Sensori-motor adaptation to knee osteoarthritis during stepping-down before and after total knee replacement

Investigation of Biopsychosocial Status, Fatigue, Sleep Quality, Alexithymia, Cognitive Functions, and Quality of Life in Behçet's Disease

Objective

The aim of this study was to compare the effects of Behçet's disease in terms of anxiety, biopsychosocial status, fatigue, sleep quality, alexithymia, cognitive level, and quality of life according to major and minor organ involvement.

Methods

The study was planned as a single-centre cohort study. Fifty patients diagnosed with Behçet's (mean age 43±11.96 years) were included in the study. The patients were divided into two groups as major organ involvement (uveitis, neuro-Behçet's, or vascular type Behçet's disease) and minor organ involvement (mucocutaneous type Behçet's disease). Biopsychosocial status was evaluated with Biopsychosocial Questionnaire (BETY-BQ), anxiety with Beck Anxiety Inventory (BAI), fatigue with Multidimensional Assessment of Fatigue (MAF) Scale, sleep quality with Pittsburgh Sleep Quality Index (PSQI), alexithymia with Toronto Alexithymia Scale-20 (TAS-20), cognition level with Mini-Mental State Examination (MMSE), and quality of life with Short Form-36 (SF-36).

Results

In the comparison according to minor and major organ involvement, there was no significant difference between the groups in BETY-BQ, BAI, MAF, PSQI, TAS-20, MMSE and SF-36 (p>0.05).

Conclusion

Behçet's disease negatively effects in parameters such as biopsychosocial status, fatigue, sleep quality, alexithymia and quality of life. The presence of major or minor organ involvement in the patients did not change these negative effects.

How New Technology Is Improving Physical Therapy

PURPOSE OF REVIEW

As rehabilitation patient volume across the age spectrum increases and reimbursement rates decrease, clinicians are forced to produce favorable outcomes with limited resources and time. The purpose of this review is to highlight new technologies being utilized to improve standardization and outcomes for patients rehabilitating orthopedic injuries ranging from sports medicine to trauma to joint arthroplasty.

RECENT FINDINGS

A proliferation of new technologies in rehabilitation has recently occurred with the hope of improved outcomes, better patient compliance and safety, and return to athletic performance. These include technologies applied directly to the patient such as exoskeletons and instrumented insoles to extrinsic applications such as biofeedback and personalized reference charts. Well-structured randomized trials are ongoing centered around the efficacy and safety of these new technologies to help guide clinical necessity and appropriate application. We present a range of new technologies that may assist a diverse population of orthopedic conditions. Many of these interventions are already supported by level 1 evidence and appear safe and feasible for most clinical settings.

Identification of physical and psychosocial problems based on symptoms in patients with Behçet's disease

The purpose of this study was to use the International Classification of Functioning, Disability and Health (ICF) to identify physical and psychosocial problems associated with symptoms of Behçet's disease (BD) in Japanese patients. Thirty patients with BD were interviewed in a pilot study using the "ICF Checklist", and a team of medical experts selected categories related to physical and psychosocial aspects of BD. To identify specific physical and psychosocial problems of Japanese patients with BD, 100 new patients were interviewed using the selected categories. Among the 128 categories in the original ICF Checklist, 80 categories were identified as impaired, and another 12 ICF categories were added based on expert discussion of patients input. The number of problem categories was significantly greater in patients with BD with eye involvement and fatigue (eye involvement, 25.7 categories; fatigue, 25.2 categories; both P < 0.001). Specifically, patients with eye involvement had more difficulties with problems in daily life, such as writing (odds ratio 4.2), understanding such nonverbal messages as gestures and facial expressions (13.7), moving (5.7), walking in intense sunlight and bright light (17.6), and patients with fatigue had more difficulties with climate problems such as symptoms getting worse at the turn of the seasons or on cold days (2.5), compared to those without these symptoms. This study demonstrated that support focusing not only on physical symptoms but on other aspects of life as well is necessary for patients with BD, particularly patients with eye involvement and fatigue.

Preoperative high-intensity strength training improves postural control after TKA: randomized-controlled trial

PURPOSE

This study investigates the effectiveness of preoperative high-intensity strength training (with a special emphasis on lower limb muscle strength and secondarily on balance training) on postural control after TKA.

METHODS

Forty-four subjects (7 men, 37 women, and mean age 66.7 ± 3.9 years) scheduled for unilateral TKA for osteoarthritis (OA) participated in this randomized-controlled trial. Each patient performed two postural control tests: Romberg test with eyes open and closed. These tests were assessed at 8 weeks before surgery (T1), after 8 weeks of training (T2), 1 month after TKA (T3), and finally 3 months after TKA (T4). The intervention group completed an 8-week training program 3 days per week prior to surgery, while the control group received no intervention.

RESULTS

The Center of Pressure area (COP) was lower (i.e., better score) for the intervention group at T2, T3, and T4. The anteroposterior range of COP with eyes open was lower in the intervention group at T2, T3, and T4 and with eyes closed at T2. The medial-lateral standard deviation of COP with eyes open was lower in the intervention group at T2 and T4 and with eyes closed at T2 and T3. The anteroposterior standard deviation of COP with eyes open did not change, while that with eyes closed the intervention group showed lower score at T2.

CONCLUSION

Preoperative high-intensity strength training is effective for improving postural control before and early after TKA. Recommendations should include preoperative strength training, and not only balance training, to speed-up recovery of postural control after TKA.

LEVEL OF EVIDENCE

1.

Postural adaptations to unilateral knee joint hypomobility induced by orthosis wear during gait initiation

Balance control and whole-body progression during gait initiation (GI) involve knee-joint mobility. Single knee-joint hypomobility often occurs with aging, orthopedics or neurological conditions. The goal of the present study was to investigate the capacity of the CNS to adapt GI organization to single knee-joint hypomobility induced by the wear of an orthosis. Twenty-seven healthy adults performed a GI series on a force-plate in the following conditions: without orthosis ("control"), with knee orthosis over the swing leg ("orth-swing") and with the orthosis over the contralateral stance leg ("orth-stance"). In orth-swing, amplitude of mediolateral anticipatory postural adjustments (APAs) and step width were larger, execution phase duration longer, and anteroposterior APAs smaller than in control. In orth-stance, mediolateral APAs duration was longer, step width larger, and amplitude of anteroposterior APAs smaller than in control. Consequently, step length and progression velocity (which relate to the "motor performance") were reduced whereas stability was enhanced compared to control. Vertical force impact at foot-contact did not change across conditions, despite a smaller step length in orthosis conditions compared to control. These results show that the application of a local mechanical constraint induced profound changes in the global GI organization, altering motor performance but ensuring greater stability.

Postural control and contingent negative variation during transient floor translation while standing with the ankle fixed

Background

Adaptation changes in postural muscle activity and anticipatory attention were investigated with the ankle joint fixed to change postural control strategies during transient floor translation.

Methods

For 15 healthy young adults, 40 transient floor translations (S2) in the anterior direction were applied 2 s after an auditory warning signal (S1), under conditions with or without fixation of the ankle. Activity of the frontal postural muscles (tibialis anterior (TA), rectus femoris (RF), rectus abdominis) and contingent negative variation (CNV, brain potential) were analyzed for 20 trials each of the early and latter halves under each fixation condition.

Results

With fixation, peak amplitude of muscle activity after S2 was significantly decreased in TA and increased in RF. These muscles showed marked adaptive decreases. The early component of CNV reduced with adaptation, particularly under fixation condition. Only in RF, background activity increased just before S2, with adaptation under fixation. A significant correlation was found between timings of CNV peak and RF activation just before S2 only after adaptation under fixation.

Conclusion

These results suggest that the main activation muscle changes from TA to RF with fixation. Under such condition, attention would be focused on the knee with adaptation, and the need for heightening attention in the early stage may have declined. Correspondingly, the timing to heighten stiffness of the RF became later, and attention would have been paid to RF activation just before S2.

Center of Pressure Displacement of Standing Posture during Rapid Movements Is Reorganised Due to Experimental Lower Extremity Muscle Pain

Background

Postural control during rapid movements may be impaired due to musculoskeletal pain. The purpose of this study was to investigate the effect of experimental knee-related muscle pain on the center of pressure (CoP) displacement in a reaction time task condition.

Methods

Nine healthy males performed two reaction time tasks (dominant side shoulder flexion and bilateral heel lift) before, during, and after experimental pain induced in the dominant side vastus medialis or the tibialis anterior muscles by hypertonic saline injections. The CoP displacement was extracted from the ipsilateral and contralateral side by two force plates and the net CoP displacement was calculated.

Results

Compared with non-painful sessions, tibialis anterior muscle pain during the peak and peak-to-peak displacement for the CoP during anticipatory postural adjustments (APAs) of the shoulder task reduced the peak-to-peak displacement of the net CoP in the medial-lateral direction (P<0.05). Tibialis anterior and vastus medialis muscle pain during shoulder flexion task reduced the anterior-posterior peak-to-peak displacement in the ipsilateral side (P<0.05).

Conclusions

The central nervous system in healthy individuals was sufficiently robust in maintaining the APA characteristics during pain, although the displacement of net and ipsilateral CoP in the medial-lateral and anterior-posterior directions during unilateral fast shoulder movement was altered.

Topical Ginger Treatment With a Compress or Patch for Osteoarthritis Symptoms

AIM

This article is a report of a study evaluating changes in health status before and after topical ginger treatment for adults with moderate to severe osteoarthritis.

METHOD

In 2011, 20 adults with chronic osteoarthritis were randomly assigned to one of two groups for 7 consecutive days of topical ginger treatment by trained nurses: Group 1 received a manually prepared ginger compress and Group 2 a standardized ginger patch. Participants had the option to continue self-treatment using the ginger patch for a further 24 weeks. A brief arthritis health questionnaire was completed weekly for 3 weeks and 4 weekly for 24 weeks.

RESULTS

The mean scores for Group 1 and Group 2 show a notable decline following 1-week topical ginger treatment; scores in pain, fatigue, global effect, and functional status reduced by 48%, 49%, 40%, and 31%, respectively, whereas health satisfaction improved from 80% dissatisfied to 70% satisfied. Scores for all participants in all five domains progressively reduced over the following 24 weeks of self-treatment.

CONCLUSION

Topical ginger treatment has the potential to relieve symptoms, improve the overall health, and increase independence of people with chronic osteoarthritis.

Effects of balance training on functional outcome after total knee replacement in patients with knee osteoarthritis: a randomized controlled trial

Objective:

To evaluate the effectiveness of additional balance training on mobility and function outcome in patients with knee osteoarthritis after total knee replacement.

Design:

A prospective intervention study and randomized controlled trial.

Setting:

A university-based teaching hospital.

Participants:

Patients who received total knee replacement surgery were recruited sequentially from the orthopedic department. They were randomly assigned to either the experimental group or control group.

Interventions:

The control group received conventional function training for eight weeks. The experimental group not only received the same conventional training as the control group, but also received additional balance exercises in each admission.

Main outcome measures:

Before and after training we took the following measurements: distance of functional forward reach; duration of single leg stance; timed sit-to-stand test; timed up-and-down stair test; timed 10-m walk; timed up-and-go test; and the Western Ontario and McMaster Universities Osteoarthritis Index score.

Results:

58 patients in the experimental group with a mean (SD) age of 71.4 (6.6) years and 55 in the control group with mean (SD) age of 72.9 (7.3) years, completed the study. After eight-weeks intervention with additional balance exercises, the experimental group demonstrated significant changes in 10-m walk ( P < 0.001, 95% confidence interval (CI): 3.6 to 4.4 seconds) and in timed up-and-go ( P < 0.001, 95% confidence interval: 2.6 to 3.4 seconds) tests. Significant changes of all other measures and Western Ontario and McMaster Universities Osteoarthritis Index score were also observed in the experimental group (all P < 0.001).

Conclusion:

Additional balance training exerted a significant beneficial effect on the function recovery and mobility outcome in patients with knee osteoarthritis after total knee replacement.

A pilot study of post-total knee replacement gait rehabilitation using lower limbs robot-assisted training system

The aim of this study was to explore the application value of the lower limbs robot-assisted training system for post-total knee replacement (TKR) gait rehabilitation. A total of 60 patients with osteoarthritis of the knee were equally randomized into the traditional and robot-assisted rehabilitation training groups within 1 week after TKR. All patients received 2-week training. Scores of hospital for special surgery (HSS), knee kinesthesia grades, knee proprioception grades, functional ambulation (FAC) scores, Berg balance scores, 10-m sitting-standing time, and 6-min walking distances were compared between the groups. The HSS score, Berg score, 10-m sitting-standing time, and 6-min walking distance of the robot-assisted training group were significantly higher than the control group (P < 0.05). Its knee kinesthesia grade, knee proprioception grade, and FAC score were better than the control group but not significantly (P > 0.05). Lower limbs robot-assisted rehabilitation training improves post-TKR patients' knee proprioception and stability more effectively compared with the traditional method. It improves patients' gait and symptoms, increases their walking speed, and prolongs their walking distances, which benefit their return to family and society.

Ginger compress therapy for adults with osteoarthritis

AIM

This paper is a report of a study to explicate the phenomenon of ginger compresses for people with osteoarthritis.

BACKGROUND

Osteoarthritis is claimed to be the leading cause of musculoskeletal pain and disability in Western society. Management ideally combines non-pharmacological strategies, including complementary therapies and pain-relieving medication. Ginger has been applied externally for over a thousand years in China to manage arthritis symptoms.

METHOD

Husserlian phenomenological methodology was used and the data were collected in 2007. Ten purposively selected adults who had suffered osteoarthritis for at least a year kept daily diaries and made drawings, and follow-up interviews and telephone conversations were conducted.

FINDINGS

Seven themes were identified in the data: (1) Meditative-like stillness and relaxation of thoughts; (2) Constant penetrating warmth throughout the body; (3) Positive change in outlook; (4) Increased energy and interest in the world; (5) Deeply relaxed state that progressed to a gradual shift in pain and increased interest in others; (6) Increased suppleness within the body and (7) More comfortable, flexible joint mobility. The essential experience of ginger compresses exposed the unique qualities of heat, stimulation, anti-inflammation and analgesia.

CONCLUSION

Nurses could consider this therapy as part of a holistic treatment for people with osteoarthritis symptoms. Controlled research is needed with larger numbers of older people to explore further the effects of the ginger compress therapy.

Comparison of lumbar proprioception as measured in unrestrained standing in individuals with disc replacement, with low back pain, and without low back pain

STUDY DESIGN

Cross-sectional laboratory study.

OBJECTIVE

To determine whether individuals with spinal pain and those who have undergone spinal surgery have difficulty discriminating small movement differences using a spinal proprioception test for active flexion movements.

BACKGROUND

Structures contributing to proprioception may be affected during disc replacement surgery. Postsurgical assessment of proprioceptive ability to make discriminations in the range used for maintaining upright postural stability is needed to inform postoperative rehabilitation.

METHODS

Proprioceptive sensitivity to differences between lumbar spine movements of 11 degrees, 13 degrees, 15 degrees, 17 degrees, and 19 degrees of forward flexion was measured in unrestrained standing, with vision of the target obscured. Individuals after disc replacement (n=16), with disc degeneration and discogenic back pain (n=19), and without back pain (n=18) performed 50 movement trials and stated the amount of movement performed for each trial (11 degrees, 13 degrees, 15 degrees, 17 degrees, or 19 degrees).

RESULTS

The pattern of discrimination scores between adjacent lumbar flexion movement pairs shown by the individuals in the discogenic back pain group differed significantly from the disc replacement and healthy control groups (P=.024), which were not significantly different from each other. Although mean discrimination scores averaged over all movement pairs did not differ significantly between the groups, participants with discogenic back pain discriminated between the 2 smallest lumbar flexion movements significantly better than those in the other 2 groups (P=.013).

CONCLUSION

The greater sensitivity of the individuals with disc pain to discriminate between the 2 smallest flexion movements was interpreted as a contrast effect arising from differences between the groups in usual upright posture, with disc replacement restoring the same pattern of posture as seen for healthy controls.

Musculoskeletal diseases as a causal factor of cervical vertigo

OBJECTIVE

To analyze the frequency of musculoskeletal diseases in patients with cervical vertigo, as well as the relations of neck tenderness, psychiatric symptoms, and autonomic abnormalities with pain and age.

METHODS

One hundred and seventy-six patients with cervical vertigo were analyzed. The groups with or without pain and the groups aged > or =66 years or < or =65 years old were compared.

RESULTS

Musculoskeletal diseases were very common (present in 86%). In the group with pain, neck tenderness, CMI III-IV, and orthostatic hypotension were significantly more frequent. In the older group, neck tenderness and orthostatic hypotension were significantly more common than in the younger group. Abnormal ETT and OKP results were also frequently observed.

CONCLUSIONS

Musculoskeletal diseases might have a role in cervical vertigo. In addition, there seem to be some relations among neck tenderness, psychiatric symptoms, autonomic abnormalities, pain, and age. Furthermore, brain stem abnormalities may participate in cervical vertigo.