Reliability of hip joint position sense tests using a clinically applicable measurement tool in elderly participants with unilateral hip osteoarthritis

Balancing act: Unraveling the link between muscle strength, proprioception, and stability in unilateral hip osteoarthritis

The objectives of this study are to compare hip muscle strength, hip joint proprioception, and functional balance between individuals with unilateral hip OA and asymptomatic individuals and to examine the relationships among these variables in the hip OA population. In a prospective cross-sectional study, 122 participants (unilateral Hip OA: n = 56, asymptomatic: n = 56) were assessed at the CAMS/KKU musculoskeletal Physical Therapy laboratory. Ethical standards were upheld throughout the research, with informed consent obtained. Hip muscle strength was measured using a hand-held dynamometer, hip joint proprioception with a digital inclinometer, and functional balance using the Berg Balance Scale (BBS) and Timed Up and Go (TUG) test. Hip OA individuals exhibited significantly lower muscle strength and proprioceptive accuracy, and poorer functional balance than controls (p < 0.003). Correlation analyses revealed a positive correlation between muscle strength and BBS scores (r = 0.38 to 0.42) and a negative correlation with TUG test times (r = -0.36 to -0.41). Hip joint reposition sense (JRS) in flexion showed a negative correlation with balance (r = -0.46), while JRS in abduction was positively correlated (r = 0.46). The study highlights the clinical importance of muscle strength and proprioception in functional balance among individuals with unilateral hip OA. The results support the incorporation of muscle strengthening and proprioceptive training in interventions to improve balance and mobility in this population.

Exploring the Nexus of lower extremity proprioception and postural stability in older adults with osteoporosis: a cross-sectional investigation

Background

Osteoporosis, characterized by reduced bone mass and micro-architectural deterioration, poses a significant public health concern due to increased fracture susceptibility. Beyond bone health, this cross-sectional study aimed to assess and compare lower extremity proprioception and postural stability in individuals with and without osteoporosis and to explore their correlation within the osteoporosis group.

Method

In this prospective cross-sectional study, 80 participants were divided into two groups: osteoporosis (n = 40) and control (n = 40). The demographic characteristics and clinical parameters of the participants were as follows: Age (years) - Osteoporosis group: 65.04 ± 4.33, Control group: 65.24 ± 4.63; Sex (%) - Osteoporosis group: Male 30%, Female 70%; Control group: Male 30%, Female 70%; Body mass index (kg/m2) - Osteoporosis group: 23.7 ± 3.2, Control group: 24.5 ± 4.6; T-score (Lumbar) - Osteoporosis group: -2.86 ± 1.23, Control group: 0.27 ± 0.58; T-score (hip) - Osteoporosis group: -2.28 ± 0.79, Control group: 0.68 ± 0.86. Joint Position Sense (JPS) at the hip, knee, and ankle was assessed using a digital inclinometer, and postural stability was measured using computerized force platforms.

Result

Osteoporosis participants exhibited higher errors in hip (5.63° vs. 2.36°), knee (4.86° vs. 1.98°), and ankle (4.46° vs. 2.02°) JPS compared to controls. Postural stability measures showed increased anterior-posterior sway (10.86 mm vs. 3.98 mm), medial-lateral sway (8.67 mm vs. 2.89 mm), and ellipse area (966.88 mm2 vs. 446.19 mm2) in osteoporosis participants. Furthermore, correlation analyses within the osteoporosis group unveiled significant positive associations between lower extremity proprioception and postural stability. Specifically, hip JPS exhibited a strong positive correlation with anterior-posterior sway (r = 0.493, p = 0.003), medial-lateral sway (r = 0.485, p = 0.003), and ellipse area (r = 0.496, p < 0.001). Knee JPS displayed a moderate positive correlation with anterior-posterior sway (r = 0.397, p = 0.012), medial-lateral sway (r = 0.337, p = 0.032), and ellipse area (r = 0.378, p < 0.001). Similarly, ankle JPS showed a moderate positive correlation with anterior-posterior sway (r = 0.373, p = 0.023), medial-lateral sway (r = 0.308, p = 0.045), and ellipse area (r = 0.368, p = 0.021).

Conclusion

These findings underscore the interplay between proprioceptive deficits, compromised postural stability, and osteoporosis, emphasizing the need for targeted interventions to improve fall prevention strategies and enhance the quality of life for individuals with osteoporosis.

Efficacy of Preoperative Physiotherapy Protocols in a 30-Year-Old Patient With Bilateral Osteoarthritis of Hip Secondary to Avascular Necrosis

Osteoarthritis (OA) of the hip is a rare condition that occurs in adults can be a result of avascular necrosis or a history of steroids that can wear away the articulating cartilage of the hip joint causing friction, pain in the groin region, stiffness, and decreased functional mobility. We present a 30-year-old adult who came with chief complaints of pain in the groin region, stiffness, difficulty in walking, and experiencing pain while walking, which had reduced his activity of daily living. The investigation was done, and the patient was diagnosed with bilateral hip OA secondary to avascular necrosis. To reduce morbidity, preoperative physiotherapy management for eight weeks was planned and started before the operation. The purpose was to educate the patient about the condition, reduce pain, increase the ranges of the hip, improve strength, and provide gait re-education. We added basic proprioception training and plyometric exercises for the hip to improve strength and balance. At the end of the session patient, positive results were achieved. The progress of proprioception or balance training can be improved by using single-leg balance as an outcome measure. Hence, our study aims to use exercise therapy to reduce or postpone the need for hip arthroscopy. However, future research should focus on plyometric exercises for the lower limbs or any abnormalities associated with the lower limbs. However, they should be carried out when some recovery is observed in patients.

A Cross-Sectional Study Investigating Lumbar Proprioception Impairments in Individuals with Type 2 Diabetes Mellitus: Correlations with Glycated Hemoglobin Levels

Impaired proprioception is a recognized complication in individuals with type 2 diabetes mellitus (T2DM), contributing to balance deficits and increased risk of falls. However, limited research has focused on lumbar proprioception in this population. This study aimed to investigate lumbar proprioception in individuals with T2DM, as well as healthy individuals. Additionally, this study aimed to examine the correlation between lumbar proprioception and glycated hemoglobin (HbA1c) levels, which is a marker of long-term glycemic control in T2DM. A cross-sectional study was conducted, comparing lumbar joint reposition errors (JRE) between a T2DM group (n = 85) and a healthy group (n = 85). Lumbar JRE was assessed in flexion, extension, lateral bending left, and lateral bending right using a dual inclinometer device. HbA1c levels were measured as an indicator of glycemic control. Significant differences in lumbar JRE were found between the T2DM and healthy groups, with individuals with T2DM exhibiting larger JRE values, indicating impaired lumbar proprioception (p < 0.001). The correlation analysis revealed significant positive associations between HbA1c levels and lumbar JRE. Higher HbA1c levels were correlated with greater joint JRE in flexion (r = 0.49, p < 0.001), extension (r = 0.51, p < 0.001), left lateral bending (r = 0.45, p < 0.001), and right lateral bending (r = 0.48, p < 0.001) in the T2DM group. This study provides evidence of impaired lumbar proprioception in individuals with T2DM, as evidenced by larger lumbar JRE compared to the healthy group.

Shoulder Proprioception and Its Correlation with Pain Intensity and Functional Disability in Individuals with Subacromial Impingement Syndrome-A Cross-Sectional Study

Subacromial Impingement Syndrome (SAIS) is a common shoulder condition characterized by pain and functional impairment. Proprioception, the sense of joint position and movement, is crucial in maintaining joint stability and coordinating movements. The relationship between shoulder proprioception, pain intensity, and functional disability in individuals with SAIS remains unclear, with conflicting findings in the literature. This cross-sectional study aimed to evaluate shoulder proprioception, examine its correlation with pain intensity and functional disability, and contribute to our understanding of the clinical implications of proprioceptive deficits in individuals with SAIS. Forty-two individuals were diagnosed with SAIS, and an equal number of asymptomatic controls were recruited. Shoulder proprioception was assessed using a digital inclinometer, measuring joint position sense at various angles of flexion and rotation. Pain intensity was measured using the Visual Analog Scale (VAS), and functional disability was assessed using the Shoulder Pain and Disability Index (SPADI). Results: Individuals with SAIS exhibited significantly higher joint position error (JPE) values compared to asymptomatic controls in all measured angles of flexion and rotation (p < 0.001). Strong positive correlations were observed between JPE and pain intensity (r = 0.61 to 0.71, p < 0.01) and disability (r = 0.56 to 0.68, p < 0.01). These findings suggest impaired shoulder proprioception is associated with higher pain intensity and functional disability in SAIS. This study provides evidence of impaired shoulder proprioception in individuals with SAIS and its correlation with pain intensity and functional disability. The results highlight the clinical relevance of proprioceptive deficits in SAIS and emphasize the importance of incorporating proprioceptive assessment and targeted rehabilitation interventions into managing this condition. Future research should focus on longitudinal studies with larger and more diverse samples to further understand the underlying mechanisms and evaluate the effectiveness of proprioceptive interventions in improving outcomes for individuals with SAIS.

Investigating Knee Joint Proprioception and Its Impact on Limits of Stability Using Dynamic Posturography in Individuals with Bilateral Knee Osteoarthritis-A Cross-Sectional Study of Comparisons and Correlations

(1) Background: Proprioception and limits of stability can significantly impact static and dynamic balance. Knee proprioception and limits of stability may be impaired in individuals with knee osteoarthritis (KOA). Impaired knee proprioception may impact the limits of stability, and understanding the associations between these factors is important for formulating treatment strategies in this population. The objectives of this study are to (a) compare the knee joint position error (JPE) and limits of stability between KOA and asymptomatic individuals and (b) assess the correlation between knee JPE and the limits of stability in KOA individuals. (2) Methods: This cross-sectional study included 50 individuals diagnosed with bilateral KOA and 50 asymptomatic individuals. Knee JPE was measured using a dual digital inclinometer at 25° and 45° of knee flexion (in the dominant and nondominant legs). The limits of stability variables, including reaction time (s), maximum excursion (%), and direction control (%), were evaluated using computerized dynamic posturography. (3) Results: The magnitude of the mean knee JPE is significantly larger in KOA individuals (p < 0.001) compared to asymptomatic individuals assessed at 25° and 45° of knee flexion in both the dominant and nondominant legs. The limits of stability test showed that KOA group individuals had a longer reaction time (1.64 ± 0.30 s) and reduced maximum excursion (4.37 ± 0.45) and direction control (78.42 ± 5.47) percentages compared to the asymptomatic group (reaction time = 0.89 ± 0.29, maximum excursion = 5.25 ± 1.34, direction control = 87.50 ± 4.49). Knee JPE showed moderate to strong correlations with the reaction time (r = 0.60 to 0.68, p < 0.001), maximum excursion (r = -0.28 to -0.38, p < 0.001) and direction control (r = -0.59 to -0.65, p < 0.001) parameters in the limits of stability test. (4) Conclusions: Knee proprioception and limits of stability are impaired in KOA individuals compared to asymptomatic individuals, and knee JPE showed significant relationships with the limits of stability variables. These factors and correlations may be considered when evaluating and developing treatment strategies for KOA patients.

A Randomized, Double-Blind Placebo Control Study on the Effect of a Blood Flow Restriction by an Inflatable Cuff Worn around the Arm on the Wrist Joint Position Sense in Healthy Recreational Athletes

The number of blood flow restriction (BFR) training practitioners is rapidly increasing, so understanding the safety issues associated with limb occlusion is strongly needed. The present study determined the effect of BFR by an inflatable cuff worn around the arm on the wrist joint position sense (JPS) in healthy recreational athletes. In the prospective randomized, double-blind placebo control study, sixty healthy right-handed recreational athletes aged x = 22.93 ± 1.26 years were assigned to groups of equal size and gender rates: BFR, placebo, and control. The active wrist JPS was assessed in two separate sessions using an isokinetic dynamometer. The first assessment was performed with no cuffs. In the second session, a cuff with a standardized pressure was worn on the examined limb in the BFR group. In the placebo group, the cuff was uninflated. A between-session comparison in each group of collected angular errors expressed in degrees was carried out. The angular error in the BFR group was larger during the second measurement than the first one (p = 0.011-0.336). On the contrary, in the placebo (p = 0.241-0.948) and control (p = 0.093-0.904) groups, the error value in the second session was comparable or smaller. It was determined that BFR by an inflatable cuff around the arm impairs the wrist position sense. Hence, BFR training should be performed with caution.

Comparisons and Associations between Hip-Joint Position Sense and Glycosylated Hemoglobin in Elderly Subjects with Type 2 Diabetes Mellitus-A Cross-Sectional Study

Hip-joint position sense (JPS) accuracy may be impaired in individuals with type 2 diabetes mellitus (T2DM). An impaired hip JPS can alter postural control and bodily balance. The objectives of this study are to (1) compare the hip JPS between T2DM and asymptomatic and (2) assess the relationship between hip JPS and glycosylated hemoglobin (HbAlc). This comparative cross-sectional study included 117 elderly individuals with T2DM (mean age: 59.82 ± 6.80 y) and 142 who were asymptomatic (mean age: 57.52 ± 6.90 y). The hip JPS was measured using a digital inclinometer. The individuals were repositioned to a target position with their eyes closed, and the magnitudes of matching errors were estimated as reposition errors. The hip JPS was evaluated in the flexion and abduction directions. The magnitude of reposition errors was significantly larger in the T2DM group in the right flexion (p < 0.001), the right abduction (p < 0.001), the left flexion (p < 0.001), and the left abduction (p < 0.001) directions compared to the asymptomatic group. HbA1c values showed a significant positive correlation with JPS in the right-hip flexion (r = 0.43, p < 0.001), the right-hip abduction (r = 0.36, p < 0.001), the left-hip flexion (r = 0.44, p < 0.001), and the left-hip abduction (r = 0.49, p < 0.001) directions. Hip JPS testing may be considered when assessing and formulating treatment strategies for individuals with type 2 diabetes. Future research should focus on how hip JPS can impact balance and falls in individuals with T2DM.

Correlation and comparison of quadriceps endurance and knee joint position sense in individuals with and without unilateral knee osteoarthritis

Background

Knee osteoarthritis (KOA) is a painful degenerative joint disease that may limit activities of daily living. This study aimed to determine the relationship between quadriceps endurance and knee joint position sense (JPS) in KOA individuals and compare the quadriceps endurance and knee JPS with and without KOA.

Methods

This comparative cross-sectional study was conducted in medical rehabilitation clinics, King Khalid University, Saudi Arabia. This study recruited 50 individuals diagnosed with unilateral KOA (mean age = 67.10 ± 4.36 years) and 50 asymptomatic individuals (mean age = 66.50 ± 3.63 years). Quadriceps isometric endurance capacity (sec) was measured using a fatigue resistance test, and knee JPS (degrees) were assessed using a digital inclinometer and evaluated in sitting and standing positions.

Results

Quadriceps isometric endurance showed a significant moderate negative correlation with knee JPS in 20° of flexion (r = -0.48, p < 0.001); 40° of flexion: r = -0.62, p < 0.001; 60° of flexion: r = -0.58, p < 0.001) in sitting and 20° of flexion (r = -0.25, p = 0.084) in standing position in KOA individuals. When compared to the asymptomatic, the quadriceps endurance was lower (p < 0.001), and knee joint position errors were larger (p < 0.001) in KOA individuals.

Conclusion

Results of this study showed that quadriceps endurance capacity is negatively associated with knee JPS. KOA individuals demonstrated lower quadriceps endurance and larger JPS compared to asymptomatic.

Comparison and correlation of cervical proprioception and muscle endurance in general joint hypermobility participants with and without non-specific neck pain-a cross-sectional study

Background

Cervical proprioception and muscle endurance are essential for maintaining cervical functional joint stability. Proprioception and muscle endurance may be impaired in those with general joint hypermobility (GJH). Examining these aspects is crucial. This study's aims are to (1) compare the cervical joint position error (JPE) and muscle endurance holding capacities in GJH individuals with and without non-specific neck pain (NSNP) (2) to assess the relationship between hypermobility Beighton scores, cervical JPE's, and muscle endurance in GJH individuals with and without NSNP.

Methods

In this cross-sectional comparative study, 33 GJH participants with NSNP (mean age 21.7 ± 1.8 years) and 35 asymptomatic participants GJH (mean age 22.42 ± 1.7 years) participated. Beighton's score of ≥4 of 9 tests was used as criteria to diagnose GJH. Cervical JPEs were estimated in degrees using a cervical range of motion device, and muscle endurance (flexor and extensor) were estimated in seconds using a stopwatch.

Results

GJH participants with NSNP showed significantly larger cervical JPEs (p < 0.001) and decreased muscle endurance holding times (p < 0.001) compared to asymptomatic participants. Beighton hypermobility scores showed a significant moderate positive correlation with cervical JPEs (flexion: r = 0.43, p = 0.013), left rotation: r = 0.47, p = 0.005, right rotation: r = 0.57, p = 0.001) in NSNP individuals. Also, Beighton hypermobility scores showed a moderate negative correlation with muscle endurance in NSNP (flexor muscles: r = -0.40, p = 0.020, extensor muscles: r = -0.41, p = 0.020, and asymptomatic individuals (flexor muscles: -0.34, p = 0.045, extensor muscles: r = -0.45, p = 0.007).

Conclusion

GJH individuals with NSNP showed increased cervical JPEs and reduced muscle endurance compared to asymptomatic. Individuals with GJH with higher Beighton scores demonstrated increased cervical JPEs and reduced neck muscle endurance holding ability. In clinical practice, therapists should be aware of these findings, incorporate proprioceptive and muscle endurance assessments, and formulate rehabilitation strategies for NSNP individuals with GJM.