Measures of movement and mobility used in clinical practice and research: a scoping review

OBJECTIVE

The first objective of this scoping review was to identify all the tools designed to measure movement or mobility in adults. The second objective was to compare the tools to the conceptual definitions of movement and mobility by mapping them to the International Classification of Functioning, Disability and Health (ICF).

INTRODUCTION

The concepts of movement and mobility are distinct concepts that are often conflated, and the differences are important to patient care. Movement is a change in the place or position of a part of the body or of the whole body. Mobility is derived from movement and is defined as the ability to move with ease. Researchers and clinicians, including nurses, physiotherapists, and occupational therapists who work with adults and in rehabilitation, need to be confident that they are measuring the outcome of interest.

INCLUSION CRITERIA

This scoping review considered studies that included participants who are adults, aged 19 and older, with any level of ability or disability. The concepts of interest were tools that measured movement or mobility relative to the human body. Studies were considered regardless of country of origin, health care setting, or sociocultural setting.

METHODS

CINAHL, Health and Psychosocial Instruments, MEDLINE, and Embase were searched in June 2018 and OpenGrey, Dissertation Abstracts International, and Google Scholar were searched in November 2018. The searches were limited to articles in English, and the date range was from the inception of the database to the current date. Data were extracted from the studies using a custom data extraction tool. Once tools were identified for analysis, they were coded using the table format developed by Cieza and colleagues.

RESULTS

There were 702 unique tools identified, with 651 of them available to be coded for the ICF. There were 385 ICF codes used when coding the tools. From these codes, the percentage of codes of the defining attributes of movement and mobility that were covered could be calculated, as well as the percentage of tool items that were linked to the antecedents, consequences, or defining attributes of movement or mobility.

CONCLUSIONS

Although there are many tools that measure only movement or mobility, there are many that measure a mixture of the defining attributes as well as the antecedents and consequences. The tool name alone should not be considered a guarantee of the concept measured, and tool selection should be done with a critical eye. This study provides a starting point from which clinicians and researchers can find tools that measure the concepts of movement and mobility of interest and importance to their patient population.

Relationship Between Lateral Patellar Stability Following Tibial Tubercle Osteotomy for Varying Patellofemoral Geometries

The geometry of the patellofemoral joint affects function and pathology. However, the impact of trochlear groove depth on treatments for patellar instability and pain is not clear. Tibial tubercle osteotomy is a common surgical intervention for patellar instability where the tibial insertion of the patellar tendon is translated to align the extensor mechanism and stabilize the joint. The aim of this work was to investigate the interaction between trochlear groove depth and patellar tendon insertion and their effect on patellar stability. Patellofemoral geometry was modified based on a statistical shape model to create knees with a range of trochlear groove depths. A Monte Carlo approach was used and 750 instances of a musculoskeletal model were generated with varying geometry and anterior and medial transfer of the patellar tendon. Stability was assessed by applying a lateral perturbation force to the patella during simulation of overground walking. In knees with deep trochlear grooves, a medialized patellar tendon increased stability. However, in knees with shallow trochlear grooves, stability was maximized for tendon insertion ~1 mm medial to its neutral location. This patellar tendon insertion also corresponded to the best alignment of the patella in the trochlear groove in these knees, indicating that good alignment may be important to maximizing stability. Anterior patellar tendon transfer had minimal effect on stability for all geometries. A better understanding of the effects of articular geometry and tubercle location on stability may aid clinicians in patient-specific surgical planning.

Immediate and short-term effects of gait retraining on the knee joint moments and symptoms in patients with early tibiofemoral joint osteoarthritis: a randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of a knee adduction moment (KAM) gait retraining in patients with early knee osteoarthritis up to 6 months post-training.

METHOD

We conducted a single blinded randomized controlled trial on a total of 23 patients with early knee osteoarthritis who were randomly allocated to the gait retraining group and walking exercise group. Twenty of them completed the corresponding training and the 6-month evaluation. We measured KAM, knee flexion moment (KFM) and western ontario and McMaster universities osteoarthritis index (WOMAC) osteoarthritis index before, immediate after, and 6 months after training. A repeated measures analysis of covariance (ANCOVA) was used to compare KAM, KFM and WOMAC osteoarthritis index scores across the three time points i.e., pre-training, post-training, and 6-month follow-up with gender, knee osteoarthritis severity, and pre-training KAM, KFM and WOMAC scores set as covariates. Post-hoc analyses were conducted when indicated.

RESULTS

Significant time × group interactions were found for both KAM and WOMAC osteoarthritis index scores (P < 0.002). No interaction was found for KFM (P = 0.123). KAM after gait retraining was significantly lower than the pre-training value (P < 0.001) and such effect was maintained at 6-month follow-up (P = 0.01). There was no significant difference in the KAM across time in the walking exercise group (P > 0.208). WOMAC osteoarthritis index score after training and score at the 6-month follow-up were significantly improved in the gait retraining group (P = 0.001), while the WOMAC osteoarthritis index score remained similar.

CONCLUSIONS

Gait retraining is an effective intervention to reduce KAM during walking and to improve the symptoms of patients with early knee osteoarthritis in short term.

Quantification of inertial sensor-based 3D joint angle measurement accuracy using an instrumented gimbal

This study quantified the accuracy of inertial sensors in 3D anatomical joint angle measurement with respect to an instrumented gimbal. The gimbal rotated about three axes and directly measured the angles in the ISB recommended knee joint coordinate system. Through the use of sensor attachment devices physically fixed to the gimbal, the joint angle estimation error due to sensor attachment (the inaccuracy of the sensor attachment matrix) was essentially eliminated, leaving only error due to the inertial sensors. The angle estimation error (RMSE) corresponding to the sensor was found to be 3.20° in flexion/extension, 3.42° in abduction/adduction and 2.88° in internal/external rotation. Bland-Altman means of maximum absolute value were -1.63° inflexion/extension, 3.22° in abduction/adduction and -2.61° in internal/external rotation. The magnitude of the errors reported in this study imply that even under ideal conditions irreproducible in human gait studies, inertial angle measurement will be subject to errors of a few degrees. Conversely, the reported errors are smaller than those reported previously in human gait studies, which suggest that the sensor attachment is also significant source of error in inertial gait measurement. The proposed apparatus and methodology could be used to quantify the performance of different sensor systems and orientation estimation algorithms, and to verify experimental protocols before human experimentation.

Accuracy of single-plane fluoroscopy in determining relative position and orientation of total knee replacement components

The accuracy of estimating the relative pose between knee replacement components, in terms of clinical motion, is important in the study of knee joint kinematics. The objective of this study was to determine the accuracy of the single-plane fluoroscopy method in calculating the relative pose between the femoral component and the tibial component, along knee motion axes, while the components were in motion relative to one another. The kinematics of total knee replacement components were determined in vitro using two simultaneous methods: single-plane fluoroscopic shape matching and an optoelectronic motion tracking system. The largest mean differences in relative pose between the two methods for any testing condition were 2.1°, 0.3°, and 1.1° in extension, abduction, and internal rotation respectively, and 1.3, 0.9, and 1.9 mm in anterior, distal, and lateral translations, respectively. For the optimized position of the components during dynamic trials, the limits of agreement, between which 95% of differences can be expected to fall, were -2.9 to 4.5° in flexion, -0.9 to 1.5° in abduction, -2.4 to 2.1° in external rotation, -2.0 to 3.9 mm in anterior-posterior translation, -2.2 to 0.4mm in distal-proximal translation and -7.2 to 8.6mm in medial-lateral translation. These mean accuracy values and limits of agreement can be used to determine whether the shape-matching approach using single-plane fluoroscopic images is sufficiently accurate for an intended motion tracking application.

A cadaver model evaluating femoral intramedullary reaming: a comparison between new reamer design (Pressure Sentinel) and a novel suction/irrigation reamer (RIA)

OBJECTIVE

To compare the intramedullary pressures developed during reaming of cadaveric femurs with the Synthes Reamer/Irrigator/Aspirator (RIA) reamer and the Zimmer Pressure Sentinel (PS) reamer, controlling for the force and speed of reaming.

METHOD

Fifteen matched pairs of frozen unpreserved femurs were used in the study. Two pressure transducers and two thermocouples were screwed into holes drilled into the femoral shaft. The femurs were stabilized in the vertical position by mechanically attaching them to a custom jig equipped with a load cell to detect the vertical component of force applied to the reamer. Proximally a linear voltage displacement transducer (LVDT) was attached to the reamer to record the continuous position of the reamer. All femurs were reamed to a diameter 2 mm larger than the narrowest point of the canal. Proximal and distal pressures, proximal and distal temperatures, applied vertical force and displacement were measured continuously throughout the reaming process. Maximum and minimum, and average proximal and distal pressures for each reamer were obtained and compared using paired t-tests. Averages were also calculated and compared in the same manner. A p-value of <0.05 was considered statistically significant.

RESULTS

The maximum, minimum and average intramedullary pressures during reaming were significantly lower with the RIA system than the PS reamer. In general, the pressures produced by the RIA system were consistently below atmospheric pressure for the majority of the reaming time. This was not true for the PS system. No appreciable temperature changes were observed during any of the trials.

CONCLUSION

The RIA reaming system significantly reduces the intramedullary pressures produced during the reaming process compared to the PS reaming system.

Pendulum-based method for determining the temporal accuracy of digital video-based motion capture systems

OBJECTIVE

To develop a simple method to determine the temporal accuracy of motion analysis systems incorporating commercial digital video cameras.

METHODS

A planar column pendulum with a natural frequency of 0.872 Hz was used to analyse five systems incorporating commercially available cameras and a single codec.

FINDING

The frame rate for each camera was measured to be within 3% of the US National Television Systems Committee (NTSC) broadcasting digital video standard of 29.97 fps; however some cameras produced a frame duplication artefact. Least squares curve-fitting using a sinusoidal function revealed RMS differences between 3-5% for angular position and 5-15% for angular speed compared to the captured motion data.

CONCLUSION

A simple method of evaluating temporal accuracy of a digital-based motion capturing system is demonstrated and it is shown that some digital-video cameras and computer playback software contain data compression technology that may produce substantial temporal frame inaccuracies in recovered video sequences. The results indicate that temporal accuracy should be evaluated in digital-based human motion analysis systems prior to their use in experimentation.

Muscle co-activation patterns during walking in those with severe knee osteoarthritis

BACKGROUND

Sensory and motor impairments have been found for those with knee osteoarthritis; however, how these impairments are manifested during functional movements such as walking is not well established. A few studies suggest an increase in co-activity among lower limb muscles. The objective of this study was to characterize the neuromuscular patterns of knee joint muscles during walking for those with severe knee osteoarthritis using pattern recognition techniques on the entire waveform.

METHODS

Fifty-one subjects received a gait assessment within one-week prior to total knee replacement surgery. Subjects walked along a 6-m walkway at their preferred walking speed while surface electromyograms from seven muscles were recorded. The electromyographic data were entered into a pattern recognition procedure that captured both the amplitude and shape characteristics of electromyographic waveforms. ANOVA models tested whether differences existed both among and within muscle groups for these waveform characteristics.

FINDINGS

Four principal patterns explained 97% of the variance in the waveform data, with principal pattern one explaining 86% of the total variance. There were statistically significant differences (P<0.05) among muscle sites for all principal pattern scores. The analyses supported the hypothesis that similarities existed in patterns among muscles from different groups indicating (i) a general co-activity pattern and (ii) differential recruitment between muscles within a muscle group.

INTERPRETATION

In addition to the roles during impact loading and propulsion, the muscle responses were consistent with attempts to (i) decrease medial knee joint loading, (ii) decrease peak knee joint loading during push off and (iii) increase stiffness during stance phase to improve joint stability. The technique employed provides a novel approach to quantify synergistic co-activity.

Effects of pelvic asymmetry and low back pain on trunk kinematics during sitting: a comparison with standing

STUDY DESIGN

A prospective study was conducted on a group of patients with unilateral nonspecific low back pain (LBP) and healthy controls.

OBJECTIVES

To answer 3 questions: (1) Does pelvic asymmetry measured in standing affect the dynamics of motion performed in sitting? (2) Do patients with LBP perform trunk motions differently from non-LBP participants in sitting position? and (3) Do the kinematics of lateral flexion and axial rotation differ between sitting and standing positions?

SUMMARY OF BACKGROUND DATA

The effect of pelvic asymmetry on trunk motion while sitting remains unclear. LBP has been associated with altered trunk kinematics in standing; however, there is limited information available describing trunk kinematics in sitting position in comparison to standing.

METHODS

Pelvic asymmetry was measured in 54 patients with unilateral nonspecific LBP and 59 control subjects. A motion-analysis system was used to test the range and symmetry of lateral flexion and axial rotation in sitting and standing positions. Bivariate correlations, regression, multivariate analysis of variance, and paired sample t tests were used to test for associations between variables and differences between groups.

RESULTS

We found significant: (1) correlations between pelvic asymmetry and asymmetric trunk motion performed in sitting, (2) differences between the LBP and control groups in patterns of trunk motion performed in a sitting posture, and (3) differences between kinematics of motions performed in sitting versus standing postures.

CONCLUSIONS

This study shows a link between pelvic asymmetry and altered trunk motion in sitting position. We suggest that people with LBP may have a distinct compensatory mechanism, secondary to pelvic asymmetry, which puts the lumbar spine under higher stress. Movement asymmetry, rather than range of motion, may be a better indicator of disturbed function for people with LBP. Structural and functional asymmetries are factors that may be considered in the seating design and work environment.

Effects of pelvic skeletal asymmetry on trunk movement: three-dimensional analysis in healthy individuals versus patients with mechanical low back pain

STUDY DESIGN

Comparative analysis and correlational research design were used to investigate the association between anthropometry and biomechanical performance among asymptomatic subjects and patients with low back pain (LBP).

OBJECTIVES

To examine the association between pelvic asymmetry and patterns of trunk motion in asymptomatic and LBP subjects. Secondary objective was to investigate the association between restricted trunk motion, laterality of referred pain, and pelvic asymmetry.

SUMMARY OF BACKGROUND DATA

Subtle pelvic asymmetry (exhibited as either lateral pelvic tilt or iliac rotational asymmetry), which is common among normal individuals, has not been convincingly linked to abnormalities in back movements. Given the difficulty in diagnosing most LBP, a classification using pelvic asymmetry and patterns of movement could be helpful in establishing a rational treatment plan.

METHODS

Fifty-nine subjects with no history of LBP and 54 patients with mechanical unilateral LBP were tested. An anthropometric frame was used to measure pelvic asymmetry in standing. Dynamic motion data, comprised of the principal and coupled movements, were collected using the Qualysis Motion Capture System.

RESULTS

While the groups did not differ in the total range of lumbar movement, the LBP group exhibited significantly higher asymmetry in the principal motion. The groups differed significantly in the pattern of coupled rotation during lateral flexion. Asymmetry in lumbar lateral flexion was highly related to two types of pelvic asymmetry: lateral pelvic tilt (LPT) and iliac rotation asymmetry (IRA). Asymmetry in lumbar axial rotation was highly related to IRA but weakly related to LPT.

CONCLUSIONS

This study demonstrates objective differences in patterns of lumbar movement between asymptomatic subjects and patients with LBP. The study also demonstrates that subtle anatomic abnormality in the pelvis is associated with altered mechanics in the lumbar spine. We suggest that asymmetry of lumbar movement may be a better indicator of functional deficit than the absolute range of movement in LBP.