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Buist BD, Kramer BE, Wright KE, Edwards PK, Petrofes AM, Furzer BJ. "It's a Very Good Second Option": Older Adults' Experience of Telehealth. J Phys Act Health 2024:1-7. [PMID: 38684218 DOI: 10.1123/jpah.2023-0176] [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] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 02/14/2024] [Accepted: 03/04/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION The growing ability to provide online services has enabled the proliferation of exercise-based telehealth interventions; however, adoption in older adults may be impacted by low digital literacy and "technophobia." OBJECTIVES The aim of this study was to explore the experience of community and aged-care dwelling older adults following exercise-based telehealth services to provide insights that could guide future telehealth exercise delivery. DESIGN Semi-structured interviews for qualitative analysis. METHODS Participants (age ≥60) who had completed at least one online exercise session from a registered health professional were recruited through a combination of purposeful and snowball sampling methods via their exercise facility or provider. A semi-structured interview guide was used by 2 interviewers to investigate participants' experiences and a "critical friends" approach used to identify common themes. RESULTS Thirteen interviews with 21 participants were conducted from 2 different facilities. Analysis identified meaning units within 3 themes and subthemes. Technology subthemes related to digital confidence prior to telehealth and changes during interventions, as well as the usability of technology for telehealth. Clinical practice subthemes described the different motivations to exercise, perceived benefits of telehealth, important implications for practitioners, and perceptions of safety. The social connection theme related to the social benefits of telehealth. CONCLUSIONS Older adults in our sample were technologically confident and capable of performing exercise sessions delivered via telehealth. They notice benefits from this form of exercise delivery however, prefer face-to-face exercise delivery.
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Affiliation(s)
- Brett D Buist
- School of Human Sciences (Exercise & Sport Science), The University of Western Australia, Crawley, WA, Australia
| | - Ben E Kramer
- School of Human Sciences (Exercise & Sport Science), The University of Western Australia, Crawley, WA, Australia
| | - Kemi E Wright
- School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Peter K Edwards
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Alyssa M Petrofes
- School of Human Sciences (Exercise & Sport Science), The University of Western Australia, Crawley, WA, Australia
| | - Bonnie J Furzer
- School of Human Sciences (Exercise & Sport Science), The University of Western Australia, Crawley, WA, Australia
- Fremantle Hospital Mental Health Service, South Metropolitan Health Service, Perth, WA, Australia
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Edwards PK, Kwong PWH, Ackland T, Wang A, Donnelly CJ, Ebert JR. Electromyographic Evaluation of Early-Stage Shoulder Rehabilitation Exercises Following Rotator Cuff Repair. Int J Sports Phys Ther 2021; 16:1459-1469. [PMID: 34909253 PMCID: PMC8637301 DOI: 10.26603/001c.29513] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Electromyography (EMG) is frequently used as a guide for exercise rehabilitation progression following rotator cuff repair. Knowledge of EMG activity during passive and active-assisted exercises may help guide clinicians when considering exercise prescription in the early post-operative period. PURPOSE The purpose of this study was to investigate EMG activity of the rotator cuff and deltoid musculature during passive and active-assisted shoulder range of motion (ROM) exercises commonly performed in post-operative rehabilitation. STUDY DESIGN Descriptive cohort laboratory study using healthy subjects. METHODS In sixteen active healthy volunteers, surface and fine-wire EMG activity was measured in the supraspinatus, infraspinatus, subscapularis, and anterior, middle and posterior deltoid muscles during eight common ROM exercises. Mean %MVIC values and 95% confidence intervals were used to rank exercises from the least to the most amount of muscular activity generated during the exercises. RESULTS Standard pendulum exercises generated low levels of EMG activity in the supraspinatus and infraspinatus (≤15% MVIC), while active-assisted table slides, and the upright wall slide generated low levels of EMG activity in only the supraspinatus. No exercises were found to generate low levels of muscular activation (≤15% MVIC) in the subscapularis. CONCLUSION This study found no clear distinctions between the EMG activity of the supraspinatus or the infraspinatus occurring during common passive and active-assisted ROM exercises. Subdividing ROM exercises based on muscle activity, may not be necessary to guide progression of exercises prior to commencing active motion after rotator cuff repair. LEVEL OF EVIDENCE Level 3b.
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Affiliation(s)
- Peter K Edwards
- School of Human Sciences, University of Western Australia; School of Physiotherapy and Exercise Science, Curtin University
| | | | | | - Allan Wang
- Department of Orthopaedic Surgery, The University of Western Australia; Murdoch Centre of Orthopaedic Research
| | - Cyril J Donnelly
- School of Human Sciences, University of Western Australia; Rehabilitation Research Institute of Singapore, Nanyang Technological University
| | - Jay R Ebert
- School of Human Sciences, University of Western Australia
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Edwards PK, Ebert JR, Joss B, Ackland T, Wang A. A randomised trial comparing two rehabilitation approaches following reverse total shoulder arthroplasty. Shoulder Elbow 2021; 13:557-572. [PMID: 34659491 PMCID: PMC8512973 DOI: 10.1177/1758573220937394] [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: 01/05/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rehabilitation contributes to post-operative success following reverse total shoulder arthroplasty; however, randomised trials comparing the effectiveness of rehabilitation following reverse total shoulder arthroplasty are lacking. This study sought to determine if early, active mobilisation targeting the deltoid and the external rotator muscles, would exhibit greater improvements in post-operative outcomes compared to a delayed and deltoid-focused mobilisation programme. METHODS Patients scheduled for reverse total shoulder arthroplasty were randomly assigned to either an early active or delayed active rehabilitation group. Patient-reported outcomes for pain and function were assessed pre-surgery and at 3, 6 and 12 months post-surgery. Objective measures (Constant Score, range of motion, isometric strength) were assessed at 3, 6 and 12 months post-surgery. RESULTS Sixty-one patients (63 shoulders) underwent reverse total shoulder arthroplasty. There were no significant interaction effects or between-group differences for any patient-reported outcomes or objective measures at 3, 6 or 12 months post-surgery. However, significantly better (p = 0.019) active arm flexion was observed in the early active group at three months post-surgery. Significantly more patients in the early active group reported improvement in patient-reported function that reached minimal clinically important difference from three to six months post-surgery (p = 0.016). CONCLUSION Early, active rehabilitation after reverse total shoulder arthroplasty is safe and effective, and may have early clinical benefits over a conservative, delayed mobilisation programme. LEVEL OF EVIDENCE Therapy, level 1b. Trial registered 15 June 2016 at www.anzctr.org.au (ACTRN12616000779471).
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Affiliation(s)
- Peter K Edwards
- School of Human Sciences, University of
Western Australia, Perth, Australia,School of Physiotherapy and Exercise
Science, Curtin University, Perth, Australia,Peter K Edwards, Curtin University, Building
408, Brand Drive Bentley, Western Australia 6102, Australia.
| | - Jay R Ebert
- School of Human Sciences, University of
Western Australia, Perth, Australia
| | - Brendan Joss
- School of Human Sciences, University of
Western Australia, Perth, Australia
| | - Timothy Ackland
- School of Human Sciences, University of
Western Australia, Perth, Australia
| | - Allan Wang
- Department of Orthopaedic Surgery, The
University of Western Australia, Perth, Australia,Murdoch Centre of Orthopaedic Research,
Murdoch, Australia
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Edwards PK, Ebert JR, Morrow MM, Goodwin BM, Ackland T, Wang A. Accelerometry evaluation of shoulder movement and its association with patient-reported and clinical outcomes following reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:2308-2318. [PMID: 32669199 DOI: 10.1016/j.jse.2020.03.030] [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: 11/20/2019] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Accelerometers provide a new method to objectively measure recovery of movement and physical activity in patients following reverse total shoulder arthroplasty (RTSA) and may overcome common limitations associated with patient-reported outcome measures (PROMs). The aim of this study was to assess changes in upper limb movement using accelerometers following RTSA and investigate their association with other clinical outcome measures. METHODS Thirty-six patients who underwent RTSA wore accelerometers on both wrists and arms for 3 days at 3, 6, and 12 months postsurgery. PROMs (Constant score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, visual analog scale for pain, Single Assessment Numerical Evaluation, Shoulder Activity Level) and isometric shoulder strength were also assessed. Accelerometer outcomes were calculated to quantify counts of forearm and arm activity and the contribution of both arms to activity (limb symmetry and magnitude ratio). Changes and differences in all clinical measures and objective movement measures were evaluated with within-subjects analysis of variance. Correlations between limb activity and other clinical measures were investigated using Spearman correlation coefficients. RESULTS Objective movement of the operated arm increased from 3-6 months postsurgery (P = .004), but not from 6-12 months (P = .240). Limb asymmetries were observed at 3 and 6 months and improved by 12 months postsurgery. No associations were demonstrated between PROMs and objective upper limb movement at 12 months postsurgery. DISCUSSION Despite early recovery of function and pain relief assessed by PROMs, objective movement using accelerometers showed delayed recovery of the operated arm postoperatively, before normalizing by 12 months postsurgery. Accelerometers provide a unique insight into functional recovery following RTSA.
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Affiliation(s)
- Peter K Edwards
- School of Human Sciences, University of Western Australia, Perth, WA, Australia; School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.
| | - Jay R Ebert
- School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - Melissa M Morrow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Brianna M Goodwin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Timothy Ackland
- School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - Allan Wang
- Department of Orthopaedic Surgery, University of Western Australia, Perth, WA, Australia; Murdoch Centre of Orthopaedic Research, Murdoch, WA, Australia
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Edwards PK, Ebert JR, Littlewood C, Ackland T, Wang A. Effectiveness of formal physical therapy following total shoulder arthroplasty: A systematic review. Shoulder Elbow 2020; 12:136-143. [PMID: 32313563 PMCID: PMC7153202 DOI: 10.1177/1758573218812038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/27/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Physical therapy is considered routine practice following total shoulder arthroplasty. To date, current regimens are based on clinical opinion, with evidence-based recommendations. The aim of this systematic review was to evaluate the effectiveness of total shoulder arthroplasty physical therapy programmes with a view to inform current clinical practice, as well as to develop a platform upon which future research might be conducted. METHODS An electronic search of MEDLINE, EMBASE, CINAHL and Cochrane Library to March 2018 was complemented by hand and citation-searching. Studies were selected in relation to pre-defined criteria. A narrative synthesis was undertaken. RESULTS A total of 506 papers were identified in the electronic database search, with only one study showing moderate evidence of early physical therapy promoting a more rapid return of short-term improvement in function and pain. No studies evaluated the effectiveness of physical therapy programmes in reverse total shoulder arthroplasty procedures. DISCUSSION Restoring range of motion and strength following total shoulder arthroplasty is considered important for patients to obtain a good outcome post-surgery and, when applied early, may offer more rapid recovery. Given the rising incidence of total shoulder arthroplasties, especially reverse total shoulder arthroplasty, there is an urgent need for high-quality, adequately powered randomised controlled trials to determine the effectiveness of rehabilitation programmes following these surgeries.
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Affiliation(s)
- Peter K Edwards
- School of Human Sciences, University of Western Australia, Perth, Australia,Peter K Edwards, School of Human Sciences (M408), University of Western Australia, 35 Stirling Highway, Crawley 6009, Western Australia, Australia.
| | - Jay R Ebert
- School of Human Sciences, University of Western Australia, Perth, Australia
| | - Chris Littlewood
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele Clinical Trials Unit, David Weatherall Building, Keele University, Keele, UK
| | - Tim Ackland
- School of Human Sciences, University of Western Australia, Perth, Australia
| | - Allan Wang
- School of Human Sciences, University of Western Australia, Perth, Australia,Department of Orthopaedic Surgery, University of Western Australia, Perth, Australia,St John of God Hospital, Subiaco, Perth, Australia
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Fletcher JG, DeLone DR, Kotsenas AL, Campeau NG, Lehman VT, Yu L, Leng S, Holmes DR, Edwards PK, Johnson MP, Michalak GJ, Carter RE, McCollough CH. Evaluation of Lower-Dose Spiral Head CT for Detection of Intracranial Findings Causing Neurologic Deficits. AJNR Am J Neuroradiol 2019; 40:1855-1863. [PMID: 31649155 DOI: 10.3174/ajnr.a6251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/21/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Despite the frequent use of unenhanced head CT for the detection of acute neurologic deficit, the radiation dose for this exam varies widely. Our aim was to evaluate the performance of lower-dose head CT for detection of intracranial findings resulting in acute neurologic deficit. MATERIALS AND METHODS Projection data from 83 patients undergoing unenhanced spiral head CT for suspected neurologic deficits were collected. Cases positive for infarction, intra-axial hemorrhage, mass, or extra-axial hemorrhage required confirmation by histopathology, surgery, progression of findings, or corresponding neurologic deficit; cases negative for these target diagnoses required negative assessments by two neuroradiologists and a clinical neurologist. A routine dose head CT was obtained using 250 effective mAs and iterative reconstruction. Lower-dose configurations were reconstructed (25-effective mAs iterative reconstruction, 50-effective mAs filtered back-projection and iterative reconstruction, 100-effective mAs filtered back-projection and iterative reconstruction, 200-effective mAs filtered back-projection). Three neuroradiologists circled findings, indicating diagnosis, confidence (0-100), and image quality. The difference between the jackknife alternative free-response receiver operating characteristic figure of merit at routine and lower-dose configurations was estimated. A lower 95% CI estimate of the difference greater than -0.10 indicated noninferiority. RESULTS Forty-two of 83 patients had 70 intracranial findings (29 infarcts, 25 masses, 10 extra- and 6 intra-axial hemorrhages) at routine head CT (CT dose index = 38.3 mGy). The routine-dose jackknife alternative free-response receiver operating characteristic figure of merit was 0.87 (95% CI, 0.81-0.93). Noninferiority was shown for 100-effective mAs iterative reconstruction (figure of merit difference, -0.04; 95% CI, -0.08 to 0.004) and 200-effective mAs filtered back-projection (-0.02; 95% CI, -0.06 to 0.02) but not for 100-effective mAs filtered back-projection (-0.06; 95% CI, -0.10 to -0.02) or lower-dose levels. Image quality was better at higher-dose levels and with iterative reconstruction (P < .05). CONCLUSIONS Observer performance for dose levels using 100-200 eff mAs was noninferior to that observed at 250 effective mAs with iterative reconstruction, with iterative reconstruction preserving noninferiority at a mean CT dose index of 15.2 mGy.
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Affiliation(s)
- J G Fletcher
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - D R DeLone
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - A L Kotsenas
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - N G Campeau
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - V T Lehman
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - L Yu
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - S Leng
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - D R Holmes
- Biomedical Imaging Resource (D.R.H., P.E.)
| | | | - M P Johnson
- Biomedical Statistics and Informatics (M.P.J.), Mayo Clinic, Rochester, Minnesota
| | - G J Michalak
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - R E Carter
- Health Sciences Research (R.E.C.), Mayo Clinic, Jacksonville, Florida
| | - C H McCollough
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
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Ebert JR, Webster KE, Edwards PK, Joss BK, D'Alessandro P, Janes G, Annear P. Current perspectives of Australian therapists on rehabilitation and return to sport after anterior cruciate ligament reconstruction: A survey. Phys Ther Sport 2018; 35:139-145. [PMID: 30557764 DOI: 10.1016/j.ptsp.2018.12.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 08/02/2018] [Revised: 12/07/2018] [Accepted: 12/08/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate views and practices of Australian therapists on rehabilitation and return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR). DESIGN Survey-based study. SETTING Online survey platform. PARTICIPANTS Australian Physiotherapists and Accredited Exercise Physiologists (n = 223). MAIN OUTCOME MEASURES 1) perceived benefit, timing and frequency of rehabilitation, 2) timing of RTS and information on RTS evaluation and discharge criteria. RESULTS Therapists preferred to consult patients for the first time at 1-4 days (27.8%), ≤7 days (25.6%) or 7-14 days (30.5%) post-surgery. Within the first 6 weeks, 82.1% of therapists preferred patient visitation 1-2 times per week. Between 3 and 6 months, therapists mainly recommended less frequent visitation with a focus on home exercises. While 22.0% and 53.8% of therapists were willing to discharge patients for sport at 6-9 and 9-12 months, respectively, 22.9% preferred 12-18 months. Common RTS considerations were functional capacity (98.7%), strength (87.0%), lower limb and trunk mechanics (96.0%) and psychological readiness (87.9%). Knee strength was evaluated via manual muscle testing (33.0%), hand held (26.7%) and isokinetic (11.8%) dynamometry. For functional evaluation, 84.3% of therapists employed a hop battery (≥2 hop tests). CONCLUSIONS This survey revealed variation in beliefs and practices surrounding rehabilitation and RTS evaluation in Australian therapists.
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Western Australia, Australia; HFRC Rehabilitation Clinic, Nedlands, Western Australia, Australia.
| | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Peter K Edwards
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Western Australia, Australia; HFRC Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Brendan K Joss
- HFRC Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Peter D'Alessandro
- Coastal Orthopaedics, Bethesda Hospital, Claremont, Western Australia, Australia
| | - Greg Janes
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
| | - Peter Annear
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
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Edwards PK, Ebert JR, Joss B, Ackland T, Annear P, Buelow JU, Hewitt B. Patient Characteristics and Predictors of Return to Sport at 12 Months After Anterior Cruciate Ligament Reconstruction: The Importance of Patient Age and Postoperative Rehabilitation. Orthop J Sports Med 2018; 6:2325967118797575. [PMID: 30263898 PMCID: PMC6149022 DOI: 10.1177/2325967118797575] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 01/25/2023] Open
Abstract
Background: Preventing and mitigating the risk of reinjury after anterior cruciate
ligament reconstruction (ACLR) rest on variables including age, surgical
restoration of knee stability, adequate physical function, and thorough and
complete postoperative rehabilitation, but to what degree these factors
influence return to sport is unclear. Purpose: To investigate factors predictive of return to sport 12 months after ACLR.
The factors specifically evaluated were strength, hop function,
self-reported knee function, patient age, and quality of postoperative
rehabilitation. Study Design: Case-control study; Level of evidence, 3. Methods: This study evaluated 113 patients approximately 12 months after ACLR using a
rehabilitation grading tool, the subjective International Knee Documentation
Committee (IKDC) form, and a return-to-sport battery consisting of maximal
isokinetic quadriceps and hamstring strength and 4 functional hop tests.
Mann-Whitney U tests and chi-square analyses were used to
determine differences between patients who had or had not returned to sport.
A subsequent binary logistic hierarchical regression determined the factors
predictive of a patient’s return to sport. In those patients who had
returned to sport, relationships between either age or level of
rehabilitation and passing the return-to-sport battery were also
investigated. Results: Complete rehabilitation (adjusted odds ratio [OR], 7.95; P =
.009), age ≤25 years (adjusted OR, 3.84; P = .024), and
higher IKDC scores (P < .001) were predictive of return
to sport at 12 months. In participants who had returned to sport, 21% passed
the return-to-sport battery compared with only 5% who did not. Of those who
had returned to sport, 37% who underwent complete rehabilitation passed the
return-to-sport battery as opposed to 5% who underwent incomplete
rehabilitation. In patients aged ≤25 years, only 48% underwent complete
rehabilitation, despite having returned to sport. Additionally, in this
group of patients, 40% underwent complete rehabilitation and passed the
physical performance battery as opposed to only 4% who did not undergo
complete rehabilitation. Conclusion: Younger patients and higher subjective IKDC scores were predictive of return
to sport. Patients who completed 6 months of rehabilitation incorporating
jumping and agility tasks had a higher rate of return to sport, suggesting
that postoperative rehabilitation is important in predicting return to
sport. Specialists and physical therapists alike should stress the
importance of thorough postoperative rehabilitation and adequate
neuromuscular strength and function to patients whose goals are to return to
sport.
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Affiliation(s)
- Peter K Edwards
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia.,Hollywood Functional Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Jay R Ebert
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia.,Hollywood Functional Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Brendan Joss
- Hollywood Functional Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Timothy Ackland
- Hollywood Functional Rehabilitation Clinic, Nedlands, Western Australia, Australia
| | - Peter Annear
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
| | - Jens-Ulrich Buelow
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
| | - Ben Hewitt
- Orthology, West Perth, Western Australia, Australia
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Ebert JR, Edwards PK, Fallon M, Ackland TR, Janes GC, Wood DJ. Two-Year Outcomes of a Randomized Trial Investigating a 6-Week Return to Full Weightbearing After Matrix-Induced Autologous Chondrocyte Implantation. Am J Sports Med 2017; 45:838-848. [PMID: 27881381 DOI: 10.1177/0363546516673837] [Citation(s) in RCA: 23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated encouraging outcomes in treating patients with knee cartilage defects. Postoperatively, the time required to attain full weightbearing (WB) remains conservative. HYPOTHESIS We hypothesized that patients would have no significant clinical or radiological differences or graft complications after an 8-week or 6-week return to full WB after MACI. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 37 knees (n = 35 patients) were randomly allocated to either an 8-week return to full WB that we considered current best practice based on the existing literature (CR group; n = 19 knees) or an accelerated 6-week WB approach (AR group; n = 18 knees). Patients were evaluated preoperatively and at 1, 2, 3, 6, 12, and 24 months after surgery, using the Knee Injury and Osteoarthritis Outcome Score, 36-Item Short Form Health Survey, visual analog pain scale, 6-minute walk test, and active knee range of motion. Isokinetic dynamometry was used to assess peak knee extension and flexion strength and limb symmetry indices (LSIs) between the operated and nonoperated limbs. Magnetic resonance imaging (MRI) was undertaken to evaluate the quality and quantity of repair tissue as well as to calculate an MRI composite score. RESULTS Significant improvements ( P < .05) were observed in all subjective scores, active knee flexion and extension, 6-minute capacity, peak knee extensor torque in the operated limb, and knee extensor LSI, although no group differences existed. Although knee flexor LSIs were above 100% for both groups at 12 and 24 months after surgery, LSIs for knee extensor torque at 24 months were 93.7% and 87.5% for the AR and CR groups, respectively. The MRI composite score and pertinent graft parameters significantly improved over time ( P < .05), with some superior in the AR group at 24 months. All patients in the AR group (100%) demonstrated good to excellent infill at 24 months, compared with 83% of patients in the CR group. Two cases of graft failure were observed, both in the CR group. At 24 months, 83% of patients in the CR group and 88% in the AR group were satisfied with the results of their MACI surgery. CONCLUSION Patients in the AR group who reduced the length of time spent ambulating on crutches produced comparable outcomes up to 24 months, without compromising graft integrity.
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Affiliation(s)
- Jay R Ebert
- School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Australia
| | - Peter K Edwards
- School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Australia
| | | | - Timothy R Ackland
- School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Australia
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Australia
| | - David J Wood
- School of Surgery (Orthopaedics), University of Western Australia, Crawley, Australia
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Edwards PK, Ackland TR, Ebert JR. Accelerated weightbearing rehabilitation after matrix-induced autologous chondrocyte implantation in the tibiofemoral joint: early clinical and radiological outcomes. Am J Sports Med 2013; 41:2314-24. [PMID: 23880403 DOI: 10.1177/0363546513495637] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Matrix-induced autologous chondrocyte implantation (MACI) has become an established technique for the repair of full-thickness chondral defects in the knee, although best patient outcomes appear limited by a lack of evidence-based knowledge on how to progressively increase postoperative weightbearing (WB) and rehabilitation exercises. HYPOTHESIS To determine the safety and efficacy of an accelerated WB regimen after MACI in the tibiofemoral joint. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Clinical and radiological assessments were performed in 28 knees at 12 months after MACI to the medial or lateral femoral condyle. Both rehabilitation interventions sought to protect the implant for an initial period and then incrementally increase load bearing. Under the "accelerated" (AR) protocol, patients reached full WB at 6 weeks after surgery compared with 8 weeks for what was considered to be the current "best practice" (CR) WB regimen based on previous research. Assessments included the Knee Injury and Osteoarthritis Outcome Score (KOOS), 36-Item Short Form Health Survey (SF-36), visual analog scale, 6-minute walk test, and active knee range of motion (ROM). High-resolution magnetic resonance imaging (MRI) was used to describe the quality and quantity of repair tissue via the assessment of pertinent parameters of graft repair as well as an MRI composite score. RESULTS Patients in both groups demonstrated significant improvement (P < .05) in all clinical measures over the preoperative and postoperative timeline from before surgery to 12 months after surgery. The AR group reported significantly better (P < .05) SF-36 physical component scores at 8 weeks and significantly greater (P < .05) KOOS quality of life scores at 6 and 12 months postoperatively. Although no differences (P > .05) were observed between the 2 groups for active knee ROM, the AR group did achieve full active knee extension as early as 4 weeks compared with the CR group at 12 weeks. There was no difference (P > .05) in graft quality as assessed by MRI (MOCART composite score: AR, 3.34; CR, 3.04), with no patients suffering any adverse effects from the implant up to 12 months, regardless of the rehabilitation protocol employed. CONCLUSION The AR approach that reduced the length of time spent ambulating on crutches resulted in improved general physical function and quality of life and an earlier attainment of full active knee extension when compared with the CR approach. There were no graft complications ascertained through MRI. This regimen appears safe and may potentially speed up the recovery of normal gait function. A larger patient cohort and follow-up are required to observe long-term graft outcomes.
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Affiliation(s)
- Peter K Edwards
- Peter K. Edwards, School of Sport Science, Exercise and Health (M408 The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia. )
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Ebert JR, Smith A, Edwards PK, Hambly K, Wood DJ, Ackland TR. Factors predictive of outcome 5 years after matrix-induced autologous chondrocyte implantation in the tibiofemoral joint. Am J Sports Med 2013; 41:1245-54. [PMID: 23618699 DOI: 10.1177/0363546513484696] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Matrix-induced autologous chondrocyte implantation (MACI) has become an established technique for the repair of full-thickness chondral defects in the knee. However, little is known about what variables most contribute to postoperative clinical and graft outcomes as well as overall patient satisfaction with the surgery. PURPOSE To estimate the improvement in clinical and radiological outcomes and investigate the independent contribution of pertinent preoperative and postoperative patient, chondral defect, injury/surgery history, and rehabilitation factors to clinical and radiological outcomes, as well as patient satisfaction, 5 years after MACI. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study was undertaken in 104 patients of an eligible 115 patients who were recruited with complete clinical and radiological follow-up at 5 years after MACI to the femoral or tibial condyles. After a review of the literature, a range of preoperative and postoperative variables that had demonstrated an association with postoperative clinical and graft outcomes was selected for investigation. These included age, sex, and body mass index; preoperative 36-item Short Form Health Survey (SF-36) mental component score (MCS) and physical component score (PCS); chondral defect size and location; duration of symptoms and prior surgeries; and postoperative time to full weightbearing gait. The sport and recreation (sport/rec) and knee-related quality of life (QOL) subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used as the patient-reported clinical evaluation tools at 5 years, while high-resolution magnetic resonance imaging (MRI) was used to evaluate graft assessment. An MRI composite score was calculated based on the magnetic resonance observation of cartilage repair tissue score. A patient satisfaction questionnaire was completed by all patients at 5 years. Regression analysis was used to investigate the contribution of these pertinent variables to 5-year postoperative clinical, radiological, and patient satisfaction outcomes. RESULTS Preoperative MCS and PCS and duration of symptoms contributed significantly to the KOOS sport/rec score at 5 years, while no variables, apart from the baseline KOOS QOL score, contributed significantly to the KOOS QOL score at 5 years. Preoperative MCS, duration of symptoms, and graft size were statistically significant predictors of the MRI score at 5 years after surgery. An 8-week postoperative return to full weightbearing (vs 12 weeks) was the only variable significantly associated with an improved level of patient satisfaction at 5 years. CONCLUSION This study outlined factors such as preoperative SF-36 scores, duration of knee symptoms, graft size, and postoperative course of weightbearing rehabilitation as pertinent variables involved in 5-year clinical and radiological outcomes and overall satisfaction. This information may allow orthopaedic surgeons to better screen their patients as good candidates for MACI, while allowing treating therapists to better individualize their preoperative preparatory and postoperative rehabilitation regimens for a best possible outcome.
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Affiliation(s)
- Jay R Ebert
- School of Sport Science, Exercise and Health (M408 The University of Western Australia, 35 Stirling Highway, Crawley, 6009 WA, Australia.
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Tipton CM, Sebastian LA, Edwards PK, Moran MM. Influence of simulated microgravity on the exercise performance of Fischer 344 rats. J Gravit Physiol 2001; 2:P62-3. [PMID: 11538935] [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] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Measurements from mission specialists after space flights or from subjects subjected to head down tilt experiments have demonstrated a decrease in exercise performance. Similar decreases have been reported for rats that have participated in simulated microgravity studies using the head down-tail suspended method of Morey-Holton (HDS). Because it is unclear whether older animal populations would exhibit similar responses, we undertook a HDS study with Fischer 344 male rats.
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Affiliation(s)
- C M Tipton
- Exercise & Sport Sciences, The University of Arizona, Tucson 85721, USA
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Eidsmoe DC, Edwards PK. Sex, lies, and insurance coverage? Insurance carrier coverage defenses for sexually transmitted disease claims. Tort Insur Law J 2001; 34:921-48. [PMID: 11475506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- D C Eidsmoe
- Country Mutual Insurance, Bloomington, Illinois, USA
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Edwards PK. [Communicating with English-speaking patients]. Rev Enferm 1990; 13:49-50. [PMID: 2277905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Edwards PK, Jones JA, Edwards JN. The social demography of shared housing. J Aust Popul Assoc 1986; 3:130-43. [PMID: 12268181 DOI: 10.1007/bf03029480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
"Despite the prevalence of shared housing in Australia, almost one-third of all households, little is known about who are the people who share accommodation, and why they do so. Using a sample of 4,560 households, this paper presents a demographic profile of shared dwellings and tests some of the prevailing assumptions about why certain groups may have a propensity to share. Some of the implications of the findings for existing housing policies are pointed out and directions for future research are suggested."
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Edwards PK, Ballweg JA. Predictors of family planning approval and adoption. Fam Plann Resume 1978; 2:215-23. [PMID: 12309777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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