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Losciale JM, Truong LK, Zhang K, Silvester-Lee T, Miciak M, Pajkic A, Le CY, Xie H, Hoens AM, Mosewich AD, Hunt MA, Li LC, Roos EM, Whittaker JL. Assessing the efficacy of the Stop OsteoARthritis (SOAR) program: A randomized delayed-controlled trial in persons at increased risk of early onset post-traumatic knee osteoarthritis. Osteoarthritis Cartilage 2024:S1063-4584(24)01151-8. [PMID: 38615974 DOI: 10.1016/j.joca.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Assess the efficacy of an 8-week virtual, physiotherapist (PT)-guided knee health program (Stop OsteoARthritis (SOAR)) to improve knee extensor strength in individuals at risk of post-traumatic knee osteoarthritis (PTOA). METHOD In this superiority, randomized delayed-control trial, persons aged 16-35 years, 1-4 years after a self-reported knee joint injury were randomly assigned (1:1) to receive the SOAR program immediately (experimental group) or after a 9-week delay (control group). SOAR includes 1) one-time Knee Camp (virtual PT-guided group education, knee assessment, 1:1 exercise and physical activity (PA) goal-setting); 2) Weekly personalized home-based exercise and PA program with tracking; 3) Weekly 1:1 PT counseling (virtual). The primary outcome was a change in isokinetic knee extensor strength (baseline to 9-weeks). Additional outcomes included change in self-reported knee-related quality-of-life (QOL), self-efficacy, self-management and kinesiophobia, and PA (accelerometer) at 9 and 18-weeks. Linear regression models estimated the effect of the 8-week intervention at the primary endpoint (9-week). RESULTS 49 of 54 randomized participants completed the study (91%). Participants were a mean ± standard deviation age of 27 ± 5.0 years, and 2.4 ± 0.9 years post-injury. No mean between group differences for the primary (0.05; 95% confidence interval (CI): -0.10, 0.19) or other outcomes were seen at 9 weeks except for greater improvements in perceived self-management (Partner in Health Scale; 11.3/96, 95%CI: 5.5, 17.1) and kinesiophobia (Tampa Scale of Kinesiophobia; -4.4/33, 95%CI: -7.0, -1.8). CONCLUSION For active persons with elevated risk of PTOA, an 8-week SOAR program did not change knee-related strength, QOL, self-efficacy, or PA, on average, but may benefit the ability to self-manage knee health and kinesiophobia.
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Affiliation(s)
- Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Kexin Zhang
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Pajkic
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Christina Y Le
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alison M Hoens
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Amber D Mosewich
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Michael A Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Ewa M Roos
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada.
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Losciale JM, Truong LK, Zhang K, Scarr T, Xie H, Li LC, Mitchell C, Hunt MA, Whittaker JL. The association between knee muscle performance and clinical outcomes of knee function 1-4 years after a sport-related knee joint injury. Phys Ther Sport 2023; 64:147-155. [PMID: 37922747 DOI: 10.1016/j.ptsp.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Estimate the association between index leg knee muscle strength and rate of torque development (RTD), and self-reported and performance-based (i.e., hop) knee function in persons 1-4 years after a sport-related knee joint injury. METHODS Data were collected at baseline of a clinical trial. Assessments included the Knee injury and Osteoarthritis Outcome Score Sport & Recreation subscale (KOOSsport), 6-m timed hop (TH), and peak concentric isokinetic knee extensor and flexor torque and isometric RTD. Associations between peak torque and RTD with KOOSsport and TH were assessed using multivariable regression with nonlinear transformations. RESULTS 53 participants (64.2% female) were included. Knee extensor peak torque was nonlinearly related to TH time, with a strong inverse relationship at lower torque values that changed as torque increased. Results were inconsistent for flexor peak torque, extensor RTD and flexor RTD, with inconsistencies in relationship shape and estimates of association between primary and sensitivity analyses. There was no association between strength/RTD and KOOSsport. CONCLUSION There was a nonlinear relationship between knee extensor strength and hop function, with lower strength being associated with a stronger relationship. As strength values increased, the relationship attenuated. Knee extensor and flexor strength, or RTD, were not associated with self-reported function.
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Affiliation(s)
- Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Kexin Zhang
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Thomas Scarr
- Allan McGavin Sports Medicine Clinic, Vancouver, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Cameron Mitchell
- Department of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada
| | - Michael A Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada.
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Hunt MA, Tse CTF, Ryan MB, Scott A, Sayre EC. Clinically-accessible and laboratory-derived predictors of biomechanical response to standalone and supported lateral wedge insoles in people with knee osteoarthritis. J Foot Ankle Res 2023; 16:74. [PMID: 37885001 PMCID: PMC10601168 DOI: 10.1186/s13047-023-00671-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Lateral wedge insoles (both standalone and those incorporating individualized arch support) have been frequently studied for the effects on knee joint loading and pain in people with knee osteoarthritis. It has been shown that many people who use these insoles do not obtain the intended biomechanical effect, and thus may not experience a clinical benefit. The ability to identify biomechanical responders to lateral wedge insoles before research or clinical intervention is an important objective for efficient resource use and optimizing patient outcomes. The purpose of our exploratory, hypothesis-generating study was to provide an initial assessment of variables that are associated with the biomechanical response to lateral wedge insoles in people with knee osteoarthritis. METHODS We collected a number of demographic (age, sex, body mass index, foot posture), clinical (knee pain, foot pain, radiographic disease severity), and walking-related (speed, knee alignment, frontal plane subtalar movement, and foot rotation) outcomes from 53 individuals with painful, radiographically-confirmed knee osteoarthritis. The walking-related outcomes were obtained using equipment both from the research laboratory and the clinical setting. We used logistic regression to generate predictive models to determine candidate variables associated with a reduction in the knee adduction moment during walking - a surrogate for tibiofemoral load distribution, and a known biomechanical risk factor for osteoarthritis progression - with the use of standalone and arch-supported lateral wedge insoles. Three different response thresholds (2%, 6%, and 10% reductions in the knee adduction moment) were used. RESULTS In general, biomechanical responders were those who walked faster, were female, had less varus alignment, and had less severe radiographic severity. Findings were similar between the standalone and arch-supported lateral wedge insoles, as well as between models using the laboratory-derived or clinically-available measures of walking performance. CONCLUSIONS Our hypothesis-generating study provides valuable information that will inform future research into the efficient and effective use of lateral wedge insoles in the conservative management of knee osteoarthritis.
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Affiliation(s)
- Michael A Hunt
- Department of Physical Therapy, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.
| | - Calvin T F Tse
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
- Kintec Footlabs Inc., Surrey, BC, Canada
| | - Michael B Ryan
- Kintec Footlabs Inc., Surrey, BC, Canada
- School of Mechatronic Systems Engineering, Simon Fraser University, Burnaby, BC, Canada
| | - Alexander Scott
- Department of Physical Therapy, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Eric C Sayre
- British Columbia Centre On Substance Use, Vancouver, BC, Canada
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Charlton JM, Krowchuk NM, Eng JJ, Li LC, Hunt MA. Remotely delivered, individualized, and self-directed gait modification for knee osteoarthritis: A pilot trial. Clin Biomech (Bristol, Avon) 2023; 106:105981. [PMID: 37201438 DOI: 10.1016/j.clinbiomech.2023.105981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 03/29/2023] [Accepted: 04/28/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Gait modification interventions have reported variable results and relied on in-person biofeedback limiting clinical accessibility. Our objective was to assess a remotely delivered and self-directed gait modification for knee osteoarthritis. METHODS This was an unblinded, 2-arm, delayed control, randomized pilot trial (NCT04683913). Adults aged ≥50 years with symptomatic medial knee osteoarthritis were randomized to an immediate group (Week 0: Baseline, Intervention; Week 6: Follow-up, Week 10: Retention) or delayed group (Week 0: Baseline, Wait Period, Week 6: Secondary Baseline, Intervention, Week 12: Follow-up, Week 16: Retention). Participants practiced modifying their foot progression angle "as much as was comfortable" while receiving support via weekly telerehabilitation appointments and remote monitoring with an instrumented shoe. Primary outcomes included participation, foot progression angle modification magnitude, confidence, difficulty, and satisfaction while secondary outcomes included symptoms and knee biomechanics during gait. RESULTS We screened 134 people and randomized 20. There was no loss to follow up and 100% attendance at the telerehabilitation appointments. By follow up, participants reported high confidence (8.6/10), low difficulty (2.0/10), and satisfaction (75%) with the intervention and no significant adverse events. Foot progression angle was modified by 11.4° ± 5.6, which was significantly different (p < 0.001, η2g = 0.8) when compared between groups. No other between-group differences were significant, while several significant pre-post improvements in pain (d = 0.6, p = 0.006) and knee moments (d = 0.6, p = 0.01) were observed. INTERPRETATION A personalized, self-directed gait modification supported with telerehabilitation is feasible, and the preliminary effects on symptoms and biomechanics align with past trials. A larger trial is warranted to evaluate efficacy.
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Affiliation(s)
- Jesse M Charlton
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Centre for Aging SMART at Vancouver Coastal Health, Vancouver, Canada.
| | - Natasha M Krowchuk
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Centre for Aging SMART at Vancouver Coastal Health, Vancouver, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Centre for Aging SMART at Vancouver Coastal Health, Vancouver, Canada
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Charlton JM, Xia H, Shull PB, Eng JJ, Li LC, Hunt MA. Multi-day monitoring of foot progression angles during unsupervised, real-world walking in people with and without knee osteoarthritis. Clin Biomech (Bristol, Avon) 2023; 105:105957. [PMID: 37084548 DOI: 10.1016/j.clinbiomech.2023.105957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 03/03/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Foot progression angle is a biomechanical target in gait modification interventions for knee osteoarthritis. To date, it has only been evaluated within laboratory settings. METHODS Adults with symptomatic knee osteoarthritis (n = 30) and healthy adults (n = 15) completed two conditions: 1) treadmill walking in the laboratory (5-min), and 2) real-world walking outside of the laboratory (1-week). Foot progression angle was estimated via shoe-embedded inertial sensing. We calculated the foot progression angle magnitude (median) and variability (interquartile range, coefficient of variation), and used mixed models to compare outcomes between the conditions, participant groups, and disease severities. Reliability was quantified by the intraclass correlation coefficient, standardized error of the measurement, and the minimum detectable change. FINDINGS Foot progression angle magnitude did not differ between groups or conditions but variability significantly higher in real-world walking (P < 0.001). Structural and symptomatic severity were unrelated to FPA in either walking condition, except for real-world coefficient of variation which was higher for moderate-severe structural osteoarthritis compared to the treadmill for those with mild structural severity (P < 0.034). All real-world outcomes showed excellent reliability including intraclass correlation coefficients above 0.95. The participants recorded a mean (standard deviation) of 298 (33) and 10,447 (5232) steps in the laboratory and real-world walking conditions, respectively. INTERPRETATION This study provides the first characterization of foot progression angles during real-world walking in people with and without symptomatic knee osteoarthritis. These results indicate that foot progression angles can be feasibly and reliably measured in unsupervised real-world walking conditions.
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Affiliation(s)
- Jesse M Charlton
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Centre for Aging SMART at Vancouver Coastal Health, Vancouver, Canada.
| | - Haisheng Xia
- Department of Automation, University of Science and Technology of China, Hefei, China; Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, China
| | - Peter B Shull
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Centre for Aging SMART at Vancouver Coastal Health, Vancouver, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Centre for Aging SMART at Vancouver Coastal Health, Vancouver, Canada
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Charlton JM, Kuo C, Hunt MA. The number of steps for representative real-world, unsupervised walking data using a shoe-worn inertial sensor. IEEE Trans Neural Syst Rehabil Eng 2023; PP. [PMID: 37028071 DOI: 10.1109/tnsre.2023.3250612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Inertial measurement units are now commonly used to quantify gait in healthy and clinical populations outside the laboratory environment, yet it is unclear how much data needs to be collected in these highly variable environments before a consistent gait pattern is identified. We investigated the number of steps to reach consistent outcomes calculated from real-world, unsupervised walking in people with (n=15) and without (n=15) knee osteoarthritis. A shoe-embedded inertial sensor measured seven foot-derived biomechanical variables on a step-by-step basis during purposeful, outdoor walking over seven days. Univariate Gaussian distributions were generated from incrementally larger training data blocks (increased in 5 step increments) and compared to all unique testing data blocks (5 steps/block). A consistent outcome was defined when the addition of another testing block did not change the percent similarity of the training block by more than 0.01% and this was maintained for the subsequent 100 training blocks (equivalent to 500 steps). No evidence was found for differences between those with and without knee osteoarthritis (p=0.490), but the measured gait outcomes differed in the number of steps to become consistent (p<0.001). The results demonstrate that collecting consistent foot-specific gait biomechanics is feasible in free-living conditions. This supports the potential for shorter or more targeted data collection periods that could reduce participant or equipment burden.
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Affiliation(s)
- Jesse M. Charlton
- School of Biomedical Engineering and the School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Calvin Kuo
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Michael A. Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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Esculier JF, Besomi M, Silva DDO, Passigli S, Rathleff MS, Van Middelkoop M, Barton C, Callaghan MJ, Harkey MS, Hoens AM, Krowchuk NM, Teoli A, Vicenzino B, Willy RW, Hunt MA. Do the General Public and Health Care Professionals Think That Running Is Bad for the Knees? A Cross-sectional International Multilanguage Online Survey. Orthop J Sports Med 2022; 10:23259671221124141. [PMID: 36199830 PMCID: PMC9528027 DOI: 10.1177/23259671221124141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Running is a popular sport with widely recognized health benefits. Given the high rates of knee injury in runners and the growing prevalence of knee osteoarthritis (KOA), it may be useful to assess perceptions about running and knee joint health. Purpose: The objectives of this study were to (1) explore and compare the perceptions of the general public (PUB) and health care professionals (HCPs) on the topic of running and knee health and (2) explore recommendations about running and knee health provided by HCPs. Study Design: Cross-sectional study. Methods: We conducted an online survey between June 18 and October 1, 2020. The questionnaire included questions on running and knee health, and HCPs were asked about their typical recommendations and level of confidence in providing recommendations on the topic. Perceptions (proportions) were compared between the PUB and HCPs using the chi-square test. Results: In total, 4521 responses (PUB, n = 2514; HCPs, n = 2007) were analyzed. A greater proportion of HCPs perceived regular running as healthy for knees (86% vs 68%; P < .001). More of the PUB than HCPs ( P < .001) believed that running frequently (29% vs 13%), long distances (54% vs 45%), and on hard surfaces (60% vs 36%) increased the risk of developing KOA. Running for those with KOA was perceived by the PUB as posing an increased risk of getting more knee pain (48%) and needing joint replacement surgery (38%), more so than by HCPs (26% and 17%, respectively). The majority of HCPs reported being relatively confident in providing evidence-based recommendations about running and knee health and mostly recommended that runners with KOA modify training parameters instead of quit. Conclusion: More HCPs perceived running as healthy for knees when compared with the PUB. Most HCPs felt confident in providing evidence-based recommendations about running and knee health.
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Affiliation(s)
| | - Manuela Besomi
- Investigation performed at University of British Columbia, Vancouver, Canada
| | | | - Samuele Passigli
- Investigation performed at University of British Columbia, Vancouver, Canada
| | | | | | - Christian Barton
- Investigation performed at University of British Columbia, Vancouver, Canada
| | | | - Matthew S. Harkey
- Investigation performed at University of British Columbia, Vancouver, Canada
| | - Alison M. Hoens
- Investigation performed at University of British Columbia, Vancouver, Canada
| | - Natasha M. Krowchuk
- Investigation performed at University of British Columbia, Vancouver, Canada
| | - Anthony Teoli
- Investigation performed at University of British Columbia, Vancouver, Canada
| | - Bill Vicenzino
- Investigation performed at University of British Columbia, Vancouver, Canada
| | - Richard W. Willy
- Investigation performed at University of British Columbia, Vancouver, Canada
| | - Michael A. Hunt
- Investigation performed at University of British Columbia, Vancouver, Canada
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Lai AKM, Wakeling JM, Garland SJ, Hunt MA, Ivanova TD, Pollock CL. Does the stimulus provoking a stepping reaction correlate with step characteristics and clinical measures of balance and mobility post-stroke? Clin Biomech (Bristol, Avon) 2022; 93:105595. [PMID: 35247709 DOI: 10.1016/j.clinbiomech.2022.105595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 02/05/2022] [Accepted: 02/10/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Retraining stepping reactions in people post-stroke is vital. However, the relationship between the stimulus and resulting stepping performance in people post-stroke is unknown. We explored relationships between stepping stimulus and stepping reactions initiated by either paretic or non-paretic legs of people post-stroke and controls. Relationships were examined in the context of clinical measures of balance. METHODS Centre of mass dynamics were measured during self-initiated destabilizing leaning stimuli that required stepping reactions by paretic and non-paretic legs of people post-stroke (n = 10) and controls (n = 10) to recover balance. Step characteristics of the first two steps of stepping reactions were measured. Correlations were calculated between clinical measures of balance and mobility and the centre of mass and step characteristics. FINDINGS Steps were shorter and slower with decreased centre of mass fore-aft and downward displacement and velocity when initiated by paretic and non-paretic legs compared with controls. However, increase in centre of mass displacement and velocity in the fore-aft and downward direction tended to be associated with a greater increase in step length and speed when stepping reactions were initiated by the paretic and non-paretic legs compared with controls. Time to step initiation in response to onset of falling stimulus did not differ between groups. Strong positive correlations were found between clinical balance and mobility scores and centre of mass and step dynamics in fore-aft and vertical directions. INTERPRETATION These results support objective measurement of centre of mass to quantify the stimulus influencing step dynamics and stepping performance during retraining interventions following stroke.
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Affiliation(s)
- Adrian K M Lai
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - James M Wakeling
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - S Jayne Garland
- Faculty of Health Sciences, Western University, London, Canada
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada
| | - Tanya D Ivanova
- Faculty of Health Sciences, Western University, London, Canada
| | - Courtney L Pollock
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
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Whittaker JL, Truong LK, Losciale JM, Silvester-Lee T, Miciak M, Pajkic A, Le CY, Hoens AM, Mosewich A, Hunt MA, Li LC, Roos EM. Efficacy of the SOAR knee health program: protocol for a two-arm stepped-wedge randomized delayed-controlled trial. BMC Musculoskelet Disord 2022; 23:85. [PMID: 35078446 PMCID: PMC8790851 DOI: 10.1186/s12891-022-05019-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/11/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Knee trauma permanently elevates one's risk for knee osteoarthritis. Despite this, people at-risk of post-traumatic knee osteoarthritis rarely seek or receive care, and accessible and efficacious interventions to promote knee health after injury are lacking. Exercise can ameliorate some mechanisms and independent risk factors for osteoarthritis and, education and action-planning improve adherence to exercise and promote healthy behaviours. METHODS To assess the efficacy of a virtually-delivered, physiotherapist-guided exercise-based program (SOAR) to improve knee health in persons discharged from care after an activity-related knee injury, 70 people (16-35 years of age, 12-48 months post-injury) in Vancouver Canada will be recruited for a two-arm step-wedged assessor-blinded delayed-control randomized trial. Participants will be randomly allocated to receive the intervention immediately or after a 10-week delay. The program consists of 1) one-time Knee Camp (group education, 1:1 individualized exercise and activity goal-setting); 2) weekly individualized home-based exercise and activity program with tracking, and; 3) weekly 1:1 physiotherapy-guided action-planning with optional group exercise class. Outcomes will be measured at baseline, 9- (primary endpoint), and 18-weeks. The primary outcome is 9-week change in knee extension strength (normalized peak concentric torque; isokinetic dynamometer). Secondary outcomes include 9-week change in moderate-to-vigorous physical activity (accelerometer) and self-reported knee-related quality-of-life (Knee injury and OA Outcome Score subscale) and self-efficacy (Knee Self Efficacy Scale). Exploratory outcomes include 18-week change in primary and secondary outcomes, and 9- and 18- week change in other components of knee extensor and flexor muscle function, hop function, and self-reported symptoms, function, physical activity, social support, perceived self-care and kinesiophobia. Secondary study objectives will assess the feasibility of a future hybrid effectiveness-implementation trial protocol, determine the optimal intervention length, and explore stakeholder experiences. DISCUSSION This study will assess the efficacy of a novel, virtually-delivered, physiotherapist-guided exercise-based program to optimize knee health in persons at increased risk of osteoarthritis due to a past knee injury. Findings will provide valuable information to inform the management of osteoarthritis risk after knee trauma and the conduct of a future effectiveness-implementation trial. TRIAL REGISTRATION Clinicaltrials.gov reference: NTC04956393. Registered August 5, 2021, https://clinicaltrials.gov/ct2/show/NCT04956393?term=SOAR&cond=osteoarthritis&cntry=CA&city=Vancouver&draw=2&rank=1.
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Affiliation(s)
- Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
- Arthritis Research Canada, Vancouver, Canada.
| | - Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | | | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Andrea Pajkic
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Canada
| | - Christina Y Le
- Arthritis Research Canada, Vancouver, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Alison M Hoens
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Amber Mosewich
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Canada
| | - Michael A Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Ewa M Roos
- Department of Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
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10
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Whittaker JL, Truong LK, Silvester-Lee T, Losciale JM, Miciak M, Pajkic A, Le CY, Hoens AM, Mosewich AD, Hunt MA, Li LC, Roos EM. Feasibility of the SOAR (Stop OsteoARthritis) program. Osteoarthritis and Cartilage Open 2022; 4:100239. [DOI: 10.1016/j.ocarto.2022.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/26/2022] [Indexed: 10/19/2022] Open
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11
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Mohtajeb M, Cibere J, Mony M, Zhang H, Sullivan E, Hunt MA, Wilson DR. Open MRI assessment of anterior femoroacetabular clearance in active and passive impingement-provoking postures. Bone Jt Open 2021; 2:988-996. [PMID: 34825828 PMCID: PMC8636292 DOI: 10.1302/2633-1462.211.bjo-2021-0143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims Cam and pincer morphologies are potential precursors to hip osteoarthritis and important contributors to non-arthritic hip pain. However, only some hips with these pathomorphologies develop symptoms and joint degeneration, and it is not clear why. Anterior impingement between the femoral head-neck contour and acetabular rim in positions of hip flexion combined with rotation is a proposed pathomechanism in these hips, but this has not been studied in active postures. Our aim was to assess the anterior impingement pathomechanism in both active and passive postures with high hip flexion that are thought to provoke impingement. Methods We recruited nine participants with cam and/or pincer morphologies and with pain, 13 participants with cam and/or pincer morphologies and without pain, and 11 controls from a population-based cohort. We scanned hips in active squatting and passive sitting flexion, adduction, and internal rotation using open MRI and quantified anterior femoroacetabular clearance using the β angle. Results In squatting, we found significantly decreased anterior femoroacetabular clearance in painful hips with cam and/or pincer morphologies (mean -11.3° (SD 19.2°)) compared to pain-free hips with cam and/or pincer morphologies (mean 8.5° (SD 14.6°); p = 0.022) and controls (mean 18.6° (SD 8.5°); p < 0.001). In sitting flexion, adduction, and internal rotation, we found significantly decreased anterior clearance in both painful (mean -15.2° (SD 15.3°); p = 0.002) and painfree hips (mean -4.7° (SD 13°); p = 0.010) with cam and/pincer morphologies compared to the controls (mean 7.1° (SD 5.9°)). Conclusion Our results support the anterior femoroacetabular impingement pathomechanism in hips with cam and/or pincer morphologies and highlight the effect of posture on this pathomechanism. Cite this article: Bone Jt Open 2021;2(11):988–996.
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Affiliation(s)
- Maryam Mohtajeb
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada.,Center for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jolanda Cibere
- Arthritis Research Centre of Canada, Richmond, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Mony
- Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
| | - Honglin Zhang
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Sullivan
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - David R Wilson
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Mohtajeb M, Cibere J, Graffos A, Mony M, Zhang H, Hunt MA, Wilson DR. Open MRI validation of a hip model driven with subject-specific motion capture data in predicting anterior femoroacetabular clearance. BMC Musculoskelet Disord 2021; 22:972. [PMID: 34814875 PMCID: PMC8609822 DOI: 10.1186/s12891-021-04820-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cam and/or pincer morphologies (CPM) are potential precursors to hip osteoarthritis (OA) and important contributors to non-arthritic hip pain. However, only some CPM hips develop OA and/or pain, and it is not clear why. Anterior impingement between the femoral head/neck contour and acetabular rim during motion is a proposed pathomechanism. Understanding how activity and deformity combine to produce impingement may shed light on the causes of hip degeneration/pain. The objective of this study was to determine the accuracy of a subject-specific hip model driven by subject-specific motion data in predicting anterior impingement. METHODS We recruited 22 participants with CPM (both with and without pain) and 11 controls. We collected subject-specific 3D kinematics during squatting and sitting flexion, adduction, and internal rotation (FADIR) (an active and a passive maneuver, respectively, proposed to provoke impingement). We then developed 3D subject-specific hip models from supine 3T hip MRI scans that predicted the beta angle (a measure of anterior femoroacetabular clearance) for each frame of acquired kinematics. To assess the accuracy of these predictions, we measured the beta angle directly in the final position of squatting and sitting FADIR using open MRI scans. We selected the frame of motion data matching the static imaged posture using the least-squares error in hip angles. Model accuracy for each subject was calculated as the absolute error between the open MRI measure of beta and the model prediction of beta at the matched time frame. To make the final model accuracy independent of goodness of match between open MRI position and motion data, a threshold was set for least-squares error in hip angles, and only participants that were below this threshold were considered in the final model accuracy calculation, yielding results from 10 participants for squatting and 7 participants for sitting FADIR. RESULTS For squatting and sitting FADIR, we found an accuracy of 1.1°(0.8°) and 1.3°(mean (SD), and root mean squared error, respectively) and 0.5°(0.3°) and 0.6°, respectively. CONCLUSION This subject-specific hip model predicts anterior femoroacetabular clearance with an accuracy of about 1°, making it useful to predict anterior impingement during activities measured with motion analysis.
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Affiliation(s)
- Maryam Mohtajeb
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Jolanda Cibere
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Centre of Canada, Richmond, BC, Canada
| | - Angelo Graffos
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Mony
- Arthritis Research Centre of Canada, Richmond, BC, Canada
| | - Honglin Zhang
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - David R Wilson
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada.
- Department of Orthopaedics, University of British Columbia, 7/F, 2635 Laurel Street, Vancouver, BC, V5Z1M9, Canada.
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13
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Sharma S, Wilson R, Pryymachenko Y, Pathak A, Chua J, Gwynne-Jones D, Bennell KL, Metcalf B, Hinman RS, Hunt MA, Boon-Whatt L, Abbott JH. Reliability, validity, responsiveness, and minimum important change of the Stair Climb Test in adults with hip and knee osteoarthritis. Arthritis Care Res (Hoboken) 2021; 75:1147-1157. [PMID: 34806338 DOI: 10.1002/acr.24821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/04/2021] [Accepted: 11/16/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The Osteoarthritis Research Society International (OARSI) recommends assessment of physical function using a performance-based test of stair negotiation, but was unable to recommend any specific test. We assessed the reliability, validity, responsiveness, measurement error, and minimum important change (MIC) of the 6-step timed Stair Climb Test (SCT). METHODS We used pooled data from 397 participants with hip or knee osteoarthritis (54% women) from four clinical trials (86% retained at 12-week follow-up). Construct validity was assessed by testing six a priori hypotheses against other OARSI-recommended physical function measures. A self-reported Global Rating of Change scale was used to classify participants as worsened, improved and stable. Participants who worsened in physical function were excluded from all analyses. Responsiveness and MIC were assessed using multiple anchor-based and distribution-based approaches. Test-retest reliability, standard error of measurement (SEM) and smallest detectable change (SDC) were assessed on stable participants. RESULTS Five of six hypotheses (83%) for construct validity were met. Test-retest reliability was excellent (intraclass correlation coefficient2,1 : 0.83; 95% confidence interval: 0.71, 0.90). The SEM and SDC values were 0.44 and 1.21 seconds respectively. We did not find adequate support for responsiveness. The MIC values ranged from 0.78 to 1.95 seconds using different approaches (median=1.37 seconds). CONCLUSION The 6-step timed SCT adequately assesses the construct of physical function in individuals with hip or knee osteoarthritis with excellent 12-week test-retest reliability. However, support for its responsiveness was inadequate to recommend its use as an outcome measure in people with osteoarthritis for research and clinical practice.
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Affiliation(s)
- Saurab Sharma
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Ross Wilson
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Yana Pryymachenko
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Anupa Pathak
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Jason Chua
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - David Gwynne-Jones
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | - Ben Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Lim Boon-Whatt
- School of Applied Science, Republic Polytechnic, Singapore
| | - J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
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14
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Damji F, MacDonald K, Hunt MA, Taunton J, Scott A. Assessing acute:chronic workload ratio methodologies for the prediction of knee pain in men's elite volleyball. Translational Sports Med 2021. [DOI: 10.1002/tsm2.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Faraz Damji
- Centre for Hip Health and Mobility Vancouver Coastal Health Research Institute Vancouver BC Canada
- Department of Physical Therapy Faculty of Medicine University of British Columbia Vancouver BC Canada
| | - Kerry MacDonald
- Department of Athletics and Recreation University of British Columbia Vancouver BC Canada
- School of Kinesiology Faculty of Education University of British Columbia Vancouver BC Canada
| | - Michael A. Hunt
- Department of Physical Therapy Faculty of Medicine University of British Columbia Vancouver BC Canada
| | - Jack Taunton
- Department of Family Medicine Faculty of Medicine University of British Columbia Vancouver BC Canada
| | - Alex Scott
- Centre for Hip Health and Mobility Vancouver Coastal Health Research Institute Vancouver BC Canada
- Department of Physical Therapy Faculty of Medicine University of British Columbia Vancouver BC Canada
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15
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Tse CTF, Ryan MB, Dien J, Scott A, Hunt MA. An exploration of changes in plantar pressure distributions during walking with standalone and supported lateral wedge insole designs. J Foot Ankle Res 2021; 14:55. [PMID: 34615545 PMCID: PMC8493692 DOI: 10.1186/s13047-021-00493-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background Lateral wedge insoles (LWI), standalone or with medial arch support (supported-LWI), have been thoroughly investigated for their effects on modifying gait biomechanics for people with knee osteoarthritis. However, plantar pressure distribution between these insole types has not been investigated and could provide insight towards insole prescription with concomitant foot symptoms taken into consideration. Methods In a sample of healthy individuals (n = 40), in-shoe plantar pressure was measured during walking with LWI, with or without medial arch support (variable- and uniform-stiffness designs), and a flat control insole condition. Pressure data from the plantar surface of the foot were divided into seven regions: medial/lateral rearfoot, midfoot, medial/central/lateral forefoot, hallux. Plantar pressure outcomes assessed were the medial-lateral pressure index (MLPI) for the whole foot, and the peak pressure, pressure-time integral (PTI), and contact area in each plantar region. Comfort in each insole condition was rated as a change relative to the flat control insole condition. Repeated-measures analyses of variance were calculated to compare the plantar pressure outcomes between insole conditions. Results Regionally, medial rearfoot and forefoot pressure were reduced by all wedged insoles, with the variable-stiffness supported-wedge showing greater reductions than the standalone wedge. Lateral rearfoot and forefoot pressure were reduced by both supported-LWI, but unchanged by the standalone wedge. In the midfoot, the standalone wedge maintained pressure but reduced regional contact area, while both supported-LWI increased midfoot pressure and contact area. All LWI increased the MLPI, indicating a lateral shift in plantar pressure distribution throughout the weightbearing phase of gait. Comfort ratings were not significantly different between insole conditions. Conclusions Regional differences in plantar pressure may help determine an appropriate lateral wedge insole variation to avoid exacerbation of concomitant foot symptoms by minimizing pressure in symptomatic regions. Lateral shifts in plantar pressure distribution were observed in all laterally wedged conditions, including one supported-LWI that was previously shown to be biomechanically ineffective for modifying knee joint load distribution. Thus, shifts in foot centre of pressure may not be a primary mechanism by which LWI can modify knee joint load distribution for people with knee osteoarthritis. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00493-5.
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Affiliation(s)
- Calvin T F Tse
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada.,Kintec Footlabs Inc, Surrey, BC, Canada
| | - Michael B Ryan
- Kintec Footlabs Inc, Surrey, BC, Canada.,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Jason Dien
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Alex Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada. .,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
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16
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Squier K, Scott A, Hunt MA, Brunham LR, Wilson DR, Screen H, Waugh CM. The effects of cholesterol accumulation on Achilles tendon biomechanics: A cross-sectional study. PLoS One 2021; 16:e0257269. [PMID: 34529718 PMCID: PMC8445482 DOI: 10.1371/journal.pone.0257269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022] Open
Abstract
Familial hypercholesterolemia, a common genetic metabolic disorder characterized by high cholesterol levels, is involved in the development of atherosclerosis and other preventable diseases. Familial hypercholesterolemia can also cause tendinous abnormalities, such as thickening and xanthoma (tendon lipid accumulation) in the Achilles, which may impede tendon biomechanics. The objective of this study was to investigate the effect of cholesterol accumulation on the biomechanical performance of Achilles tendons, in vivo. 16 participants (10 men, 6 women; 37±6 years) with familial hypercholesterolemia, diagnosed with tendon xanthoma, and 16 controls (10 men, 6 women; 36±7 years) underwent Achilles biomechanical assessment. Achilles biomechanical data was obtained during preferred pace, shod, walking by analysis of lower limb kinematics and kinetics utilizing 3D motion capture and an instrumented treadmill. Gastrocnemius medialis muscle-tendon junction displacement was imaged using ultrasonography. Achilles stiffness, hysteresis, strain and force were calculated from displacement-force data acquired during loading cycles, and tested for statistical differences using one-way ANOVA. Statistical parametric mapping was used to examine group differences in temporal data. Participants with familial hypercholesterolemia displayed lower Achilles stiffness compared to the control group (familial hypercholesterolemia group: 87±20 N/mm; controls: 111±18 N/mm; p = 0.001), which appeared to be linked to Achilles loading rate rather than an increased strain (FH: 5.27±1.2%; controls: 4.95±0.9%; p = 0.413). We found different Achilles loading patterns in the familial hypercholesterolemia group, which were traced to differences in the centre of pressure progression that affected ankle moment. This finding may indicate that individuals with familial hypercholesterolemia use different Achilles loading strategies. Participants with familial hypercholesterolemia also demonstrated significantly greater Achilles hysteresis than the control group (familial hypercholesterolemia: 57.5±7.3%; controls: 43.8±10%; p<0.001), suggesting that walking may require a greater metabolic cost. Our results indicate that cholesterol accumulation could contribute to reduced Achilles function, while potentially increasing the chance of injury.
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Affiliation(s)
- Kipling Squier
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Alexander Scott
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Michael A. Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Liam R. Brunham
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David R. Wilson
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hazel Screen
- School of Engineering & Materials Science, Queen Mary University of London, London, United Kingdom
| | - Charlie M. Waugh
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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17
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Shull PB, Xia H, Charlton JM, Hunt MA. Wearable Real-Time Haptic Biofeedback Foot Progression Angle Gait Modification to Assess Short-Term Retention and Cognitive Demand. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1858-1865. [PMID: 34478376 DOI: 10.1109/tnsre.2021.3110202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Foot progression angle gait (FPA) modification is an important part of rehabilitation for a variety of neuromuscular and musculoskeletal diseases. While wearable haptic biofeedback could enable FPA gait modification for more widespread use than traditional tethered, laboratory-based approaches, retention, and cognitive demand in FPA gait modification via wearable haptic biofeedback are currently unknown and may be important to real-life implementation. Thus, the purpose of this study was to assess the feasibility of wearable haptic biofeedback to assess short-term retention and cognitive demand during FPA gait modification. Ten healthy participants performed toe-in (target 10 degrees change in internal rotation) and toe-out (target 10 degrees change in external rotation) haptic gait training trials followed by short-term retention trials, and cognitive multitasking trials. Results showed that participants were able to initially respond to the wearable haptic feedback to modify their FPA to adopt the new toe-in (9.7 ± 0.8 degree change in internal rotation) and toe-out (8.9 ± 1.0 degree change in external rotation) gait patterns. Participants retained the modified gait pattern on average within 3.9 ± 3.6 deg of the final haptic gait training FPA values. Furthermore, cognitive multitasking did not influence short-term retention in that there were no differences in gait performance during retention trials with or without cognitive multitasking. These results demonstrate that wearable haptic biofeedback can be used to assess short-term retention and cognitive demand during FPA gait modification without the need for traditional, tethered systems.
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18
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Hunt MA, Charlton JM, Felson DT, Liu A, Chapman GJ, Graffos A, Jones RK. Frontal plane knee alignment mediates the effect of frontal plane rearfoot motion on knee joint load distribution during walking in people with medial knee osteoarthritis. Osteoarthritis Cartilage 2021; 29:678-686. [PMID: 33582238 DOI: 10.1016/j.joca.2021.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/08/2021] [Accepted: 02/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the nature of differences in the relationship between frontal plane rearfoot kinematics and knee adduction moment (KAM) magnitudes. DESIGN Cross-sectional study resulting from a combination of overground walking biomechanics data obtained from participants with medial tibiofemoral osteoarthritis at two separate sites. Statistical models were created to examine the relationship between minimum frontal plane rearfoot angle (negative values = eversion) and different measures of the KAM, including examination of confounding, mediation, and effect modification from knee pain, radiographic disease severity, static rearfoot alignment, and frontal plane knee angle. RESULTS Bivariable relationships between minimum frontal plane rearfoot angle and the KAM showed consistent negative correlations (r = -0.411 to -0.447), indicating higher KAM magnitudes associated with the rearfoot in a more everted position during stance. However, the nature of this relationship appears to be mainly influenced by frontal plane knee kinematics. Specifically, frontal plane knee angle during gait was found to completely mediate the relationship between minimum frontal plane rearfoot angle and the KAM, and was also an effect modifier in this relationship. No other variable significantly altered the relationship. CONCLUSIONS While there does appear to be a moderate relationship between frontal plane rearfoot angle and the KAM, any differences in the magnitude of this relationship can likely be explained through an examination of frontal plane knee angle during walking. This finding suggests that interventions derived distal to the knee should account for the effect of frontal plane knee angle to have the desired effect on the KAM.
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Affiliation(s)
- M A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia: Vancouver, BC, Canada; Department of Physical Therapy, University of British Columbia: Vancouver, BC, Canada.
| | - J M Charlton
- Motion Analysis and Biofeedback Laboratory, University of British Columbia: Vancouver, BC, Canada; Graduate Programs in Rehabilitation Sciences, University of British Columbia: Vancouver, BC, Canada.
| | - D T Felson
- Department of Rheumatology, Boston University School of Medicine, Boston, MA, USA; NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester, UK; Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
| | - A Liu
- School of Health and Society, University of Salford: Manchester, UK.
| | - G J Chapman
- School of Sport and Health Sciences, University of Central Lancashire: Preston, UK.
| | - A Graffos
- Motion Analysis and Biofeedback Laboratory, University of British Columbia: Vancouver, BC, Canada; Graduate Programs in Rehabilitation Sciences, University of British Columbia: Vancouver, BC, Canada.
| | - R K Jones
- School of Health and Society, University of Salford: Manchester, UK.
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19
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Tse CTF, Charlton JM, Lam J, Ho J, Bears J, Serek A, Hunt MA. Smartphone Inclinometry Is a Valid and Reliable Tool for Measuring Frontal Plane Tibial Alignment in Healthy and Osteoarthritic Knees. Phys Ther 2021; 101:6168354. [PMID: 33710269 PMCID: PMC8248042 DOI: 10.1093/ptj/pzab091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/13/2020] [Accepted: 02/17/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Frontal plane knee alignment plays an integral role in tibiofemoral knee osteoarthritis development and progression. Accessible methods for obtaining direct or indirect measures of knee alignment may help inform clinical decision making when specialized equipment is unavailable. The present study evaluated the concurrent validity, as well as intersession (within-rater) and interrater (within-session) reliability of smartphone inclinometry for measuring static frontal plane tibial alignment-a known proxy of frontal plane knee alignment. METHODS Twenty healthy individuals and 38 patients with knee osteoarthritis were measured for frontal plane tibial alignment by a pair of raters using smartphone inclinometry, manual inclinometry, and 3-dimensional motion capture simultaneously. Healthy participants were measured on 2 separate days. Bland-Altman analysis, supplemented with intraclass correlation coefficient (ICC)(2,k), was used to assess concurrent validity. ICC(2,k), SEM, and minimum detectable change with 95% confidence limits (MDC95) were used to assess measurement reliability. RESULTS Compared against motion capture, smartphone inclinometry measured frontal plane tibial alignment with a mean difference of 0.7 and 1.1 degrees (biased toward varus) for healthy participants and participants with knee osteoarthritis, respectively (ICC[2,k] ≥ 0.87). Smartphone inclinometry measurements demonstrated adequate intersession (within-rater) relative (ICC[2,k] = 0.91) and absolute (SEM = 0.7 degrees; MDC95 = 1.8 degrees) reliability, which outperformed manual inclinometry (ICC[2,k] = 0.85; SEM = 1.0 degrees; MDC95 = 2.6 degrees). Interrater (within-session) reliability of smartphone inclinometry was acceptable in both cohorts (ICC[2,k] = 0.93; SEM = 0.4 degrees to 1.2 degrees; MDC95 = 1.2 degrees to 3.2 degrees). CONCLUSION Smartphone inclinometry is sufficiently valid and reliable for measuring frontal plane tibial alignment in healthy individuals and patients with medial tibiofemoral knee osteoarthritis. IMPACT Smartphones are readily accessible by clinicians and researchers. Our assessment of measurement validity and reliability supports the use of smartphone inclinometry as a clinically available tool to measure frontal plane tibial alignment without medical imaging or specialized equipment.
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Affiliation(s)
- Calvin T F Tse
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada,Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jesse M Charlton
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada,Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Lam
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanne Ho
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Bears
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda Serek
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, British Columbia, Canada,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada,Address all correspondence to Dr Hunt at:
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Pollock CL, Hunt MA, Garland SJ, Ivanova TD, Wakeling JM. Relationships Between Stepping-Reaction Movement Patterns and Clinical Measures of Balance, Motor Impairment, and Step Characteristics After Stroke. Phys Ther 2021; 101:6145045. [PMID: 33615368 PMCID: PMC8164842 DOI: 10.1093/ptj/pzab069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 09/14/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Successful stepping reactions, led by either the paretic or nonparetic leg, in response to a loss of balance are critical to safe mobility poststroke. The purpose of this study was to measure sagittal plane hip, knee, ankle, and trunk kinematics during 2-step stepping reactions initiated by paretic and nonparetic legs of people who had stroke and members of a control group. METHODS Principal component analysis (PCA) was used to reduce the data into movement patterns explaining interlimb coordination of the stepping and stance legs. Correlations among principal components loading scores and clinical measures of balance ability (as measured on the Community Balance and Mobility scale), motor impairment (as measured on the foot and leg sections of the Chedoke-McMaster Stroke Assessment), and step characteristics (length and velocity) were used to examine the effect of stroke on stepping reaction movement patterns. RESULTS The first 5 principal components explained 95.9% of the movement pattern of stepping reactions and differentiated between stepping reactions initiated by paretic legs, nonparetic legs, or the legs of controls. Moderate-strong associations (ρ/r > 0.50) between specific principal component loading scores and clinical measures and step characteristics were dependent on the initiating leg. Lower levels of motor impairment, higher levels of balance ability, and faster and longer steps were associated with stepping reactions initiated by the paretic leg that comprised paretic leg flexion and nonparetic leg extension. Step initiation with the nonparetic leg showed associations between higher scores on clinical measures and movement patterns of flexion in both paretic and nonparetic legs. CONCLUSIONS Movement patterns of stepping reactions poststroke were influenced by the initiating leg. After stroke, specific movement patterns showed associations with clinical measures depending on the initiating leg, suggesting that these movement patterns are important to retraining of stepping reactions. Specifically, use of flexion patterning and assessment of between-leg pattern differentiation may be important aspects to consider during retraining of stepping reactions poststroke. IMPACT Evidence-based interventions targeting balance reactions are still in their infancy. This investigation of stepping reactions poststroke addresses a major gap in research.
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Affiliation(s)
- Courtney L Pollock
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada,Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada,Address all correspondence to Dr Pollock at:
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - S Jayne Garland
- Faculty of Health Sciences, Western University, London, Canada
| | - Tanya D Ivanova
- Faculty of Health Sciences, Western University, London, Canada
| | - James M Wakeling
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
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21
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Charlton JM, Eng JJ, Li LC, Hunt MA. Learning Gait Modifications for Musculoskeletal Rehabilitation: Applying Motor Learning Principles to Improve Research and Clinical Implementation. Phys Ther 2021; 101:pzaa207. [PMID: 33351940 PMCID: PMC7899063 DOI: 10.1093/ptj/pzaa207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 10/04/2020] [Indexed: 12/11/2022]
Abstract
Gait modifications are used in the rehabilitation of musculoskeletal conditions like osteoarthritis and patellofemoral pain syndrome. While most of the research has focused on the biomechanical and clinical outcomes affected by gait modification, the process of learning these new gait patterns has received little attention. Without adequate learning, it is unlikely that the modification will be performed in daily life, limiting the likelihood of long-term benefit. There is a vast body of literature examining motor learning, though little has involved gait modifications, especially in populations with musculoskeletal conditions. The studies that have examined gait modifications in these populations are often limited due to incomplete reporting and study design decisions that prohibit strong conclusions about motor learning. This perspective draws on evidence from the broader motor learning literature for application in the context of modifying gait. Where possible, specific gait modification examples are included to highlight the current literature and what can be improved on going forward. A brief theoretical overview of motor learning is outlined, followed by strategies that are known to improve motor learning, and finally, how assessments of learning need to be conducted to make meaningful conclusions.
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Affiliation(s)
- Jesse M Charlton
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Janice J Eng
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Richmond, BC, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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22
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Damji F, MacDonald K, Hunt MA, Taunton J, Scott A. Using the VERT wearable device to monitor jumping loads in elite volleyball athletes. PLoS One 2021; 16:e0245299. [PMID: 33481847 PMCID: PMC7822237 DOI: 10.1371/journal.pone.0245299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/24/2020] [Indexed: 11/19/2022] Open
Abstract
Sport is becoming increasingly competitive and athletes are being exposed to greater physical demands, leaving them prone to injuries. Monitoring athletes with the use of wearable technology could provide a way to potentially manage training and competition loads and reduce injuries. One such technology is the VERT inertial measurement unit, a commercially available discrete wearable device containing a 3-axis accelerometer, 3-axis gyroscope and 3-axis magnetometer. Some of the main measurement outputs include jump count, jump height and landing impacts. While several studies have examined the accuracy of the VERT's measures of jump height and jump count, landing impact force has not yet been investigated. The objective of this research study was to explore the validity of the VERT landing impact values. We hypothesized that the absolute peak VERT acceleration values during a jump-land cycle would fall within 10% of the peak acceleration values derived simultaneously from a research-grade accelerometer (Shimmer). Fourteen elite university-level volleyball players each performed 10 jumps while wearing both devices simultaneously. The results showed that VERT peak accelerations were variable (limits of agreement of -84.13% and 52.37%) and had a propensity to be lower (mean bias of -15.88%) when compared to the Shimmer. In conclusion, the validity of the VERT device's landing impact values are generally poor, when compared to the Shimmer.
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Affiliation(s)
- Faraz Damji
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry MacDonald
- Department of Athletics and Recreation, University of British Columbia, Vancouver, British Columbia, Canada
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A. Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jack Taunton
- Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Scott
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Charlton JM, Birmingham TB, Leitch KM, Hunt MA. Knee-specific gait biomechanics are reliable when collected in multiple laboratories by independent raters. J Biomech 2020; 115:110182. [PMID: 33388485 DOI: 10.1016/j.jbiomech.2020.110182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/09/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
Multi-centre gait biomechanics studies provide the opportunity to increase sample size and the confidence in results, yet differences between centres may introduce additional error. While previous investigations have compared gait biomechanics from different laboratories assessed by different raters, estimates of relative reliability, measurement error, and thresholds for real change are still unknown. These metrics are imperative to interpret multi-centre study results. Therefore, we examined the reliability of gait biomechanics assessed in two different laboratories, by two different raters, and using the same study sample. Twelve healthy participants underwent gait assessments by two raters in two laboratories at different institutions. Identical protocols were used to collect five walking trials per participant. Discrete data were examined for knee joint angles and moments, gait speed, and stride length. Reliability was assessed using the intraclass correlation coefficient (ICC), standardized error of the measurement (SEM), minimum detectable difference (MDD), and Bland and Altman plots. All spatiotemporal, joint angle, and joint moment measures had ICCs = 0.83-0.94, except for the knee adduction moment peak in late stance (ICC = 0.69 and 0.72). The knee adduction moment SEMs indicate that measurement errors due to the laboratory effect are between 0.19% and 0.31% body weight times height (0.03-0.05 Nm/kg). Meanwhile, measurement error for the knee flexion-extension angle is <2°. Our results are similar to previous test-retest reliability results from a single laboratory, and multiple laboratories, while adding previously unreported reliability metrics necessary for interpreting multi-centre study results.
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Affiliation(s)
- Jesse M Charlton
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada; Graduate Programs in Rehabilitation Sciences, University of British Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Trevor B Birmingham
- Wolf Orthopaedic Biomechanics Laboratory, 1151 Richmond Street, 3M Centre Building, University of Western Ontario, London, ON N6A 3K7, Canada; School of Physical Therapy, University of Western Ontario, Elborn College, 1201 Western Road, London, ON N6A 3K7, Canada.
| | - Kristyn M Leitch
- Wolf Orthopaedic Biomechanics Laboratory, 1151 Richmond Street, 3M Centre Building, University of Western Ontario, London, ON N6A 3K7, Canada.
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada; Department of Physical Therapy, University of British Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
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24
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Charlton JM, Esculier JF, Kobsar D, Thatcher D, Hunt MA. Symptomatic knee osteoarthritis is associated with worse but stable quality of life and physical function regardless of the compartmental involvement: Data from the OAI. Osteoarthritis and Cartilage Open 2020; 2:100117. [DOI: 10.1016/j.ocarto.2020.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022] Open
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Schmidt AM, Stockton DJ, Hunt MA, Yung A, Masri BA, Wilson DR. Reliability of tibiofemoral contact area and centroid location in upright, open MRI. BMC Musculoskelet Disord 2020; 21:795. [PMID: 33256691 PMCID: PMC7702694 DOI: 10.1186/s12891-020-03786-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 11/11/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Imaging cannot be performed during natural weightbearing in biomechanical studies using conventional closed-bore MRI, which has necessitated simulating weightbearing load on the joint. Upright, open MRI (UO-MRI) allows for joint imaging during natural weightbearing and may have the potential to better characterize the biomechanical effect of tibiofemoral pathology involving soft tissues. However open MRI scanners have lower field strengths than closed-bore scanners, which limits the image quality that can be obtained. Thus, there is a need to establish the reliability of measurements in upright weightbearing postures obtained using UO-MRI. METHODS Knees of five participants with prior anterior cruciate ligament (ACL) rupture were scanned standing in a 0.5 T upright open MRI scanner using a 3D DESS sequence. Manual segmentation of cartilage regions in contact was performed and centroids of these contact areas were automatically determined for the medial and lateral tibiofemoral compartments. Inter-rater, test-retest, and intra-rater reliability were determined and quantified using intra-class correlation (ICC3,1), standard error of measurement (SEM), and smallest detectable change with 95% confidence (SDC95). Accuracy was assessed by using a high-resolution 7 T MRI as a reference. RESULTS Contact area and centroid location reliability (inter-rater, test-retest, and intra-rater) for sagittal scans in the medial compartment had ICC3,1 values from 0.95-0.99 and 0.98-0.99 respectively. In the lateral compartment, contact area and centroid location reliability ICC3,1 values ranged from 0.83-0.91 and 0.95-1.00 respectively. The smallest detectable change in contact area was 1.28% in the medial compartment and 0.95% in the lateral compartment. Contact area and centroid location reliability for coronal scans in the medial compartment had ICC3,1 values from 0.90-0.98 and 0.98-1.00 respectively, and in the lateral compartment ICC3,1 ranged from 0.76-0.94 and 0.93-1.00 respectively. The smallest detectable change in contact area was 0.65% in the medial compartment and 1.41% in the lateral compartment. Contact area was accurate to within a mean absolute error of 11.0 mm2. CONCLUSIONS Knee contact area and contact centroid location can be assessed in upright weightbearing MRI with good to excellent reliability. The lower field strength used in upright, weightbearing MRI does not compromise the reliability of tibiofemoral contact area and centroid location measures.
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Affiliation(s)
- Andrew M Schmidt
- Centre for Hip Health and Mobility, University of British Columbia, 7/F - 2635 Laurel Street, Robert HN Ho Research Centre, Vancouver, BC, V5Z 1M9, Canada
| | - David J Stockton
- Centre for Hip Health and Mobility, University of British Columbia, 7/F - 2635 Laurel Street, Robert HN Ho Research Centre, Vancouver, BC, V5Z 1M9, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.,Clinician Investigator Program, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Centre for Hip Health and Mobility, University of British Columbia, 7/F - 2635 Laurel Street, Robert HN Ho Research Centre, Vancouver, BC, V5Z 1M9, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Andrew Yung
- Centre for Hip Health and Mobility, University of British Columbia, 7/F - 2635 Laurel Street, Robert HN Ho Research Centre, Vancouver, BC, V5Z 1M9, Canada.,MRI Research Center, University of British Columbia, Vancouver, BC, Canada
| | - Bassam A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - David R Wilson
- Centre for Hip Health and Mobility, University of British Columbia, 7/F - 2635 Laurel Street, Robert HN Ho Research Centre, Vancouver, BC, V5Z 1M9, Canada. .,Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
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Reiman MP, Agricola R, Kemp JL, Heerey JJ, Weir A, van Klij P, Kassarjian A, Mosler AB, Ageberg E, Hölmich P, Warholm KM, Griffin D, Mayes S, Khan KM, Crossley KM, Bizzini M, Bloom N, Casartelli NC, Diamond LE, Di Stasi S, Drew M, Friedman DJ, Freke M, Glyn-Jones S, Gojanovic B, Harris-Hayes M, Hunt MA, Impellizzeri FM, Ishøi L, Jones DM, King MG, Lawrenson PR, Leunig M, Lewis CL, Mathieu N, Moksnes H, Risberg MA, Scholes MJ, Semciw AI, Serner A, Thorborg K, Virgile A, Wörner T, Dijkstra HP. Infographic. Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 2020; 55:115-117. [PMID: 32868314 PMCID: PMC7788225 DOI: 10.1136/bjsports-2020-102219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Michael P Reiman
- Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Joanne L Kemp
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua J Heerey
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Adam Weir
- Department of Orthopaedic Surgery, Erasmus MC Center for Groin Injuries, Erasmus University Medical Centre, Rotterdam, Netherlands.,Aspetar Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Pim van Klij
- Department of Orthopaedic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Ara Kassarjian
- Elite Sports Imaging, SL, Madrid, Spain.,Musculoskeletal Radiology, Corades, LLC, Brookline, Massachusetts, USA
| | - Andrea B Mosler
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Eva Ageberg
- Health Sciences, Lund University, Lund, Sweden
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark, Amager-Hvidovre Hospital, Hvidovre, Copenhagen, Denmark
| | | | - Damian Griffin
- Warwick Orthopaedics, University of Warwick, Coventry, Warwick, UK.,Orthopaedics Warwick Medical School, University of Warwick, Coventry, Warwick, UK
| | - Sue Mayes
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Karim M Khan
- Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kay M Crossley
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Mario Bizzini
- Research, Schulthess Clinic Human Performance Lab, Zurich, ZH, Switzerland
| | - Nancy Bloom
- Physical Therapy, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Laura E Diamond
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Stephanie Di Stasi
- Division of Physical Therapy, The Ohio State University, Columbus, Ohio, USA
| | - Michael Drew
- Department of Physiotherapy, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia.,Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
| | - Daniel J Friedman
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Matthew Freke
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Sion Glyn-Jones
- Department of Orthopaedic Surgery, University of Oxford, Institute of Musculoskeletal Sciences, Oxford, UK
| | - Boris Gojanovic
- Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland.,Sports Medicine, University Hospital of Lausanne, Lausanne, VD, Switzerland
| | - Marcie Harris-Hayes
- Physical Therapy, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Michael A Hunt
- Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Franco M Impellizzeri
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Lasse Ishøi
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Sports Orthopedic Research Center - Copenhagen (SORC-C), Hvidovre, Denmark
| | - Denise M Jones
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Matthew G King
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Peter R Lawrenson
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Leunig
- Department of Orthopaedics, Schulthess Klinik, Zurich, Switzerland
| | - Cara L Lewis
- Physical Therapy & Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Nicolas Mathieu
- Physiotherapy, HES-SO Valais, University of Applied Sciences Western Switzerland, Leukerbad, Valais, Switzerland
| | - Håvard Moksnes
- Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway
| | - May Arna Risberg
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Mark J Scholes
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Adam I Semciw
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Andreas Serner
- Research & Scientific Support, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark, Amager-Hvidovre Hospital, Hvidovre, Copenhagen, Denmark
| | - Adam Virgile
- College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | | | - H Paul Dijkstra
- Sports Medicine, ASPETAR Orthopedic and Sports Medicine Hospital, Doha, Qatar.,Department for Continuing Education, University of Oxford, Oxford, UK
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Tse CTF, Ryan MB, Hunt MA. Influence of foot posture on immediate biomechanical responses during walking to variable-stiffness supported lateral wedge insole designs. Gait Posture 2020; 81:21-26. [PMID: 32650239 DOI: 10.1016/j.gaitpost.2020.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Novel designs of lateral wedge insoles with arch support can alter walking biomechanics as a conservative treatment option for knee osteoarthritis. However, variations in foot posture may influence individual responses to insole intervention and these effects are not yet known. RESEARCH QUESTION How does foot posture influence biomechanical responses to novel designs of lateral wedge insoles with arch support? METHODS This exploratory biomechanical investigation categorized forty healthy volunteers (age 23-34) into pronated (n = 16), neutral (n = 15), and supinated (n = 9) foot posture groups based on the Foot Posture Index. Three-dimensional gait analysis was conducted during walking with six orthotic insole conditions: flat control, lateral wedge, uniform-stiffness arch support, variable-stiffness arch support, and lateral wedge + each arch support. Frontal plane knee and ankle/subtalar joint kinetic and kinematic outcomes were compared among insole conditions and foot posture groups using a repeated measures analysis of variance. RESULTS The lateral wedge alone and lateral wedge + variable-stiffness arch support were the only insole conditions effective at reducing the knee adduction moment. However, the lateral wedge + variable-stiffness arch support had a smaller increase in peak ankle/subtalar eversion moment than the lateral wedge alone. Supinated feet had smaller ankle/subtalar eversion excursion and moment impulse than neutral and pronated feet, across all insole conditions. SIGNIFICANCE Supinated feet have less mobile ankle/subtalar joints than neutral and pronated feet and, as a result, may be less likely to respond to biomechanical intervention from orthotic insoles. Supported lateral wedge insoles incorporating an arch support design that is variable-stiffness may be better than uniform-stiffness since reductions in the knee adduction moment can be achieved while minimizing increases in the ankle/subtalar eversion moment.
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Affiliation(s)
- Calvin T F Tse
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 1Z7, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada; Kintec Footlabs, 13645 King George Blvd., Surrey, BC V3T 2TB, Canada
| | - Michael B Ryan
- Kintec Footlabs, 13645 King George Blvd., Surrey, BC V3T 2TB, Canada; Biomedical Physiological and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada; Department of Physical Therapy, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3.
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Dhillon GK, Hunt MA, Reid AL, Esculier JF. What are the perceptions of runners and healthcare professionals on footwear and running injury risk? BMJ Open Sport Exerc Med 2020; 6:e000767. [PMID: 32626599 PMCID: PMC7328975 DOI: 10.1136/bmjsem-2020-000767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives There is a gap in research exploring perceptions of runners and healthcare professionals (HCPs) about running footwear and injury risk. The objectives of this study were: (1) to document factors considered by runners when selecting footwear; (2) to compare perceptions on footwear and injury risk in runners and HCPs; and (3) to evaluate the perceived usefulness of an online educational module. Methods Using an online survey, we collected information on demographics and perceptions about footwear and injury risk. Runners reported their footwear selection strategy, and HCPs their typical recommendations. An evidence-based educational module was presented, and participants rated its usefulness. Results The survey was completed by 2442 participants, of which 1035 completed the optional postmodule questions. Runners reported relying mostly on comfort and advice from retailers when selecting shoes. Perceptions regarding the effects of specific footwear types (minimalist, maximalist), characteristics (softness, drop) and selection strategy (foot type, transition) on biomechanics and injury risk were different between HCPs and runners. Overall, runners perceived footwear as more important to prevent injury than did HCPs (7.6/10, 99% CI 7.4 to 7.7 vs 6.2/10, 99% CI 6.0 to 6.5; p<0.001). Both runners (8.1/10, 99% CI 7.9 to 8.3) and HCPs (8.7/10, 99% CI 8.6 to 8.9) found the educational module useful. A majority of respondents indicated the module changed their perceptions. Conclusion Footwear is perceived as important in reducing running injury risk. This online module was deemed useful in educating about footwear evidence. Future studies should evaluate if changes in perceptions can translate to behaviour change and, ultimately, reduced injury risk.
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Affiliation(s)
- Gurmeet K Dhillon
- Allan McGavin Sports Medicine Clinic, Vancouver, British Columbia, Canada
| | - Michael A Hunt
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada.,Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea L Reid
- Allan McGavin Sports Medicine Clinic, Vancouver, British Columbia, Canada.,Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean-Francois Esculier
- Allan McGavin Sports Medicine Clinic, Vancouver, British Columbia, Canada.,Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada.,Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.,The Running Clinic, Lac-Beauport, Quebec, Canada
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Napier C, Jiang X, MacLean CL, Menon C, Hunt MA. The use of a single sacral marker method to approximate the centre of mass trajectory during treadmill running. J Biomech 2020; 108:109886. [DOI: 10.1016/j.jbiomech.2020.109886] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/16/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
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Xia H, Charlton JM, Shull PB, Hunt MA. Portable, automated foot progression angle gait modification via a proof-of-concept haptic feedback-sensorized shoe. J Biomech 2020; 107:109789. [PMID: 32321637 DOI: 10.1016/j.jbiomech.2020.109789] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 11/28/2022]
Abstract
Modifying the foot progression angle (FPA) is a non-pharmacological, non-surgical treatment option for knee osteoarthritis, however current widespread adoption has been limited by the requirement of laboratory-based motion capture systems. We present the first customized haptic feedback-sensorized shoe for estimating and modifying FPA during walking gait, which includes an electronic inertial and magnetometer module in the sole for estimating FPA, and two vibration motors attached to the medial and lateral shoe lining for providing vibrotactile feedback. Feasibility testing was performed by comparing FPA performance while wearing the haptic feedback-sensorized shoe with the training targets. Participants performed five walking trials with five randomly-presented FPA targets (10° toe-in, 0°, 10° toe-out, 20° toe-out, and 30° toe-out) of 2 min each on a treadmill. Overall average FPA performance error across all conditions was 0.2 ± 4.1°, and the overall mean absolute FPA performance error across all conditions was 3.1 ± 2.6°. Reducing the size of the no-feedback window resulted in less performance error during walking. This study demonstrates that a novel haptic feedback-sensorized shoe can be used to effectively train FPA modifications. The haptic feedback-sensorized shoe could potentially be used for FPA gait modification outside of specialized camera-based motion capture laboratories as a conservative treatment for knee osteoarthritis or other related clinical applications requiring FPA assessment and modification in daily life.
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Affiliation(s)
- Haisheng Xia
- State Key Laboratory of Mechanical Systems and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jesse M Charlton
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Peter B Shull
- State Key Laboratory of Mechanical Systems and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.
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31
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Kobsar D, Charlton JM, Tse CTF, Esculier JF, Graffos A, Krowchuk NM, Thatcher D, Hunt MA. Validity and reliability of wearable inertial sensors in healthy adult walking: a systematic review and meta-analysis. J Neuroeng Rehabil 2020; 17:62. [PMID: 32393301 PMCID: PMC7216606 DOI: 10.1186/s12984-020-00685-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/07/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Inertial measurement units (IMUs) offer the ability to measure walking gait through a variety of biomechanical outcomes (e.g., spatiotemporal, kinematics, other). Although many studies have assessed their validity and reliability, there remains no quantitive summary of this vast body of literature. Therefore, we aimed to conduct a systematic review and meta-analysis to determine the i) concurrent validity and ii) test-retest reliability of IMUs for measuring biomechanical gait outcomes during level walking in healthy adults. METHODS Five electronic databases were searched for journal articles assessing the validity or reliability of IMUs during healthy adult walking. Two reviewers screened titles, abstracts, and full texts for studies to be included, before two reviewers examined the methodological quality of all included studies. When sufficient data were present for a given biomechanical outcome, data were meta-analyzed on Pearson correlation coefficients (r) or intraclass correlation coefficients (ICC) for validity and reliability, respectively. Alternatively, qualitative summaries of outcomes were conducted on those that could not be meta-analyzed. RESULTS A total of 82 articles, assessing the validity or reliability of over 100 outcomes, were included in this review. Seventeen biomechanical outcomes, primarily spatiotemporal parameters, were meta-analyzed. The validity and reliability of step and stride times were found to be excellent. Similarly, the validity and reliability of step and stride length, as well as swing and stance time, were found to be good to excellent. Alternatively, spatiotemporal parameter variability and symmetry displayed poor to moderate validity and reliability. IMUs were also found to display moderate reliability for the assessment of local dynamic stability during walking. The remaining biomechanical outcomes were qualitatively summarized to provide a variety of recommendations for future IMU research. CONCLUSIONS The findings of this review demonstrate the excellent validity and reliability of IMUs for mean spatiotemporal parameters during walking, but caution the use of spatiotemporal variability and symmetry metrics without strict protocol. Further, this work tentatively supports the use of IMUs for joint angle measurement and other biomechanical outcomes such as stability, regularity, and segmental accelerations. Unfortunately, the strength of these recommendations are limited based on the lack of high-quality studies for each outcome, with underpowered and/or unjustified sample sizes (sample size median 12; range: 2-95) being the primary limitation.
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Affiliation(s)
- Dylan Kobsar
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada.,Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Jesse M Charlton
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Calvin T F Tse
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Francois Esculier
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,The Running Clinic, Lac Beauport, QC, Canada
| | - Angelo Graffos
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Natasha M Krowchuk
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Thatcher
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada. .,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
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32
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Hunt MA, Charlton JM, Esculier JF. Osteoarthritis year in review 2019: mechanics. Osteoarthritis Cartilage 2020; 28:267-274. [PMID: 31877382 DOI: 10.1016/j.joca.2019.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/25/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
Abstract
Mechanics play a critical - but not sole - role in the pathogenesis of osteoarthritis, and recent research has highlighted how mechanical constructs are relevant at the cellular, joint, and whole-body level related to osteoarthritis outcomes. This review examined papers from April 2018 to April 2019 that reported on the role of mechanics in osteoarthritis etiology, with a particular emphasis on studies that focused on the interaction between movement and tissue biomechanics with other clinical outcomes relevant to the pathophysiology of osteoarthritis. Studies were grouped by themes that were particularly prevalent from the past year. Results of the search highlighted the large exposure of knee-related research relative to other body areas, as well as studies utilizing laboratory-based motion capture technology. New research from this past year highlighted the important role that rate of exerted loads and rate of muscle force development - rather than simply force capacity (strength) - have in OA etiology and treatment. Further, the role of muscle activation patterns in functional and structural aspects of joint health has received much interest, though findings remain equivocal. Finally, new research has identified potential mechanical outcome measures that may be related to osteoarthritis disease progression. Future research should continue to combine knowledge of mechanics with other relevant research techniques, and to identify mechanical markers of joint health and structural and functional disease progression that are needed to best inform disease prevention, monitoring, and treatment.
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Affiliation(s)
- M A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
| | - J M Charlton
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada; Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada.
| | - J-F Esculier
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
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33
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Impellizzeri FM, Jones DM, Griffin D, Harris-Hayes M, Thorborg K, Crossley KM, Reiman MP, Scholes MJ, Ageberg E, Agricola R, Bizzini M, Bloom N, Casartelli NC, Diamond LE, Dijkstra HP, Di Stasi S, Drew M, Friedman DJ, Freke M, Gojanovic B, Heerey JJ, Hölmich P, Hunt MA, Ishøi L, Kassarjian A, King M, Lawrenson PR, Leunig M, Lewis CL, Warholm KM, Mayes S, Moksnes H, Mosler AB, Risberg MA, Semciw A, Serner A, van Klij P, Wörner T, Kemp J. Patient-reported outcome measures for hip-related pain: a review of the available evidence and a consensus statement from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 2020; 54:848-857. [DOI: 10.1136/bjsports-2019-101456] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2020] [Indexed: 12/11/2022]
Abstract
Hip-related pain is a well-recognised complaint among active young and middle-aged active adults. People experiencing hip-related disorders commonly report pain and reduced functional capacity, including difficulties in executing activities of daily living. Patient-reported outcome measures (PROMs) are essential to accurately examine and compare the effects of different treatments on disability in those with hip pain. In November 2018, 38 researchers and clinicians working in the field of hip-related pain met in Zurich, Switzerland for the first International Hip-related Pain Research Network meeting. Prior to the meeting, evidence summaries were developed relating to four prioritised themes. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of PROMs to assess disability in young and middle-aged active adults with hip-related pain. Our process to gain consensus had five steps: (1) systematic review of systematic reviews; (2) preliminary discussion within the working group; (3) update of the more recent high-quality systematic review and examination of the psychometric properties of PROMs according to established guidelines; (4) formulation of the recommendations considering the limitations of the PROMs derived from the examination of their quality; and (5) voting and consensus. Out of 102 articles retrieved, 6 systematic reviews were selected and assessed for quality according to AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Two showed moderate quality. We then updated the most recent review. The updated literature search resulted in 10 additional studies that were included in the qualitative synthesis. The recommendations based on evidence summary and PROMs limitations were presented at the consensus meeting. The group makes the following recommendations: (1) the Hip and Groin Outcome Score (HAGOS) and the International Hip Outcome Tool (iHOT) instruments (long and reduced versions) are the most appropriate PROMs to use in young and middle-aged active adults with hip-related pain; (2) more research is needed into the utility of the HAGOS and the iHOT instruments in a non-surgical treatment context; and (3) generic quality of life measures such as the EuroQoL-5 Dimension Questionnaire and the Short Form Health Survey-36 may add value for researchers and clinicians in this field. We conclude that as none of the instruments shows acceptable quality across various psychometric properties, more methods studies are needed to further evaluate the validity of these PROMS—the HAGOS and iHOT—as well as the other (currently not recommended) PROMS.
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34
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Reiman MP, Agricola R, Kemp JL, Heerey JJ, Weir A, van Klij P, Kassarjian A, Mosler AB, Ageberg E, Hölmich P, Warholm KM, Griffin D, Mayes S, Khan KM, Crossley KM, Bizzini M, Bloom N, Casartelli NC, Diamond LE, Di Stasi S, Drew M, Friedman DJ, Freke M, Gojanovic B, Glyn-Jones S, Harris-Hayes M, Hunt MA, Impellizzeri FM, Ishøi L, Jones DM, King MG, Lawrenson PR, Leunig M, Lewis CL, Mathieu N, Moksnes H, Risberg MA, Scholes MJ, Semciw AI, Serner A, Thorborg K, Wörner T, Dijkstra HP. Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 2020; 54:631-641. [PMID: 31959678 DOI: 10.1136/bjsports-2019-101453] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2020] [Indexed: 12/31/2022]
Abstract
There is no agreement on how to classify, define or diagnose hip-related pain-a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility; a comprehensive approach is therefore essential. A negative flexion-adduction-internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head-neck radiographs are the initial diagnostic imaging of choice-advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). We recommend clear, detailed and consistent methodology of bony morphology outcome measures (definition, measurement and statistical reporting) in research. Future research on conditions with hip-related pain as the main symptom should include high-quality prospective studies on aetiology and prognosis. The most common hip conditions in active adults presenting with hip-related pain are: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without distinct osseous morphology including labral, chondral and/or ligamentum teres conditions. The last category should not be confused with the incidental imaging findings of labral, chondral and/or ligamentum teres pathology in asymptomatic people. Future research should refine our current recommendations by determining the clinical utility of clinical examination and diagnostic imaging in prospective studies.
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Affiliation(s)
- Michael P Reiman
- Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus, MC, University Medical Center, Rotterdam, Netherlands
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Adam Weir
- Orthopaedics, Erasmus MC Center for Groin Injuries, Rotterdam, The Netherlands.,Sports Groin Pain Centre, Aspetar Hospital, Doha, Qatar
| | - Pim van Klij
- Department of Orthopaedic Surgery, Erasmus, MC, University Medical Center, Rotterdam, Netherlands
| | - Ara Kassarjian
- Elite Sports Imaging SL, Madrid, Spain.,Musculoskeletal Radiology, Corades, LLC, Brookline, MA, United States
| | - Andrea Britt Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Eva Ageberg
- Sport Sciences, Deparment of Health Sciences, Lund University, Lund, Sweden
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | | | - Damian Griffin
- Orthopaedics - Medical School, University of Warwick, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Sue Mayes
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Karim M Khan
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Mario Bizzini
- Research, Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Nancy Bloom
- Physical Therapy, Washington University, St. Louis, Missouri, USA
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland Griffith University, Schoold of Allied Health Sciences, Griffith, Queensland, Australia
| | - Stephanie Di Stasi
- School of Health and Rehabilitation Sciences, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael Drew
- Athlete Availability, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia.,Research into Sport and Exercise, University of Canberra, Canberra, Bruce, Australian Capital Territory, Australia
| | | | - Matthew Freke
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Boris Gojanovic
- Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland.,Sports Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sion Glyn-Jones
- Department of Orthopaedic Surgery, University of Oxford, Institute of Musculoskeletal Sciences, Oxford, United Kingdom
| | | | - Michael A Hunt
- Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Franco M Impellizzeri
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Lasse Ishøi
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Denise M Jones
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Matthew G King
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Peter R Lawrenson
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Leunig
- Department of Orthopaedics, Schulthess Klinik, Zurich, Switzerland
| | - Cara L Lewis
- Physical Therapy & Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Nicolas Mathieu
- Physiotherapy, HES-SO Valais, University of Applied Sciences Western Switzerland, Loeche-les-Bains, Valais, Switzerland
| | | | - May-Arna Risberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Mark James Scholes
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Adam I Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Andreas Serner
- Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Tobias Wörner
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Hendrik Paulus Dijkstra
- Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
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35
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Mosler AB, Kemp J, King M, Lawrenson PR, Semciw A, Freke M, Jones DM, Casartelli NC, Wörner T, Ishøi L, Ageberg E, Diamond LE, Hunt MA, Di Stasi S, Reiman MP, Drew M, Friedman D, Thorborg K, Leunig M, Bizzini M, Khan KM, Crossley KM, Agricola R, Bloom N, Dijkstra HP, Griffin D, Gojanovic B, Harris-Hayes M, Heerey JJ, Hölmich P, Impellizzeri FM, Kassarjian A, Warholm KM, Mayes S, Moksnes H, Risberg MA, Scholes MJ, Serner A, van Klij P, Lewis CL. Standardised measurement of physical capacity in young and middle-aged active adults with hip-related pain: recommendations from the first International Hip-related Pain Research Network (IHiPRN) meeting, Zurich, 2018. Br J Sports Med 2019; 54:702-710. [DOI: 10.1136/bjsports-2019-101457] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 01/12/2023]
Abstract
Hip-related pain can significantly impact quality of life, function, work capacity, physical activity and family life. Standardised measurement methods of physical capacity of relevance to young and middle-aged active adults with hip-related pain are currently not established. The aim of this consensus paper was to provide recommendations for clinical practice and research on standardised measurement methods of physical capacity in young and middle-aged active adults with hip-related pain. Four areas of importance were identified: (1) clinical measures (range of motion, muscle strength, functional impairments), (2) laboratory-based measures (biomechanics and muscle function (muscle activity, size and adiposity)), (3) physical activity, and (4) return to sport/performance. The literature was reviewed, and a summary circulated to the working group to inform discussion at the consensus meeting. The working group developed clinical and research recommendations from the literature review, which were further discussed and modified within the working group at the consensus meeting. These recommendations were then presented to all 38 International Hip-related Pain Research Network (IHiPRN) participants for further discussion, refinement and consensus voting. Therefore, the recommendations voted on were based on a combination of current evidence and expert opinion. The consensus meeting voted on 13 recommendations, six of which were clinically orientated, and seven more research specific. We recommended that clinicians working with young and middle-aged active adults with hip-related pain assess strength using objective methods of measurement, and clinically assess performance of functional tasks, including walking and running. Physical activity should be quantified using both self-reported and objective measures, and patient expectations of recovery should be quantified prior to treatment. It was recommended that return to physical activity (including sport and occupation) be quantified, and sport-specific activities should be assessed prior to return to sport. The IHiPRN participants were uncertain regarding recommendations for range of motion assessment. Research recommendations were that the measurement properties of range of motion, strength and functional performance tests be investigated, reported and improved in both clinical and research settings. Reporting of movement-related parameters (biomechanics and muscle function) should be standardised and the relationship among movement-related parameters, symptoms, function, quality of life, and intra-articular and imaging findings should be investigated. Quantification of return to physical activity (including sport and occupational demands) is required in future research, and the return to sport continuum should be used. Future research is required to determine the best criteria for rehabilitation progression and return to physical activity following hip-related pain management.
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36
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Kemp JL, Risberg MA, Mosler A, Harris-Hayes M, Serner A, Moksnes H, Bloom N, Crossley KM, Gojanovic B, Hunt MA, Ishøi L, Mathieu N, Mayes S, Scholes MJ, Gimpel M, Friedman D, Ageberg E, Agricola R, Casartelli NC, Diamond LE, Dijkstra HP, Di Stasi S, Drew M, Freke M, Griffin D, Heerey J, Hölmich P, Impellizzeri FM, Jones DM, Kassarjian A, Khan KM, King MG, Lawrenson PR, Leunig M, Lewis CL, Warholm KM, Reiman MP, Semciw A, Thorborg K, van Klij P, Wörner T, Bizzini M. Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 2019; 54:504-511. [PMID: 31732651 DOI: 10.1136/bjsports-2019-101458] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2019] [Indexed: 11/04/2022]
Abstract
The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain; (2) patient-reported outcome measures for hip-related pain; (3) measurement of physical capacity for hip-related pain; (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors such as load magnitude, number of repetitions and sets, duration of whole programme, duration of contractile element of exercise, duration of one repetition, time under tension, rest between repetitions, range of motion through which the exercise is performed, and rest between exercise sessions should be reported. (ii) Research should investigate the optimal frequency, intensity, time, type, volume and progression of exercise therapy. (iii) Research should examine the effect of patient education in people with hip-related pain. (iv) Research should investigate the effect of other treatments used in people with hip-related pain (for example: manual therapy, medications, injections). (v) Research should examine the impact of comorbidities and social determinants on treatment effectiveness in people with hip-related pain. Clinicians and researchers working with young to middle-aged active adults with hip-related pain may use these consensus recommendations to guide, develop, test and implement individualised, evidence-based physiotherapist-led rehabilitation programmes.
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Affiliation(s)
- Joanne L Kemp
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - May Arna Risberg
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Andrea Mosler
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Marcie Harris-Hayes
- Physical Therapy, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA.,Orthopaedic Surgery, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Andreas Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Nancy Bloom
- Physical Therapy, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA.,Orthopaedic Surgery, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Kay M Crossley
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Boris Gojanovic
- Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland.,SportAdo consultation, University Hospital of Lausanne (CHUV) Multidisciplinary Unit of Adolescent Health, Lausanne, Switzerland
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lasse Ishøi
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Nicolas Mathieu
- Physiotherapy, HES-SO Valais, University of Applied Sciences Western Switzerland, Leukerbad, Valais, Switzerland
| | - Sue Mayes
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,The Australian Ballet, Southbank, Victoria, Australia
| | - Mark J Scholes
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Mo Gimpel
- Performance Science, Southampton Football Club, Southampton, Hampshire, UK
| | - Daniel Friedman
- Monash School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Rintje Agricola
- Department of Orthopaedic Surgery, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE, Menzies Health Institute Queensland Griffith University, School of Allied Health Sciences, Gold Coast, Queensland, Australia
| | - H Paul Dijkstra
- Department for Continuing Education, University of Oxford, Oxford, Oxfordshire, UK.,Aspetar Sports Medicine Hospital, Doha, Qatar
| | - Stephanie Di Stasi
- Division of Physical Therapy, The Ohio State Univesity, Columbus, Ohio, USA
| | - Michael Drew
- University of Canberra Research into Sport and Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Matthew Freke
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Damian Griffin
- Warwick Orthopaedics, University of Warwick, Coventry, Warwick, UK
| | - Joshua Heerey
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Franco M Impellizzeri
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Denise M Jones
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Ara Kassarjian
- Musculoskeletal Radiology, Corades, LLC, Brookline, Massachusetts, USA.,Musculoskeletal Radiology, Elite Sports Imaging, SL, Madrid, Spain
| | - Karim M Khan
- Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew G King
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Peter R Lawrenson
- School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Leunig
- Department of Orthopaedics, Schulthess Klinik, Zurich, Switzerland
| | - Cara L Lewis
- Physical Therapy & Athletic Training, Boston University, Boston, Massachusetts, USA
| | | | - Michael P Reiman
- Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Adam Semciw
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Pim van Klij
- Department of Orthopaedic Surgery, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Tobias Wörner
- Department of Health Sciences, Lunds University, Lund, Sweden
| | - Mario Bizzini
- Schulthess Clinic Human Performance Lab, Zurich, Switzerland
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Esculier JF, Jarrett M, Krowchuk NM, Rauscher A, Wiggermann V, Taunton JE, Wilson DR, Gatti AA, Hunt MA. Cartilage recovery in runners with and without knee osteoarthritis: A pilot study. Knee 2019; 26:1049-1057. [PMID: 31434630 DOI: 10.1016/j.knee.2019.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/17/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Running is an easy way of meeting physical activity recommendations for individuals with knee osteoarthritis (KOA); however, it remains unknown how their cartilage reacts to running. The objective of this pilot study was to compare the effects of 30 min of running on T2 and T1ρ relaxation times of tibiofemoral cartilage in female runners with and without KOA. METHODS Ten female runners with symptomatic KOA (mean age 52.6 ± 7.6 years) and 10 without KOA (mean age 52.5 ± 7.8 years) ran for 30 min on a treadmill. Tibiofemoral cartilage T2 and T1ρ relaxation times were measured using magnetic resonance imaging prior to and immediately after the bout of running. Repeated-measures analyses of covariance (ANCOVA) were conducted to examine between-group differences across scanning times. RESULTS No Group × Time interactions were found for T2 (P ≥ 0.076) or T1ρ (P ≥ 0.288) relaxation times. However, runners with KOA showed increased T2 values compared with pre-running in the medial and lateral femur 55 min post-running (5.4 to 5.5%, P < 0.022) and in all four tibiofemoral compartments 90 min post-running (6.9 to 11.1%, P < 0.01). A significant group effect was found for T1ρ in the medial femur, with greater values in those with KOA compared with controls. CONCLUSION While Group × Time interactions in T2 and T1ρ relaxation times remained statistically insignificant, the observed significant increases in T2 in runners with tibiofemoral osteoarthritis TFOA may suggest slower and continuing changes in the cartilage and thus a need for longer recovery after running. Future research should investigate the effects of repeated exposure to running.
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Affiliation(s)
- Jean-Francois Esculier
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michael Jarrett
- Population Data BC, University of British Columbia, Vancouver, BC, Canada
| | - Natasha M Krowchuk
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada; Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
| | - Vanessa Wiggermann
- UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada; Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
| | - Jack E Taunton
- Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David R Wilson
- Department of Orthopaedics and Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada; Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Anthony A Gatti
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; NeuralSeg Ltd, Hamilton, ON, Canada
| | - Michael A Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Kobsar D, Charlton JM, Hunt MA. Individuals with knee osteoarthritis present increased gait pattern deviations as measured by a knee-specific gait deviation index. Gait Posture 2019; 72:82-88. [PMID: 31173950 DOI: 10.1016/j.gaitpost.2019.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/10/2019] [Accepted: 05/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A biomechanical analysis can provide valuable information on osteoarthritis (OA) gait, but important multidimensional interactions are often ignored. The Gait Deviation Index (GDI) was designed to address the issue of data complexity in gait analyses by providing a single, encompassing, value for one's deviation from a normative reference group. RESEARCH QUESTION The primary aim of this study was to examine differences in a knee-specific GDI among young adults, and older individuals with and without knee OA. Secondarily, we aimed to examine these differences while controlling for gait speed. METHOD Sagittal and frontal plane knee joint angles and moments were used in the computation of a GDI among young adults, and older individuals with and without knee OA. The GDI was calculated such that scores ≥100% were considered typical young-healthy gait and a 10% decrease below 100 equated to 1 standard deviation from typical gait. Scores were first examined using a one-way analysis of variance, and examined again after correcting for gait speed. RESULTS The GDI was calculated for three groups: young-healthy adults (n = 52), older individuals without knee OA (n = 56), and individuals with knee OA (n = 191). Those with knee osteoarthritis exhibited a mean GDI of 87.2 (11.1), which was significantly lower than young adults (99.6 (10.6); p < 0.001) and older individuals without knee OA (94.3 (11.0); p < 0.001). Differences in GDI remained consistent after controlling for gait speed. Knee OA gait waveforms displayed significant variability across similar GDIs, specifically in frontal plane patterns. CONCLUSION Those with knee osteoarthritis exhibited lower (worse) GDIs compared to those without knee osteoarthritis and young, healthy individuals. After correcting for gait speed, these findings did not change. The GDI highlighted the significant variability in gait waveforms within individuals with knee OA, but the clinical utility of the GDI score itself remains limited.
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Affiliation(s)
- Dylan Kobsar
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Jesse M Charlton
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
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Charlton JM, Xia H, Shull PB, Hunt MA. Validity and reliability of a shoe-embedded sensor module for measuring foot progression angle during over-ground walking. J Biomech 2019; 89:123-127. [DOI: 10.1016/j.jbiomech.2019.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 10/27/2022]
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40
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Gallina A, Wakeling JM, Hodges PW, Hunt MA, Garland SJ. Regional Vastus Medialis and Vastus Lateralis Activation in Females with Patellofemoral Pain. Med Sci Sports Exerc 2018; 51:411-420. [PMID: 30339659 DOI: 10.1249/mss.0000000000001810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION This study aimed to investigate whether regional activation patterns in the vasti muscles differ between females with and without patellofemoral pain (PFP), and whether muscle activation patterns correlate with knee extension strength. METHODS Thirty-six females with PFP and 20 pain-free controls performed a standardized knee flexion-extension task. The activation of vastus medialis (VM) and vastus lateralis (VL) was collected using high-density surface EMG and analyzed using principal component (PC) analysis. Spatial locations and temporal coefficients of the PC, and the percent variance they explain, were compared between groups and between the concentric and the eccentric phases of the movement. Correlations were assessed between PC features and knee extension strength. RESULTS The spatial weights of PC1 (general vasti activation) and PC2 (reflecting vastus-specific activation) were similar between groups (R > 0.95). Activation patterns in PFP were less complex than controls. Fewer PC features were necessary to reconstruct 90% of the signal for PFP participants in the concentric phase (P < 0.05), and the difference in bias of activation to VM (concentric phase) or VL (eccentric phase) was less between phases for PFP participants (P < 0.05). Smaller difference in vastus-specific activation in concentric and eccentric phases (less task specificity of VM/VL coordination) was related to greater maximal knee extension strength (P < 0.05, R < -0.43). CONCLUSION These data suggest PFP involves a simpler control strategy of VM and VL. The inverse association between task specificity and maximal knee extension strength suggests different presentations of PFP: lower knee extension strength but VM/VL coordination task specificity comparable with controls, or knee extension strength comparable with controls but lower VM/VL coordination task specificity.
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Affiliation(s)
- Alessio Gallina
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, CANADA
| | - James M Wakeling
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, CANADA
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, St. Lucia, AUSTRALIA
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, CANADA
| | - S Jayne Garland
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, CANADA.,Faculty of Health Sciences, University of Western Ontario, London, Ontario, CANADA
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Charlton JM, Hatfield GL, Guenette JA, Hunt MA. Toe-in and toe-out walking require different lower limb neuromuscular patterns in people with knee osteoarthritis. J Biomech 2018; 76:112-118. [DOI: 10.1016/j.jbiomech.2018.05.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/26/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022]
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Hunt MA, Charlton JM, Krowchuk NM, Tse CTF, Hatfield GL. Clinical and biomechanical changes following a 4-month toe-out gait modification program for people with medial knee osteoarthritis: a randomized controlled trial. Osteoarthritis Cartilage 2018; 26:903-911. [PMID: 29709498 DOI: 10.1016/j.joca.2018.04.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare changes in knee pain, function, and loading following a 4-month progressive walking program with or without toe-out gait modification in people with medial tibiofemoral knee osteoarthritis. DESIGN Individuals with medial knee osteoarthritis were randomized to a 4-month program to increase walking activity with (toe-out) or without (progressive walking) concomitant toe-out gait modification. The walking program was similar between the two groups, except that the gait modification group was trained to walk with 15° more toe-out. Primary outcomes included: knee joint pain (WOMAC), foot progression angles and knee joint loading during gait (knee adduction moment (KAM)). Secondary outcomes included WOMAC function, timed stair climb, and knee flexion moments during gait. RESULTS Seventy-nine participants (40 in toe-out group, 39 in progressive walking group) were recruited. Intention-to-treat analysis showed no between-group differences in knee pain, function, or timed stair climb. However, the toe-out group exhibited significantly greater changes in foot progression angle (mean difference = -9.04° (indicating more toe-out), 95% CI: -11.22°, -6.86°; P < 0.001), late stance KAM (mean difference = -0.26 %BW*ht, 95% CI: -0.39 %BW*ht, -0.12 %BW*ht, P < 0.001) and KAM impulse (-0.06 %BW*ht*s, 95% CI: -0.11 %BW*ht*s, -0.01 %BW*ht*s; P = 0.031) compared to the progressive walking group at follow-up. The only between-group difference that remained at a 1-month retention assessment was foot progression angle, with greater changes in the toe-out group (mean difference = -6.78°, 95% CI: -8.82°, -4.75°; P < 0.001). CONCLUSIONS Though both groups experienced improvements in self-reported pain and function, only the toe-out group experienced biomechanical improvements. TRIALS REGISTRY NUMBER NCT02019108.
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Affiliation(s)
- M A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
| | - J M Charlton
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
| | - N M Krowchuk
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
| | - C T F Tse
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
| | - G L Hatfield
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Department of Kinesiology, University of the Fraser Valley, Chilliwack, BC, Canada.
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43
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Hart HF, Crossley KM, Hunt MA. Gait patterns, symptoms, and function in patients with isolated tibiofemoral osteoarthritis and combined tibiofemoral and patellofemoral osteoarthritis. J Orthop Res 2018; 36:1666-1672. [PMID: 29139573 DOI: 10.1002/jor.23805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/11/2017] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to compare hip and knee biomechanics during walking in individuals with isolated tibiofemoral osteoarthritis (TFOA), combined TFOA and patellofemoral osteoarthritis (PFOA), and those without knee osteoarthritis (OA), and to compare patient-reported symptoms and function in individuals with isolated TFOA and those with combined TFOA and PFOA. Participants with and without knee OA were assessed and categorized into (i) no OA, (ii) isolated TFOA, and (iii) combined TFOA and PFOA, based on Kellgren and Lawrence diagnostic criteria. Quantitative motion analyses were conducted during walking, and hip and knee kinematics, and external moments were calculated. Peak values in the sagittal and frontal planes during stance phase were computed. Patient-reported symptoms and function data were obtained using the Western Ontario McMaster Universities Arthritis Index. Multivariate analyses of variance were conducted to compare between-group differences in gait and patient-reported symptoms and function data. The results showed no statistically significant differences in hip and knee kinematics and external moments between the three groups. Relative to those with isolated TFOA, individuals with combined TFOA and PFOA had greater pain (mean difference [95%CI]: 1.5 [0.05-3.1]), stiffness (0.8 [0.02-1.5]), and poorer function (5.4 [0.2-10.7]). In conclusion, the combined TFOA and PFOA radiographic disease pattern is associated with worse pain and function compared to the isolated TFOA disease pattern. The results of the present study provide no indications that treatments designed to change walking biomechanics should differ between individuals with isolated TFOA and those with combined TFOA and PFOA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1666-1672, 2018.
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Affiliation(s)
- Harvi F Hart
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Victoria, Australia
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, 212-2177 Westbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada
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Napier C, MacLean CL, Taunton JE, Maurer J, Hunt MA. Peak Braking Force as a Risk Factor for Running-Related Injuries. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535546.18340.ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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45
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Esculier JF, Krowchuk NM, Li LL, Taunton JE, Hunt MA. Perception about Running and Knee Joint Health among the Public and Healthcare Practitioners. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000537005.72133.aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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46
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Gallina A, Hunt MA, Hodges PW, Garland SJ. Vastus Lateralis Motor Unit Firing Rate Is Higher in Women With Patellofemoral Pain. Arch Phys Med Rehabil 2018; 99:907-913. [DOI: 10.1016/j.apmr.2018.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/08/2017] [Accepted: 01/11/2018] [Indexed: 10/18/2022]
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Charlton JM, Krowchuk NM, Hatfield GL, Guenette JA, Hunt MA. Contralateral limb foot rotation during unilateral toe-in or toe-out walking in people with knee osteoarthritis. Gait Posture 2018; 62:132-134. [PMID: 29547793 DOI: 10.1016/j.gaitpost.2018.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/24/2018] [Accepted: 03/06/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait modification is a treatment approach often used for a variety of neuromuscular and musculoskeletal pathologies. Gait modification is commonly applied to a single limb, as is done with foot rotation (FR) in people with knee osteoarthritis (KOA). However, the extent to which gait changes observed in the trained limb are also exhibited in the untrained, contralateral limb during a training session is unknown. RESEARCH QUESTION The purpose of this study was to examine the within-limb FR differences across four unilateral FR modifications compared to natural walking. METHODS Sixteen individuals with KOA walked on a treadmill while performing four different FR conditions: 10° toe-in, 0°, 10° toe-out and 20° toe-out. Motion capture was conducted to track FR magnitude after five minutes of practice. RESULTS The change in contralateral FR angle compared to natural walking significantly increased during toe-in 10° walking (3.1°) compared to toe-out -10° and -20° walking (-1.2° and -1.5°, respectively). As expected, the ipsilateral FR angle was significantly different between all conditions. SIGNIFICANCE These results suggest that small, but statistically significant changes in the untrained contralateral limb FR are observed during FR training of the ipsilateral limb. This may indicate a desire for symmetry, or a compensation when modifying the ipsilateral limb. Therefore, clinicians may need to maintain baseline FR magnitudes in the untrained limb when a patient exhibits unilateral KOA characteristics or lateral compartment KOA.
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Affiliation(s)
- Jesse M Charlton
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Natasha M Krowchuk
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Gillian L Hatfield
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada; Department of Kinesiology, University of the Fraser Valley, Chilliwack, BC, Canada
| | - Jordan A Guenette
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Centre for Heart and Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.
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48
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Chen YW, Camp PG, Coxson HO, Road JD, Guenette JA, Hunt MA, Reid WD. A Comparison of Pain, Fatigue, Dyspnea and their Impact on Quality of Life in Pulmonary Rehabilitation Participants with Chronic Obstructive Pulmonary Disease. COPD 2017; 15:65-72. [PMID: 29227712 DOI: 10.1080/15412555.2017.1401990] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In addition to dyspnea and fatigue, pain is a prevalent symptom in chronic obstructive pulmonary disease (COPD). Understanding the relative prevalence, magnitude, and interference with aspects of daily living of these symptoms can improve COPD management. Therefore, the purposes of this study were to: (1) compare the prevalence and magnitude of dyspnea, fatigue, and pain and how each limits aspects of daily living; (2) determine the association between pain and the other two symptoms; and (3) assess the impact of these symptoms on quality of life in COPD. Participants were recruited from pulmonary rehabilitation programs. Pain, dyspnea, and fatigue were measured using the Brief Pain Inventory (BPI), Brief Fatigue Inventory (BFI), and Dyspnea Inventory (DI), respectively. Quality of life was measured using the Clinical COPD Questionnaire (CCQ). The prevalence of dyspnea, fatigue, and pain were 93%, 77%, and 74%, respectively. Individuals with COPD reported similar severity scores of the three symptoms. Dyspnea interfered with general activity more than pain (F1.7,79.9 = 3.1, p < 0.05), whilst pain interfered with mood (F1.8, 82.7 = 3.6, p < 0.05) and sleep (F1,46 = 7.4, p < 0.01) more than dyspnea and fatigue. These three symptoms were moderately-to-highly correlated with each other (ρ = 0.49-0.78, p < 0.01) and all individually impacted quality of life. In summary, pain is a common symptom in addition to dyspnea and fatigue in COPD; all three interfere similarly among aspects of daily living with some exceptions. Accordingly, management of COPD should include a multifaceted approach that addresses pain as well as dyspnea and fatigue.
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Affiliation(s)
- Yi-Wen Chen
- a Department of Physical Therapy , University of British Columbia , Vancouver , BC Canada
| | - Pat G Camp
- b Department of Physical Therapy, and Centre for Heart Lung Innovation , University of British Columbia , Vancouver , BC Canada
| | - Harvey O Coxson
- c Department of Radiology, and Centre for Heart Lung Innovation , University of British Columbia , Vancouver , BC Canada
| | - Jeremy D Road
- d Division of Respiratory Medicine, Department of Medicine , University of British Columbia , Vancouver , BC Canada
| | - Jordan A Guenette
- b Department of Physical Therapy, and Centre for Heart Lung Innovation , University of British Columbia , Vancouver , BC Canada
| | - Michael A Hunt
- a Department of Physical Therapy , University of British Columbia , Vancouver , BC Canada
| | - W Darlene Reid
- e Department of Physical Therapy , University of Toronto , Toronto , ON Canada
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49
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Hatfield GL, Charlton JM, Cochrane CK, Hammond CA, Napier C, Takacs J, Krowchuk NM, Hunt MA. The Biomechanical Demands on the Hip During Progressive Stepping Tasks. J Strength Cond Res 2017; 31:3444-3453. [DOI: 10.1519/jsc.0000000000001756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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50
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Napier C, Esculier JF, Hunt MA. Gait retraining: out of the lab and onto the streets with the benefit of wearables. Br J Sports Med 2017; 51:1642-1643. [PMID: 29066433 DOI: 10.1136/bjsports-2017-098637] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Christopher Napier
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean-Francois Esculier
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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