate ligament injury: A single-blind, randomized-controlled trial

Prediction of knee joint pain in Tai Chi practitioners: a cross-sectional machine learning approach

OBJECTIVE

To build a supervised machine learning-based classifier, which can accurately predict whether Tai Chi practitioners may experience knee pain after years of exercise.

DESIGN

A prospective approach was used. Data were collected using face-to-face through a self-designed questionnaire.

SETTING

Single centre in Shanghai, China.

PARTICIPANTS

A total of 1750 Tai Chi practitioners with a course of Tai Chi exercise over 5 years were randomly selected.

MEASURES

All participants were measured by a questionnaire survey including personal information, Tai Chi exercise pattern and Irrgang Knee Outcome Survey Activities of Daily Living Scale. The validity of the questionnaire was analysed by logical analysis and test, and the reliability of this questionnaire was mainly tested by a re-test method. Dataset 1 was established by whether the participant had knee pain, and dataset 2 by whether the participant's knee pain affected daily living function. Then both datasets were randomly assigned to a training and validating dataset and a test dataset in a ratio of 7:3. Six machine learning algorithms were selected and trained by our dataset. The area under the receiver operating characteristic curve was used to evaluate the performance of the trained models, which determined the best prediction model.

RESULTS

A total of 1703 practitioners completed the questionnaire and 47 were eliminated for lack of information. The total reliability of the scale is 0.94 and the KMO (Kaiser-Meyer-Olkin measure of sampling adequacy) value of the scale validity was 0.949 (>0.7). The CatBoost algorithm-based machine-learning model achieved the best predictive performance in distinguishing practitioners with different degrees of knee pain after Tai Chi practice. 'Having knee pain before Tai Chi practice', 'knee joint warm-up' and 'duration of each exercise' are the top three factors associated with pain after Tai Chi exercise in the model. 'Having knee pain before Tai Chi practice', 'Having Instructor' and 'Duration of each exercise' were most relevant to whether pain interfered with daily life in the model.

CONCLUSION

CatBoost-based machine learning classifier accurately predicts knee pain symptoms after practicing Tai Chi. This study provides an essential reference for practicing Tai Chi scientifically to avoid knee pain.

The Effectiveness of Proprioceptive Training for Improving Motor Performance and Motor Dysfunction: A Systematic Review

Objective

Proprioceptive training is any intervention aiming to improve proprioceptive function with the ultimate goal to enhance motor function and performance. It has been promoted as an approach to enhance athletic performance and as a tool for sensorimotor rehabilitation. Numerous studies sought to provide evidence on the effectiveness of the approach. However, many different training regimes claiming to train proprioception report a variety of sensorimotor measures that are not directly comparable. This, in turn, makes it difficult to assess effectiveness across approaches. It is the objective of this study to systematically review recent empirical evidence to gain an understanding of which outcome measures are most sensitive, which populations may benefit most from proprioceptive training, and what are the effects on proprioceptive and motor systems.

Methods

Four major databases were searched. The following inclusion criteria were applied: (1) A quantified pre- and post-treatment measure of proprioceptive function. (2) An intervention or training program believed to influence or enhance proprioceptive function. (3) Contained at least one form of treatment or outcome measure that is indicative of somatosensory function and not confounded by information from other sensory modalities. 4) The study reported of at least one quantified measure of motor performance.

Results

Of the 3,297 articles identified by the database search, 70 studies met the inclusion criteria and were included for further review. Across studies, proprioceptive training led to comparable gains in both proprioceptive (+46%) and motor performance (+45%). The majority of studies (50/70) applied active movement interventions. Interventions applying somatosensory stimulation were most successful in clinical populations. Joint position sense error (JPSE) was the most commonly used proprioceptive measure and presents a reliable and feasible measure for clinical use.

Conclusion

Proprioceptive training can lead to significant improvements in proprioceptive and motor function across a range healthy and clinical populations. Regimens requiring active movement of the trainee tended to be most successful in improving sensorimotor performance. Conclusive evidence on how long training gains are retained is still lacking. There is no solid evidence about the underlying long-term neuroplastic changes associated proprioceptive training.

Efficacy of non-surgical management and functional outcomes of partial ACL tears. A systematic review of randomised trials

Background

The incidence of anterior cruciate ligament (ACL) injuries represents a large burden of knee injuries in both the general and sporting populations, often requiring surgical intervention. Although there is much research on complete ACL tears including outcomes and indications for surgery, little is known about the short- and long-term outcomes of non-operative, physiotherapy led intervention in partial ACL tears. The primary aim of this study was to evaluate studies looking at the effectiveness of physiotherapy led interventions in improving pain and function in young and middle-aged adults with partial ACL tears. Additionally, the secondary aim was to evaluate the completeness of exercise prescription in randomised trials for physiotherapy led interventions in the management in partial ACL tears.

Methods

A comprehensive and systematic search was performed on six databases (Medline, CINAHL, EMBASE, PEDro, Scopus, SPORTDiscus and Cochrane). The search strategy consisted of two main concepts: (i) partial ACL tears, and (ii) non-operative management. 7,587 papers were identified by the search. After screening of eligible articles by two independent reviewers, 2 randomised studies were included for analysis. The same two reviewers assessed the completeness of reporting using the Toigio and Boutellier mechanobiological exercise descriptions and Template for Intervention Description and Replication (TIDieR) checklist. Group mean standard deviations (SD) for the main outcomes was extracted from both papers for analysis. Prospero Registration Number: CRD42020179892.

Results

The search strategy identified two studies; one looking at Tai Chi and the other Pilates. The analysis indicated that Tai Chi was significant in reducing pain scores and both Tai Chi and Pilates were found to increase Muscle Peak Torque Strength (MPTS) at 180 degrees. Furthermore, Tai Chi showed a significant increase in proprioception.

Conclusions

Physiotherapy led interventions such as Pilates, and Tai Chi may improve pain, proprioception and strength in young and middle-aged adults with partial ACL tears, however full scale, high-quality randomised studies are required with long term outcomes recorded.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05278-w.

Effects of neuromuscular training on knee proprioception in individuals with anterior cruciate ligament injury: a systematic review and GRADE evidence synthesis

OBJECTIVE

To systematically review and summarise the evidence for the effects of neuromuscular training compared with any other therapy (conventional training/sham) on knee proprioception following anterior cruciate ligament (ACL) injury.

DESIGN

Systematic Review.

DATA SOURCES

PubMed, CINAHL, SPORTDiscus, AMED, Scopus and Physical Education Index were searched from inception to February 2020.

ELIGIBILITY CRITERIA

Randomised controlled trials (RCTs) and controlled clinical trials investigating the effects of neuromuscular training on knee-specific proprioception tests following a unilateral ACL injury were included.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently screened and extracted data and assessed risk of bias of the eligible studies using the Cochrane risk of bias 2 tool. Overall certainty in evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool.

RESULTS

Of 2706 articles retrieved, only 9 RCTs, comprising 327 individuals with an ACL reconstruction (ACLR), met the inclusion criteria. Neuromuscular training interventions varied across studies: whole body vibration therapy, Nintendo-Wii-Fit training, balance training, sport-specific exercises, backward walking, etc. Outcome measures included joint position sense (JPS; n=7), thresholds to detect passive motion (TTDPM; n=3) or quadriceps force control (QFC; n=1). Overall, between-group mean differences indicated inconsistent findings with an increase or decrease of errors associated with JPS by ≤2°, TTDPM by ≤1.5° and QFC by ≤6 Nm in the ACLR knee following neuromuscular training. Owing to serious concerns with three or more GRADE domains (risk of bias, inconsistency, indirectness or imprecision associated with the findings) for each outcome of interest across studies, the certainty of evidence was very low.

CONCLUSIONS

The heterogeneity of interventions, methodological limitations, inconsistency of effects (on JPS/TTDPM/QFC) preclude recommendation of one optimal neuromuscular training intervention for improving proprioception following ACL injury in clinical practice. There is a need for methodologically robust RCTs with homogenous populations with ACL injury (managed conservatively or with reconstruction), novel/well-designed neuromuscular training and valid proprioception assessments, which also seem to be lacking.

PROSPERO REGISTRATION NUMBER

CRD42018107349.