Exercise- and education-based prehabilitation before total knee arthroplasty: a pilot study

OBJECTIVE

To determine the feasibility and estimates of effects of a supervised exercise- and education-based prehabilitation programme aiming to improve knee functioning compared with usual care in patients awaiting total knee arthroplasty.

DESIGN

A randomized controlled pilot study.

SUBJECTS

Patients receiving primary, unilateral total knee arthroplasty.

METHODS

Patients randomized to the intervention group participated in a personalized 4-8-week prehabilitation programme before surgery. Feasibility of the intervention and self-reported knee functioning, pain, physical performance and hospital stay were assessed at baseline, immediately preoperatively, 6 and 12 weeks after surgery.

RESULTS

Twenty patients (mean age 72.7±5.95 years) were enrolled in this study. The personalized prehabilitation programme was found to be feasible and safe, with an exercise adherence of 90%. Significant medium interaction effects between groups and over time favouring prehabilitation were reported for the sport subscale of the Knee Osteoarthritis Outcome Score (F(3/54) = 2.895, p = 0.043, η² = 0.139) and Tegner Activity Scale (F(2.2/39.1) = 3.20, p = 0.048, η² = 0.151).

CONCLUSION

The absence of adverse events and high adherence to the programme, coupled with beneficial changes shown in the intervention group, support the conduct of a full-scale trial investigating the effectiveness of prehabilitation.

Dataset of 3D gait analysis in typically developing children walking at three different speeds on an instrumented treadmill in virtual reality

In this article, gait data of typically developing (TD) children (24 boys/31 girls, mean (95% confidence interval) age 9.38 (8.51 - 10.25) years, body mass 35.67 (31.40 - 39.94) kg, leg length 0.73 (0.70 - 0.76) m, and height 1.41 (1.35 - 1.46) m) walking at different walking speeds is shared publicly. Raw and processed data is presented for each child separately and includes data of each single step of both legs. Beside, the subject demographics and the results from the physical examination are presented allowing to select TD children from the database to create a matched group, based on specific parameters (e.g. sex and body weight). For clinical application, gait data is also presented per age group, which provides quick insight into the normal gait pattern of TD children of varying age. Gait analysis was performed during treadmill walking in a virtual environment using the Computer Assisted Rehabilitation Environment (CAREN). The human body lower limb model with trunk markers (HBM2) was used as biomechanical model. Children walked at comfortable walking speed, 30% slower and 30% faster (random sequence) while wearing gymnastic shoes and a safety harness to prevent falling. For each speed condition, 250 steps were recorded. Data quality check, step detection and the calculation of gait parameters was done by custom made Matlab algorithms. Raw data files are provided per walking speed, for each child separately. The raw data is exported from the CAREN software (D-flow) and is provided in .mox and .txt files. It includes the output from the models such as subject data, marker and force data, kinematic data (joint angles), kinetic data (joint moments, GRFs, joint powers), as well as CoM data and EMG data (the last two are not described in this manuscript), for each speed condition and each child. Unfiltered and filtered data are included. C3D files with raw marker and GRF data were recorded in Nexus (Vicon software) and are available upon request. After analyzing the raw data into Matlab (R2016a, Mathworks) using custom made Matlab algorithms, processed data is obtained. The processed data is provided in .xls files and is also presented for each child separately. It contains spatiotemporal parameters, 3D joint angles, anterior-posterior and vertical ground reaction forces (GRF), 3D joint moments and sagittal joint power of each step of the left and right leg. In addition to each individual's data, overview files (.xls) are created per walking speed condition. These overviews present the averaged gait parameter (e.g. joint angle), calculated over all valid steps, of each child.

Comparison of sagittal plane gait characteristics between the overground and treadmill approach for gait analysis in typically developing children

Background

Instrumented treadmills have become more mainstream in clinical assessment of gait disorders in children, and are increasingly being applied as an alternative to overground gait analysis. Both approaches differ in multiple elements of set-up (e.g., overground versus treadmill, Pug-in Gait versus Human Body Model-II), workflow (e.g., limited amount of steps versus many successive steps) and post-processing of data (e.g., different filter techniques). These individual elements have shown to affect gait. Since the approaches are used in parallel in clinical practice, insight into the compound effect of the multiple different elements on gait is essential. This study investigates whether the outcomes of two approaches for 3D gait analysis are interchangeable in typically developing children.

Methods

Spatiotemporal parameters, sagittal joint angles and moments, and ground reaction forces were measured in typically developing children aged 3-17 years using the overground (overground walking, conventional lab environment, Plug-In Gait) and treadmill (treadmill walking in virtual environment, Human Body Model-II) approach. Spatiotemporal and coefficient of variation parameters, and peak values in kinematics and kinetics of both approaches were compared using repeated measures tests. Kinematic and kinetic waveforms from both approaches were compared using statistical parametric mapping (SPM). Differences were quantified by mean differences and root mean square differences.

Results

Children walked slower, with lower stride and stance time and shorter and wider steps with the treadmill approach than with the overground approach. Mean differences ranged from 0.02 s for stride time to 3.3 cm for step width. The patterns of sagittal kinematic and kinetic waveforms were equivalent for both approaches, but significant differences were found in amplitude. Overall, the peak joint angles were larger during the treadmill approach, showing mean differences ranging from 0.84° (pelvic tilt) to 6.42° (peak knee flexion during swing). Mean difference in peak moments ranged from 0.02 Nm/kg (peak knee extension moment) to 0.32 Nm/kg (peak hip extension moment), showing overall decreased joint moments with the treadmill approach. Normalised ground reaction forces showed mean differences ranging from 0.001 to 0.024.

Conclusion

The overground and treadmill approach to 3D gait analysis yield different sagittal gait characteristics. The systematic differences can be due to important changes in the neuromechanics of gait and to methodological choices used in both approaches, such as the biomechanical model or the walkway versus treadmill. The overview of small differences presented in this study is essential to correctly interpret the results and needs to be taken into account when data is interchanged between approaches. Together with the research/clinical question and the context of the child, the insight gained can be used to determine the best approach.

Timing characteristics of body segments during the maximal instep kick in experienced football players

BACKGROUND

The first aim of this study was to describe duration and relative timing of the phases of the maximal instep kick. The second aim was to describe the concurrence of maximal range of motion, maximal angular acceleration, maximal angular deceleration and maximal angular velocity of body segments with four key points.

METHODS

Twenty experienced football players performed three maximal instep kicks. The kicks were analysed using a full body, three-dimensional motion capture system. Camera recordings determined kicking leg events. The concurrence of peak kinematics of body segments with four key points was calculated.

RESULTS

Duration and timing of five phases were identified. Key point maximal hip extension (51.4±5.0%) concurred significantly with maximal range of motion (ROM) of shoulder extension. Key point maximal knee flexion (63.6±5.2%) concurred significantly with maximal angular acceleration of spine flexion and pelvis posterior tilt. Key point knee flexion 90 degrees (69.3±4.9%) concurred significantly with maximal angular velocity of shoulder flexion and spine flexion, maximal angular deceleration of hip flexion and maximal angular acceleration of knee extension. Key point ball impact (75.2±5.2%) concurred significantly with maximal ROM of hip deflexion and pelvis anterior rotation and with maximal angular deceleration of spine flexion and pelvis anterior rotation.

CONCLUSIONS

This study demonstrated that eleven peak kinematics of upper body and kicking leg segments, significantly concurred with four kicking leg positions. These results provide Key points for kicking coordination and stress the importance of dynamical coupling as a kicking mechanism.

Range of motion of body segments is larger during the maximal instep kick than during the submaximal kick in experienced football players

BACKGROUND

Football players with groin injury refrain from maximal kicking. Previous groin injury is related to decreased hip range of motion (ROM). Information on ROM differences between maximal and submaximal kicking within players is lacking. The first aim of this study is to quantify ROM of body segments during the maximal (MaxK) and submaximal (SubK) instep kick at four key points. The second aim is to study ROM differences of tension arc and movement trajectories between MaxK and SubK.

METHODS

Maximal (100% ball speed) and submaximal (70% ball speed) instep kicks from 15 experienced football players were registered with motion capture. ROM of hip, spine, pelvis and knee segments were determined at four key points. Differences in segmental ROM for the tension arc and movement trajectories between MaxK and SubK were studied. Effect sizes (ES) were calculated.

RESULTS

Ball speed was 98.8±9.0 km/h for MaxK and 69.5±7.1 km/h for SubK. Three key points timed similarly (P<0.05) for MaxK and SubK. MaxK shows increased ROM for all segments (P<0.05) but not for hip flexion. MaxK results in enlargement of tension arc and movement trajectories. Spine flexion (ES=3.2) and pelvis posterior tilt (ES=2.2) show the greatest relative increase.

CONCLUSIONS

Maximal kicking shows larger segmental ROM than submaximal kicking. Enlargement of tension arc and movement trajectories relate to increased segmental velocity, according to biomechanical concepts. Central body actions play an important role in kicking. This information can be used to further identify kicking strategies in athletes with injury.

Effectiveness of exercise therapy: a best-evidence summary of systematic reviews

The purpose of this project was to summarise the available evidence on the effectiveness of exercise therapy for patients with disorders of the musculoskeletal, nervous, respiratory, and cardiovascular systems. Systematic reviews were identified by means of a comprehensive search strategy in 11 bibliographic databases (08/2002), in combination with reference tracking. Reviews that included (i) at least one randomised controlled trial investigating the effectiveness of exercise therapy, (ii) clinically relevant outcome measures, and (iii) full text written in English, German or Dutch, were selected by two reviewers. Thirteen independent and blinded reviewers participated in the selection, quality assessment and data-extraction of the systematic reviews. Conclusions about the effectiveness of exercise therapy were based on the results presented in reasonable or good quality systematic reviews (quality score > or = 60 out of 100 points). A total of 104 systematic reviews were selected, 45 of which were of reasonable or good quality. Exercise therapy is effective for patients with knee osteoarthritis, sub-acute (6 to 12 weeks) and chronic (> or = 12 weeks) low back pain, cystic fibrosis, chronic obstructive pulmonary disease, and intermittent claudication. Furthermore, there are indications that exercise therapy is effective for patients with ankylosing spondylitis, hip osteoarthritis, Parkinson's disease, and for patients who have suffered a stroke. There is insufficient evidence to support or refute the effectiveness of exercise therapy for patients with neck pain, shoulder pain, repetitive strain injury, rheumatoid arthritis, asthma, and bronchiectasis. Exercise therapy is not effective for patients with acute low back pain. It is concluded that exercise therapy is effective for a wide range of chronic disorders.

The prognosis of ankle sprains

We developed a new diagnostic tool for predicting the severity of ankle sprains just after injury. Since hard data obtained by diagnostic imaging techniques are still imperfect, we decided to use data from individual medical history and signs and symptoms that are part of the admission routine. During a three month-period data were collected on thirty-five patients with lateral ankle sprains who visited the first aid department of the University Hospital of Maastricht. Assessments took place at admission and at two and four weeks after injury. Assessors were the first-aid physician, a physiotherapist and the patient. Dependent variables were healed ankle in two and four weeks. Predicting variables were the data obtained at admission by the physician, the physiotherapist and the patient. The ability to predict outcome after two and four weeks was determined in a bivariate analysis, followed by logistic modelling. Accurate prediction of recovery time at admission appeared to be possible. Best two weeks predictor was the modified function score, an accuracy of 97% was achieved. Four weeks prediction was most accurate when function score was used together with the report mark from the doctor and the palpation score (accuracy of 81%).

The prognosis of ankle sprains

We developed a new diagnostic tool for predicting the severity of ankle sprains just after injury. Since hard data obtained by diagnostic imaging techniques are still imperfect, we decided to use data from individual medical history and signs and symptoms that are part of the admission routine. During a three month-period data were collected on thirty-five patients with lateral ankle sprains who visited the first aid department of the University Hospital of Maastricht. Assessments took place at admission and at two and four weeks after injury. Assessors were the first-aid physician, a physiotherapist and the patient. Dependent variables were healed ankle in two and four weeks. Predicting variables were the data obtained at admission by the physician, the physiotherapist and the patient. The ability to predict outcome after two and four weeks was determined in a bivariate analysis, followed by logistic modelling. Accurate prediction of recovery time at admission appeared to be possible. Best two weeks predictor was the modified function score, an accuracy of 97% was achieved. Four weeks prediction was most accurate when function score was used together with the report mark from the doctor and the palpation score (accuracy of 81%).