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Jakiela JT, Voinier D, Horney JA, Golightly YM, Bye TK, White DK. The Association of Stair Climbing Behaviors With Hazard of All-Cause Mortality in Adults With or At Risk of Knee Osteoarthritis. J Rheumatol 2024; 51:408-414. [PMID: 38302165 DOI: 10.3899/jrheum.2023-0818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To investigate the association of stair climbing difficulty and stair climbing frequency with the risk of all-cause mortality over 13 years in adults with or at high risk for knee OA. METHODS We used data from the Osteoarthritis Initiative (OAI), a prospective cohort study of community-dwelling adults with or at high risk for symptomatic knee OA. The exposures were stair climbing difficulty and frequency, assessed at baseline using self-report questionnaires. The outcome was all-cause mortality, assessed from baseline through 13 years of follow-up. Kaplan-Meier survival curves and Cox proportional hazards regression were used to investigate the association between stair climbing exposures and all-cause mortality. RESULTS Three hundred seven (6.81%) and 310 (6.84%) participants in the difficulty and frequency samples, respectively, died during 13 years of follow-up. Those who were limited in any capacity in terms of their stair climbing ability had 54% to 84% greater hazard of all-cause mortality, and those who climbed at least 7 flights of stairs per week had 38% lower hazard of all-cause mortality. CONCLUSION Adults with or at high risk for knee OA who report difficulty with climbing stairs or who infrequently use stairs are at greater hazard of all-cause mortality. Stair climbing difficulty and frequency are simple to collect and changes may occur early in OA progression, allowing for early intervention. Brief questions about stair climbing behaviors can serve as a functional vital sign within the clinician's toolbox.
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Affiliation(s)
- Jason T Jakiela
- J.T. Jakiela, PhD, MS, Winston-Salem State University, Winston-Salem, North Carolina;
| | - Dana Voinier
- D. Voinier, PT, DPT, PhD, MS, J.A. Horney, PhD, MPH, T.K. Bye, PT, DPT, MS, CSCS, D.K. White, PT, ScD, MSc, University of Delaware, Newark, Delaware
| | - Jennifer A Horney
- D. Voinier, PT, DPT, PhD, MS, J.A. Horney, PhD, MPH, T.K. Bye, PT, DPT, MS, CSCS, D.K. White, PT, ScD, MSc, University of Delaware, Newark, Delaware
| | - Yvonne M Golightly
- Y.M. Golightly, PT, PhD, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Thomas K Bye
- D. Voinier, PT, DPT, PhD, MS, J.A. Horney, PhD, MPH, T.K. Bye, PT, DPT, MS, CSCS, D.K. White, PT, ScD, MSc, University of Delaware, Newark, Delaware
| | - Daniel K White
- D. Voinier, PT, DPT, PhD, MS, J.A. Horney, PhD, MPH, T.K. Bye, PT, DPT, MS, CSCS, D.K. White, PT, ScD, MSc, University of Delaware, Newark, Delaware
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Vennu V, Al-Otaibi AD, Alfadhel SA, Bindawas SM. The Relationship Between Knee Osteoarthritis-Related Pain Severity and Daily Activities Involving the Upper and Lower Limbs in Saudi Adults: A Cross-Sectional Study. Cureus 2023; 15:e48381. [PMID: 37954623 PMCID: PMC10636493 DOI: 10.7759/cureus.48381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Earlier research has shown an association between pain intensity and everyday activities in adults. However, it is vital to examine the relationship within the context of Saudi people who have knee osteoarthritis. Therefore, this study aimed to explore the connection between pain intensity and daily activities involving the lower and upper limbs among patients with knee osteoarthritis in Saudi Arabia. Methods This study enrolled 209 individuals aged 55 years and above who were diagnosed with radiographic knee osteoarthritis by physicians from five hospitals in Riyadh, Saudi Arabia, between March 2016 and March 2017. Participants were divided into two groups based on their pain intensity, measured using the visual analog scale. The first group included 141 individuals with mild or moderate pain, while the second group comprised 68 individuals with severe pain. The study assessed the physical functioning of these individuals by evaluating their ability to perform daily activities involving the lower and upper limbs, using the Physical Functioning Subscale of the 36-item Short Form Health Survey, which includes 10 items. Results Adjusted logistic regression analysis revealed that individuals experiencing severe pain related to knee osteoarthritis were more likely to encounter difficulties in climbing several flights of stairs (odds ratio [OR] = 1.19, 95% confidence interval [CI] = 1.09-1.29), and one flight of stairs (OR = 1.19, 95% CI = 1.06-1.34), with challenges in bending, kneeling, or stooping (OR = 1.14, 95% CI = 1.05-1.23), walking more than one mile (OR = 1.15, 95% CI = 1.06-1.25), walking several blocks (OR = 1.17, 95% CI = 1.08-1.27), and walking one block (OR = 1.19, 95% CI = 1.06-1.34) than those with mild or moderate pain. Conclusion Our study results highlight the significant impact of severe pain on activities like climbing stairs, bending, kneeling, stooping, and walking longer distances among people with knee osteoarthritis in Saudi Arabia.
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Affiliation(s)
- Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, SAU
| | - Ali D Al-Otaibi
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, and Physical Therapy Department, Dawadmi General Hospital, Riyadh, SAU
| | - Saud A Alfadhel
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, and Physical Therapy Department, General Directorate of Medical Services, Riyadh, SAU
| | - Saad M Bindawas
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, SAU
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Lower Limb Muscles' Activation during Ascending and Descending a Single Step-Up Movement: Comparison between In water and On land Exercise at Different Step Cadences in Young Injury-Free Adults. Healthcare (Basel) 2023; 11:healthcare11030441. [PMID: 36767016 PMCID: PMC9914687 DOI: 10.3390/healthcare11030441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/08/2023] Open
Abstract
(1) Background: Forward step-up (FSU) simulates the stance phase in stair ascension. With the benefits of physical properties of water, aquatic FSU exercise may be more suitable for patients with lower limb weakness or pain. The purpose of this study is to investigate the effect of progressive steps per min on the surface electromyography (sEMG) of gluteus maximus (GM), biceps femoris (BF), rectus femoris (RF), and gastrocnemius (GA), when performing FSU exercise with different steps per min in water and on land. (2) Methods: Participants (N = 20) were instructed to perform FSU exercises at different steps per min (35, 60, and 95 bpm) in water and on land. The sEMG of the tested muscles were collected. The percentage maximum voluntary isometric contraction (%MVIC) of GM, RF, GA and BF at different environments and steps per min was compared. (3) Result: There was a statistically significant difference of %MVIC of RF at all steps per min comparisons regardless of the movement phases and environments (p < 0.01, except for descending phases of 35 bpm vs. 60 bpm). All tested muscles showed a statistically significant lower muscle activation in water (p < 0.05) (4) Conclusion: This study found that the %MVIC of the tested muscle in both investigated environments increase as steps per minute increases. It is also found that the movement pattern of FSU exercise activates RF the most among all the tested muscles. Muscle activation of all tested muscles is also found to be smaller in water due to buoyancy property of water. Aquatic FSU exercise might be applicable to patients with lower limb weakness or knee osteoarthritis to improve their lower limb strength.
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Shen P, Li L, Song Q, Sun W, Zhang C, Fong DTP, Mao D. Proprioceptive Neuromuscular Facilitation Improves Symptoms Among Older Adults With Knee Osteoarthritis During Stair Ascending: A Randomized Controlled Trial. Am J Phys Med Rehabil 2022; 101:753-760. [PMID: 34686629 DOI: 10.1097/phm.0000000000001906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to investigate the effects of a 6-wk proprioceptive neuromuscular facilitation stretching on pain, proprioception, joint range of motion, and joint moments during stair ascending among older adults with knee osteoarthritis. DESIGN This study is a randomized, controlled, and assessor-blinded trial. Thirty-six older adults with knee osteoarthritis were randomly assigned to the proprioceptive neuromuscular facilitation and the control groups. They received proprioceptive neuromuscular facilitation stretching and health lecture series, respectively, for 6 wks. Final data analysis included 14 participants of the proprioceptive neuromuscular facilitation group and 13 of the control group. Pain score, joint proprioception, range of motion, and joint moments during stair ascending were measured before and after the stretching. Two-way (group by time) analysis of variance with repeated measures was used to evaluate stretching effects. RESULTS Significant interactions were detected in pain score, joint proprioception, external knee adduction moment, and external knee extension moment. Compared with week 0, the pain score, joint proprioception threshold, and external knee adduction moment decreased, whereas the external knee extension moment increased among older adults in the proprioceptive neuromuscular facilitation group at week 7. CONCLUSIONS Proprioceptive neuromuscular facilitation could be recommended as one of the clinical treatments for knee osteoarthritis to relieve pain, improve proprioception, and balance load distribution between medial and lateral compartments at the knee.
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Affiliation(s)
- Peixin Shen
- From the College of Human Movement Science, Beijing Sport University, Beijing, China (PS, DM); Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, Georgia (LL); College of Sports and Health, Shandong Sport University, Jinan, China (QS, WS, CZ, DM); Shandong Institute of Sport Science, Jinan, China (CZ); and School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom (DTPF)
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Relative Effect of Extracorporeal Shockwave Therapy Alone or in Combination with Noninjective Treatments on Pain and Physical Function in Knee Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials. Biomedicines 2022; 10:biomedicines10020306. [PMID: 35203516 PMCID: PMC8869515 DOI: 10.3390/biomedicines10020306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
Extracorporeal shockwave therapy (ESWT) has been recommended for managing pain in patients with knee osteoarthritis (KOA). The difference in therapeutic effects between radial shockwave characteristics (RaSW) and focused shockwave characteristics (FoSW) with different energy levels for KOA remains controversial. The purpose of this network meta-analysis (NMA) was to identify the effects relative to the different ESWT regime and combination treatments on pain and functional outcomes in individuals with KOA. The randomized controlled trials (RCTs) which investigated the efficacy of RaSW, FoSW, and combination treatments in patients with KOA were identified by searches of electronic databases. The included RCTs were analyzed through NMA and risk-of-bias assessment. We analyzed 69 RCTs with a total of 21 treatment arms in the NMA. Medium-energy FoSW plus physical therapy, medium-energy acupoint RaSW plus Chinese medicine, and high-energy FoSW alone were the most effective treatments for reducing pain [standard mean difference (SMD) = −4.51], restoring function (SMD = 4.97), and decreasing joint inflammation (SMD = −5.01). Population area and study quality influenced the treatment outcomes, particularly pain. Our findings indicate that medium-energy ESWT combined with physical therapy or Chinese medicine is beneficial for treating pain and increasing function in adults with KOA.
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Siebers HL, Eschweiler J, Michalik R, Migliorini F, Tingart M, Betsch M. Biomechanical compensation mechanisms during stair climbing - The effect of leg length inequalities. Gait Posture 2022; 91:290-296. [PMID: 34798420 DOI: 10.1016/j.gaitpost.2021.10.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 09/01/2021] [Accepted: 10/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Stair climbing is a complex and demanding daily activity with increased physical loads. Therefore, analyzing stair climbing abilities is a frequently used diagnostic tool. Leg length inequalities (LLIs) are a common condition in the population, with individual consequences like lower back pain, scoliosis, and osteoarthritis. Despite its high prevalence, the necessary treatment, for mild LLIs, is still controversial. Previously, the focus was to analyze the effects of LLIs during static standing and walking. To create a holistic view on the dynamic effects of LLIs, and since climbing stairs produces a similar biomechanical imbalance as LLIs, the compensation mechanics during stair climbing are of special interest. RESEARCH QUESTION What are the biomechanical compensation mechanisms of (simulated) LLIs during ascending and descending stairs? METHODS Thirty-five healthy participants were measured with the inertial measurement system MyoMotion during stair climbing with simulated LLIs of 0-3 cm. The maximum estimated lower limb joint angles of the long and short leg were analyzed with statistically repeated measurement models. RESULTS The long leg showed significantly increased hip and knee flexion, while the short leg showed decreased hip and knee flexion, decreased dorsiflexion, and significantly increased plantarflexion. Different mechanisms were found in the case of 1 cm LLI when compared to greater LLIs. In the former, increased hip and knee flexion in the short leg accompanied by increased dorsiflexion in the long leg was observed. In the latter, the dorsiflexion of the long leg was reduced. SIGNIFICANCE Except for the reduced dorsiflexion of the long leg (LLI >1 cm), during stair climbing compared compensation mechanisms as during walking were presented, with the long leg functionally shortened and the short leg lengthened. Although the feet were already on different levels, during stair climbing with the step-over-step technique, significant compensation mechanisms were found as a consequence of LLIs.
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Affiliation(s)
- Hannah Lena Siebers
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Roman Michalik
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of the University Heidelberg, Mannheim, Germany
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Almeida GPL, Monteiro IO, Dantas RGDO, Tavares MLA, Lima PODP. Reliability, validity and responsiveness of the Step Up and Down (StUD) test for individuals with symptomatic knee osteoarthritis. Musculoskelet Sci Pract 2021; 56:102454. [PMID: 34482195 DOI: 10.1016/j.msksp.2021.102454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/19/2021] [Accepted: 08/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stair climbing test (SCT) has been suggested as the first task affected in individuals with symptomatic knee osteoarthritis (KOA). However, there are environmental barriers for the execution of the 9- to 12-step SCT. Thus, we developed a feasible one-step SCT that could be completed in 15s. OBJECTIVE To check the clinimetric properties of the 15s Step Up and Down (StUD) test in individuals with KOA. DESIGN Prospective validity study. METHOD Eighty-two individuals with KOA participated in this study. The test-retest reliability of the StUD test was measured with a 1-week interval. The construct validity and responsiveness were assessed by testing predefined hypotheses. For this, the 30s Chair Stand Test (30CS), Timed Up and Go Test (TUG), quadriceps strength, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lequesne Algofunctional Index were used as comparator instruments. RESULTS The StUD test presented good test-retest reliability (ICC = 0.87; 95% CI = 0.79-0.91) and showed a moderate to good correlation with the 30CS (r = 0.65), TUG (r = -0.56), and quadriceps strength (r = 0.41). We found a higher correlation between the StUD test and the performance-based tests than the patient-reported outcome measures. The StUD test was responsive, with five out of the six (83.3%) hypotheses confirmed. CONCLUSION StUD test showed good reliability, adequate validity and responsiveness. Our findings suggest that StUD is a useful performance-based test for individuals with KOA.
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Affiliation(s)
- Gabriel Peixoto Leão Almeida
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Master Program in Physical Therapy and Functioning, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
| | - Isabel Oliveira Monteiro
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
| | | | - Maria Larissa Azevedo Tavares
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Master Program in Physical Therapy and Functioning, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
| | - Pedro Olavo de Paula Lima
- Knee and Sports Research Group, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Master Program in Physical Therapy and Functioning, Physical Therapy Department, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
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Şavkin R, Büker N, Güngör HR. The effects of preoperative neuromuscular electrical stimulation on the postoperative quadriceps muscle strength and functional status in patients with fast-track total knee arthroplasty. Acta Orthop Belg 2021; 87:735-744. [PMID: 35172441 DOI: 10.52628/87.4.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study aimed to investigate the effect of pre- operative neuromuscular electrical stimulation (NMES) on postoperative quadriceps muscle strength, functional status, and quality of life in patients with fast-track total knee arthroplasty (TKA). This prospective study was carried out at Orthopedics department from September 2017 to October 2018. A total of 40 patients were randomly divided into NMES (n=20) and control group (n=20). Patients in NMES group were asked to use home NMES device daily for 20 minutes, 5 times a day, for 6 weeks before surgery. The control group was placed on the 6-week waiting list for surgery without any preoperative intervention. Standard home exercise program was applied to both groups after discharge. The patients were evaluated baseline, preoperatively (6-weeks after baseline) and at the 4th and 12th weeks after surgery. Knee range of motion, quadriceps muscle strength, patient-reported (WOMAC and KOOS) and performance-based activity limitation (30-second chair-stand test, 40-meter fast-paced walk test, and stair-climb test) were evaluated at each visit. Preoperative NMES resulted in significant improvement in KOOS-function in daily living and WOMAC total score (p≤0.05) but had a non-significant trend toward to improve quadriceps muscle strength, KOOS-pain and -other symptoms, performance- based activity limitation, and quality of life scores (p>0.05). However, there was no significant difference between groups in the postoperative period (p>0.05). NMES has beneficial effects in terms of patient- reported and performance-based physical functions and quality of life in preoperative period ; however, it does not provide any additional benefit for post- operative outcomes in patients with fast-track TKA.
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Brodowski H, Andres N, Gumny M, Eicher C, Steinhagen-Thiessen E, Tannen A, Kiselev J. Reliability of stair-climbing speed in two cohorts of older adults. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims The ability to climb stairs is an important prerequisite for activities of daily living and social participation in older adults, and is therefore an important part of rehabilitation. However, there is no consensus on how to measure stair-climbing ability. The aim of this study was to investigate the test–retest reliability of the measurement of stair-climbing speed (steps per second) as a parameter for functional ability in older adults. Methods A total of 57 participants who were in hospital and 56 participants who were community-dwelling and did not have any limitations in activities in daily living, all aged 60 years and over, ascended and descended a set of 13 stairs twice. The halfway point of the staircase was marked in order to split the time required for both the ascending and the descending actions. Additional measurements consisted of the Functional Reach Test, the Timed Up and Go Test, walking ability using the GAITRite walkway system and the isometric strength of four muscle groups of the lower extremities using a handheld dynamometer. Results Test–retest reliability of the first and second half of the stair-climbing for both ascending and descending showed excellent results for the group of hospitalised participants (intraclass correlation coefficient, [ICC] 0.87, 95% confidence interval [CI] 0.79–0.93 to 0.94, 95% CI 0.9 – 0.97 for comparison of first vs second half of stair climbing; ICC 0.9, 95% CI 0.83-0.94 to ICC 0.95, 95% CI 0.92–0.97 for comparing first vs second measurement)) and moderate to excellent results for the group of community-dwelling participants with no limitations (ICC 0.58, 95% CI 0.37–0.73 to ICC 0.76, 95% 95% CI 0.63-0.85 for comparison of first vs second half of stair climbing; ICC 0.82, 95% CI 0.71-0.89 to 0.92, 95% CI 0.87–0.95 for comparing first vs second measurement). As expected, hospitalised participants took significantly longer descending than ascending stairs (t(56)=6.98, P<0.001, d=0.93). A general and significant trend of increasing speed while descending could be observed in both groups (performing paired sample t-tests). Conclusions The results indicate that stair-climbing speed is not constant and that different patterns exist in older adults who have no limitations and in those who are hospitalised. The use of stair-climbing speed as an assessment tool should include both stair ascent and descent, because differences in these speeds seem to be indicators of stair-climbing ability.
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Affiliation(s)
- Hanna Brodowski
- Institute of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck University of Luebeck, Luebeck, Germany
- Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Natascha Andres
- Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Margareta Gumny
- Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Cornelia Eicher
- Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Elisabeth Steinhagen-Thiessen
- Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Divison of Lipid Metabolism of the Department of Endocrinology and Metabolic Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Antje Tannen
- Institute of Health and Nursing Science, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Joern Kiselev
- Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Corporate Member of Function Reacheie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Anesthesiology and Intensive Care Medicine, Campus, Charité Mitte, Corporate Member of Function Reacheie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Miozzari HH, Armand S, Turcot K, Lübbeke A, Bonnefoy-Mazure A. Gait Analysis 1 Year after Primary TKA: No Difference between Gap Balancing and Measured Resection Technique. J Knee Surg 2021; 34:898-905. [PMID: 31891961 DOI: 10.1055/s-0039-3402079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mechanical alignment in total knee arthroplasty (TKA) can be achieved using dependent bone cuts. The hypothesis is that patients have a better balanced TKA, as a result. The aim of this study was to determine if this technique is superior to an independent bone cut technique in terms of gait parameters, patient-reported outcome measures (PROMs), and satisfaction assessed before surgery and at 1-year follow-up. A total of 58 patients were evaluated before and 1 year following TKA, using the Press Fit Condylar (PFC) Sigma posterior stabilizer (PS) design; 39 (70 ± 8 years; 27 women) with independent bone cuts and 19 (71 ± 7 years; 12 women) with dependent bone cuts using the Specialist TRAM. Gait was evaluated with a three-dimensional motion analysis system for spatiotemporal and kinematics parameters. Pain and functional levels were assessed using the Western Ontario and McMaster Universities arthritis index (WOMAC); general health was assessed by the short form (SF)-12. Global satisfaction, as well as patient satisfaction, related to pain and functional levels were assessed using a five-point Likert's scale. No significant difference was found between both groups in terms of age, body mass index, pain, and functional levels at baseline. At 1-year follow-up, despite an overall improvement in gait, WOMAC, SF-12 physical score and pain, none of the patients showed gait parameters comparable to a healthy control group. No surgical technique effect was observed on gait, clinical outcomes, and satisfaction level. While observing an overall improvement at 1-year follow-up, we did not find any significant difference between the two surgical techniques in terms of gait parameters, patients' outcomes, and satisfaction.
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Affiliation(s)
- Hermes H Miozzari
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Armand
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Katia Turcot
- Department of Kinesiology, Laval University, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec, Canada
| | - Anne Lübbeke
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals, Geneva, Switzerland
| | - Alice Bonnefoy-Mazure
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Kim BS, Lee SY, Kim BR, Choi JH, Kim SR, Lee HJ, Lee SJ. Associations Between Obesity With Low Muscle Mass and Physical Function in Patients With End-Stage Knee Osteoarthritis. Geriatr Orthop Surg Rehabil 2021; 12:21514593211020700. [PMID: 34104532 PMCID: PMC8165869 DOI: 10.1177/21514593211020700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/16/2022] Open
Abstract
Objective To investigate the prevalence of obesity with low muscle mass and its impact on physical function, quality of life (QOL) and pain in patients with end-stage knee osteoarthritis over 65 years old. Methods In this cross-sectional study, we assessed a total of 562 patients. After separating the group into males and females, we divided patients into 4 further groups: normal BMI with normal muscle mass, obesity with normal muscle mass, normal BMI with low muscle mass and obesity with low muscle mass. All patients completed stair climbing test (SCT), 6-minute walk test, timed up and go test (TUG), instrumental gait analysis, Western Ontario McMaster Universities Osteoarthritis Index, VAS, and EuroQOL 5 dimensions questionnaire. Results Obesity with low muscle mass was diagnosed in 6 males subjects (7.8%) and 9 female subjects (1.9%). Patients with obesity and low muscle mass performed the SCT-ascent and descent significantly slower than other body composition groups in both males and females. TUG in males and gait speed in females were also significantly slower in the obesity with low muscle mass group. Stepwise multiple linear regression analysis revealed that in males, obesity with low muscle mass was significantly predictive of SCT ascent (β = 0.409, p < 0.001), SCT-descent (β = 0.405, p < 0.001), and TUG (β = 0.283, p = 0.009), and in females, obesity with low muscle mass was significantly predictive of SCT-ascent (β = 0.231, p < 0.001), SCT-descent (β = 0.183, p < 0.001), and gait speed (β=-0.129, p = 0.004). Conclusions This study confirms that the combination of obesity and low muscle mass is associated with impaired physical function in patients with end-stage knee osteoarthritis.
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Affiliation(s)
- Beom Su Kim
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jun Hwan Choi
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Sang Rim Kim
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Hyun Jung Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Su Jong Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
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12
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Casaña J, Calatayud J, Silvestre A, Sánchez-Frutos J, Andersen LL, Jakobsen MD, Ezzatvar Y, Alakhdar Y. Knee Extensor Muscle Strength Is More Important Than Postural Balance for Stair-Climbing Ability in Elderly Patients with Severe Knee Osteoarthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073637. [PMID: 33807414 PMCID: PMC8037849 DOI: 10.3390/ijerph18073637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 12/03/2022]
Abstract
Knee osteoarthritis is a chronic joint disease which damages articular cartilage. In its severe stages, it results in impairments in balance and muscle strength loss, which affect daily life activities such as walking or climbing stairs. This study sought to investigate associated factors with stair-climbing ability in this population, with special interest in measuring the relevance of postural balance for this task. Forty-four patients scheduled to undergo unilateral total knee arthroplasty were assessed. Timed up and go test, stair ascent–descent test, three different isometric strength tests (knee flexion, knee extension and hip abduction), active knee extension and flexion range of movement and static postural balance assessment were evaluated. Spearman’s correlation coefficients and multiple linear regression analysis determined the strength of association between the different variables and stair-climbing time. No significant association between the stair-climbing time and static balance was found. Significant associations were found between stair-climbing time and timed up and go (r = 0.71; p < 0.0001) and maximal knee extensor strength (r = –0.52; p = 0.0003). One-year increase in age was associated with 0.15 s (95% CI 0.00 to 0.30) slower stair-climbing time. In conclusion, muscle strength is more important than postural balance for stair-climbing ability in this population.
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Affiliation(s)
- José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (J.C.); (Y.E.)
- Department of Physical Therapy, University of Valencia, 46010 Valencia, Spain; (J.S.-F.); (Y.A.)
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (J.C.); (Y.E.)
- Department of Physical Therapy, University of Valencia, 46010 Valencia, Spain; (J.S.-F.); (Y.A.)
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark; (L.L.A.); (M.D.J.)
- Correspondence:
| | - Antonio Silvestre
- Department of Orthopaedic Surgery, Clinic Hospital of Valencia, 46010 Valencia, Spain;
- Department of Orthopaedic Surgery, School of Medicine, Valencia University, 46010 Valencia, Spain
| | - José Sánchez-Frutos
- Department of Physical Therapy, University of Valencia, 46010 Valencia, Spain; (J.S.-F.); (Y.A.)
| | - Lars L. Andersen
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark; (L.L.A.); (M.D.J.)
- Sport Sciences, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Markus D. Jakobsen
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark; (L.L.A.); (M.D.J.)
| | - Yasmín Ezzatvar
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (J.C.); (Y.E.)
- Department of Physical Therapy, University of Valencia, 46010 Valencia, Spain; (J.S.-F.); (Y.A.)
| | - Yasser Alakhdar
- Department of Physical Therapy, University of Valencia, 46010 Valencia, Spain; (J.S.-F.); (Y.A.)
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13
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Lebleu J, Fonkoue L, Bandolo E, Fossoh H, Mahaudens P, Cornu O, Detrembleur C. Lower limb kinematics improvement after genicular nerve blockade in patients with knee osteoarthritis: a milestone study using inertial sensors. BMC Musculoskelet Disord 2020; 21:822. [PMID: 33287783 PMCID: PMC7722305 DOI: 10.1186/s12891-020-03836-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 11/25/2020] [Indexed: 01/01/2023] Open
Abstract
Background Genicular nerve blockade is a possible treatment for patients with knee osteoarthritis. Pain relief and improvement in functioning is expected. This procedure could be of major interest for patients in low-income countries where total knee arthroplasty is not available for the population. This study aims at assessing the immediate benefits on pain, gait, and stairs kinematics after a genicular nerve blockade in patients suffering from knee osteoarthritis in Cameroun. Methods A prospective study was carried out on 26 subjects in Cameroun. A genicular nerve blockade was performed on 14 women with painful knee osteoarthritis grade 2–4. Lower limb joint angles were recorded with inertial sensors before and 1 h after injection. Patient-reported outcomes of pain and perceived difficulty were collected, as well as 10 m and 6 min walking tests. A reliability analysis of inertial sensors was performed on a sample of 12 healthy subjects by calculating the intraclass correlation coefficient and the standard error of measurement. Results Pain and perceived difficulty decreased significantly (p < 0.001). Cadence increased significantly in stairs climbing (upstairs: + 7.7 steps/min; downstairs: + 7.6 steps/min). There was an improvement for hip sagittal range of motion during gait (+ 9.3°) and pelvis transverse range of motion in walking upstairs (− 3.3°). Angular speed range of the knee in the sagittal plane and of the hip in the frontal plane increased significantly in stairs descent (+ 53.7°/s, + 94.5°/s). Conclusions This study quantified improvement of gait and stair climbing immediately after a genicular nerve blockade in patients suffering from knee OA in Cameroon. This is the first study objectifying this effect, through wearable sensors. Trial registration Pan African Clinical Trial Registry, PACTR202004822698484. Registered 28 March 2020 - Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03836-8.
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Affiliation(s)
- Julien Lebleu
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Secteur des Sciences de la Santé, Avenue Mounier 53, B-1200, Brussels, Belgium.
| | - Loic Fonkoue
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Secteur des Sciences de la Santé, Avenue Mounier 53, B-1200, Brussels, Belgium.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, PO Box 1364, Yaoundé, Cameroon
| | - Eric Bandolo
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, PO Box 1364, Yaoundé, Cameroon.,Centre Hospitalier Saint Martin De Porres, PO Box 185, Yaoundé, Cameroon
| | - Herman Fossoh
- Centre Hospitalier Saint Martin De Porres, PO Box 185, Yaoundé, Cameroon
| | - Philippe Mahaudens
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Secteur des Sciences de la Santé, Avenue Mounier 53, B-1200, Brussels, Belgium.,Cliniques Universitaires Saint-Luc, Service d'orthopédie et de traumatologie de l'appareil locomoteur, Avenue Hippocrate 10, B-1200, Brussels, Belgium
| | - Olivier Cornu
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, PO Box 1364, Yaoundé, Cameroon
| | - Christine Detrembleur
- Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Secteur des Sciences de la Santé, Avenue Mounier 53, B-1200, Brussels, Belgium
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Holm PM, Kemnitz J, Bandholm T, Wernbom M, Schrøder HM, Skou ST. Muscle Function Tests as Supportive Outcome Measures for Performance-Based and Self-Reported Physical Function in Patients With Knee Osteoarthritis: Exploratory Analysis of Baseline Data From a Randomized Trial. J Strength Cond Res 2020; 36:2635-2642. [PMID: 33021580 DOI: 10.1519/jsc.0000000000003840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Holm, PM, Kemnitz, J, Bandholm, T, Wernbom, M, Schrøder, HM, and Skou, ST. Muscle function tests as supportive outcome measures for performance-based and self-reported physical function in patients with knee osteoarthritis: Exploratory analysis of baseline data from a randomized trial. J Strength Cond Res XX(X): 000-000, 2020-Uncertainty on the role of muscle function in relation to physical function in knee osteoarthritis (KOA) persists. This study aimed to assess the associations between muscle function and performance-based and self-reported physical function in patients with KOA. Physical function in 80 subjects with symptomatic and radiographic KOA was assessed using 40-m fast-paced walk, 30-second chair stand, 9-step stair climb tests, and the subscale activities of daily living from the Knee injury and Osteoarthritis Outcome Score (KOOS-ADL). Measurements of muscle function included leg extension (LE) power, knee extension (KE) torque, and estimated leg press one repetition maximum (LP RM). Associations were investigated using multivariable hierarchical linear regressions adjusted for age, sex, body mass index, self-reported physical activity, and thigh muscle lean area. Leg extension power was significantly associated with 40-m walk, stair climb, and 30-second chair stand, explaining 18, 8, and 3% of additional variance, respectively. Knee extension torque explained 13, 7, 17, and 7% of additional variance in the 40-m walk, stair climb, 30-second chair stand, and KOOS-ADL, respectively. Leg press one repetition maximum explained 11% of additional variance in the 30-second chair stand. In conclusion, LE power was the best explanatory variable for performance on the 40-m walk and stair climb tests, whereas KE torque best explained chair stand performance. Only KE torque was associated with KOOS-ADL. Our results highlight the importance of selecting supportive muscle function tests based on the specific physical function and suggest that other factors may be more important for certain physical function outcomes. Level of significance p < 0.05. Trial identifier: NCT03215602.
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Affiliation(s)
- Pætur Mikal Holm
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Jana Kemnitz
- Institute of Anatomy & Department of Imaging and Functional Musculoskeletal Research, Paracelsus Medical University Salzburg, Salzburg, Austria.,Chondrometrics GmbH Ainring, Ainring, Germany.,Department of Computer Science, University of Vienna, Vienna, Austria
| | - Thomas Bandholm
- Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research, Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark.,Clinical Research Center, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
| | - Mathias Wernbom
- Department of Food and Nutrition and Sport Science, Center for Health and Performance, University of Gothenburg, Gothenburg, Sweden.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Søren Thorgaard Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
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15
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Song Q, Shen P, Mao M, Sun W, Zhang C, Li L. Proprioceptive neuromuscular facilitation improves pain and descending mechanics among elderly with knee osteoarthritis. Scand J Med Sci Sports 2020; 30:1655-1663. [PMID: 32407583 DOI: 10.1111/sms.13709] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/15/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Knee osteoarthritis (KOA) is a common disease that causes pain and limits functionality in the elderly during daily activities, especially during stair descent. Proprioceptive neuromuscular facilitation (PNF) practices promote multiple-plane joint movements, which relieve pain and increase joint range of motion (ROM). This study aims to examine the effects of a 12-week PNF intervention on pain relief, passive and active joint ROM, external knee adduction moment (KAM), and hip adduction moment (HAM) in the elderly with KOA during stair descent. MATERIALS AND METHODS Seventy-six elderly who were diagnosed with KOA were assessed for eligibility and, 36 of them met the inclusive criteria, were randomly divided into two groups: the twelve-week PNF intervention group and the control group. Pain score was measured by the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Passive joint ROM was measured using a goniometer. Active joint ROM, KAM, and HAM during stair descent were measured using a motion analysis system with a force platform. All the data were recorded at weeks 0, 6, and 12. RESULTS Compared to the control group, the PNF group showed a decreased pain score; increased passive hip, knee, and ankle ROM; a decreased minimum knee flexion angle, and increased HAM during stair descent. PERSPECTIVE Proprioceptive neuromuscular facilitation intervention is a successful method to relieve symptoms of KOA. It relieves pain without increasing KAM, enhances passive ROM, increases active knee flexion ROM, and increases HAM during stair descent in the elderly with KOA.
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Affiliation(s)
- Qipeng Song
- Shandong Sport University, Jinan, China.,Georgia Southern University, Statesboro, GA, USA
| | | | - Min Mao
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wei Sun
- Shandong Institute of Sport Science, Jinan, China
| | - Cui Zhang
- Shandong Institute of Sport Science, Jinan, China
| | - Li Li
- Georgia Southern University, Statesboro, GA, USA.,Shanghai University of Sport, Shanghai, China
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16
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Suzuki Y, Iijima H, Aoyama T. Pain catastrophizing affects stair climbing ability in individuals with knee osteoarthritis. Clin Rheumatol 2019; 39:1257-1264. [DOI: 10.1007/s10067-019-04881-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/26/2019] [Accepted: 12/04/2019] [Indexed: 11/27/2022]
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17
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Koyama Y, Tateuchi H, Araki K, Fujita K, Umehara J, Kobayashi M, Ichihashi N. Mechanical energy efficiency for stepping up and down in persons with medial knee osteoarthritis. Gait Posture 2019; 69:143-149. [PMID: 30716670 DOI: 10.1016/j.gaitpost.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/08/2018] [Accepted: 01/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Energetic cost contributes to movement impairments observed during stair negotiation in persons with knee osteoarthritis. Specifically, the intersegmental mechanical energy exchange may be diminished in the presence of pathologies. RESEARCH QUESTION The purpose of this study was to evaluate mechanical energy efficiency in persons with knee osteoarthritis during stepping up and down based on mechanical energy analysis. METHODS Sixteen patients with medial knee osteoarthritis and 16 age-matched controls participated. A three-dimensional motion analysis system and force platforms were used to acquire biomechanical data. The participants were instructed to ascend/descend a 2-step staircase. The mechanical power exhibited during the stance phase at the lower step of the staircase were computed. Mechanical Energy Expenditure (MEE) was calculated as the integral of net joint power at each joint. Mechanical Energy Compensation (MEC) was defined as the proportion of muscle energy compensated by inter-segmental energy transfer. According to energy transfer modes, MEE and MEC were determined separately as three phases: concentric and eccentric transfer phases and no-transfer phase. RESULTS While stepping up, the patient group performed the task with less MEC at the ankle joint, which was observed prior to push-off. The patient group displayed less mechanical energy transfer from the shank to the foot segment. The concentric MEC at the hip joint in the late-stance phase of stepping down was lower in the patient group, which meant patients demonstrated less mechanical energy transfer from the pelvis to the thigh segment. SIGNIFICANCE It was disclosed that persons with knee osteoarthritis demonstrated less mechanical energy transfer while stepping up and down.
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Affiliation(s)
- Yumiko Koyama
- Kobayashi Orthopedic Clinic, Kyoto, Japan; Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Hiroshige Tateuchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Koujiro Araki
- Department of Rehabilitation, Sapporo Tokushukai Hospital, Sapporo, Japan.
| | - Kosuke Fujita
- Rehabilitation Group, Department of Medical Technique, Nagoya University Hospital, Nagoya, Japan.
| | - Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | | | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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18
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Devasenapathy N, Maddison R, Malhotra R, Zodepy S, Sharma S, Belavy DL. Preoperative Quadriceps Muscle Strength and Functional Ability Predict Performance-Based Outcomes 6 Months After Total Knee Arthroplasty: A Systematic Review. Phys Ther 2019; 99:46-61. [PMID: 30329137 DOI: 10.1093/ptj/pzy118] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 05/23/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND One-third of individuals report limitations in activities of daily living even 6 months after total knee arthroplasty (TKA). Moderate-quality evidence exists for several sociodemographic and clinical predictors of patient-reported outcome measures of perceived functionality. Objectively measured performance-based measures (PBMs) provide a less subjective approach to informing patient treatment after TKA; however, information about predictors of functionally relevant PBMs is scarce. PURPOSE This systematic review synthesized the available research on preoperative predictors of PBMs after primary TKA for osteoarthritis. DATA SOURCES In June 2016 and January 2017, MEDLINE, EMBASE, and PsycINFO databases were searched. STUDY SELECTION Cohort studies exploring preoperative predictors of stair climbing, walking speed, and gait speed measured ≥6 months after primary TKA were included. Screening of abstracts and selection of full texts were undertaken by 2 independent reviewers. DATA EXTRACTION Information on study design, patient characteristics, analysis, and results was extracted using pilot-tested forms. Two independent reviewers assessed risk of bias using modified Quality in Prognostic Studies criteria. DATA SYNTHESIS Of the eligible 12 studies involving 6 prospective cohorts, 10 studies reported information on baseline predictors. Meta-analysis of predictors was not possible because of missing information on effect size or standard errors. Narrative synthesis of evidence of predictors was therefore performed. LIMITATIONS The quality of evidence was low because of the risk of bias and heterogeneity of included studies as well as nonreporting of measures of effect. CONCLUSIONS Low-quality evidence exists for an association of preoperative functional ability and quadriceps muscle strength with functionality at 6 months after TKA. Improved reporting of predictor analyses is needed to enable evidence generation for clinical management.
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Affiliation(s)
- Niveditha Devasenapathy
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Plot 47, Sec 44, Institutional Area, Gurgaon-122002, Haryana, India; and School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Ralph Maddison
- Physical Activity and Disease Prevention, School of Exercise and Nutrition Sciences, Deakin University
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Zodepy
- Indian Institute of Public Health-Delhi, Public Health Foundation of India
| | | | - Daniel L Belavy
- Exercise and Musculoskeletal Health, School of Exercise and Nutrition Sciences, Deakin University
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Dai Z, Li Y, Yan Y, Wan R, Ran Q, Lu W, Qiao B, Li H. Evaluation of the internal fixation effect of nano-calcium-deficient hydroxyapatite/poly-amino acid composite screws for intraarticular fractures in rabbits. Int J Nanomedicine 2018; 13:6625-6636. [PMID: 30425478 PMCID: PMC6201990 DOI: 10.2147/ijn.s173358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective To evaluate the internal fixation effect of nano-calcium-deficient hydroxyapatite/poly-amino acid (n-CDHA/PAA) composite screws in the intraarticular fracture model. Materials and methods A total of 35 New Zealand White rabbits were used in a bilateral femoral intercondylar fracture model and randomly divided into two groups. n-CDHA/PAA screws were used in the experimental group, and medical metal screws were used in the control group. The fracture condition, range of motion, and the screw push-out strength were assessed, and an arthroscopic examination of knee joint was performed at 4, 8, and 12 weeks after surgery. The biodegradation of the n-CDHA/PAA screws in vivo was tested through weighing, and changes in screw structure were assessed by X-ray diffraction at 12 weeks after surgery. Results The general situation of all animals was good and showed no incision infection and dehiscence after surgery. X-ray scanning showed that significant callus growth was present in both groups at 4 weeks after surgery, and there was no significant difference (P>0.05) in the Lane-Sandhu score between the experimental and control groups at all time points after surgery. There were no statistically significant differences (P>0.05) in the range of motion and Oswestry Arthroscopy Score of arthroscopic examination of the knee joints between the two groups. The screw push-out strength of the control group was stronger than that of the experimental group at 4 weeks after surgery (P<0.05), but after that, there was no significant difference between the groups (P>0.05). The degradation tests showed that the n-CDHA/PAA screws degraded gradually after implantation, and the weight loss rate was approximately 16% at 12 weeks after surgery. The X-ray diffraction results showed that the crystal structure of the outer surface of the n-CDHA/PAA screw has changed at 12 weeks after surgery. Conclusion The n-CDHA/PAA screw is an effective and safe implant as a potential internal fixation device for an intercondylar fracture of the femur, and its internal fixation effect was similar to that of medical metal screw.
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Affiliation(s)
- Zhenyu Dai
- Department of Orthopedics, Chongqing Traditional Chinese Medicine Hospital, Chongqing, People's Republic of China,
| | - Yue Li
- Department of Clinical Laboratory, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yonggang Yan
- College of Physical Science and Technology, Sichuan University, Chengdu, People's Republic of China,
| | - Ruijie Wan
- Department of Orthopedics, Chongqing Traditional Chinese Medicine Hospital, Chongqing, People's Republic of China,
| | - Qiang Ran
- Department of Orthopedics, Chongqing Traditional Chinese Medicine Hospital, Chongqing, People's Republic of China,
| | - Weizhong Lu
- Department of Orthopedics, Chongqing Traditional Chinese Medicine Hospital, Chongqing, People's Republic of China,
| | - Bo Qiao
- Department of Orthopedics, the First Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Hong Li
- College of Physical Science and Technology, Sichuan University, Chengdu, People's Republic of China,
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20
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Hammett T, Simonian A, Austin M, Butler R, Allen KD, Ledbetter L, Goode AP. Changes in Physical Activity After Total Hip or Knee Arthroplasty: A Systematic Review and Meta-Analysis of Six- and Twelve-Month Outcomes. Arthritis Care Res (Hoboken) 2018; 70:892-901. [PMID: 28898559 DOI: 10.1002/acr.23415] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 09/05/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Little is known about the extent to which physical activity (PA) levels change following total knee or hip joint replacement relative to pain, physical function, and quality of life. Our objective was to conduct a systematic review and meta-analysis on changes in PA relative to pain, quality of life, and physical function after total knee or hip joint replacement. METHODS We searched the PubMed (Medline), Embase, and CINAHL databases for peer-reviewed, English-language cohort studies measuring PA with an accelerometer from presurgery to postsurgery. Random-effects models were used to produce standardized mean differences (SMDs) for PA, quality of life, pain, and physical function outcomes. Heterogeneity was assessed using I2 . RESULTS Seven studies (336 participants) met the eligibility criteria. No significant increase in PA was found at 6 months (SMD 0.14 [95% confidence interval (95% CI) -0.05, 0.34]; I2 = 0%) and a small to moderately significant effect was found for increasing PA at 12 months (SMD 0.43 [95% CI 0.22, 0.64]; I2 = 0%). Large improvements were found at 6 months in physical function (SMD 0.97 [95% CI 0.12, 1.82]; I2 = 92.3%), pain (SMD -1.47 [95% CI -2.28, -0.65]; I2 = 91.6%), and quality of life (SMD 1.02 [95% CI 0.30, 1.74]; I2 = 83.2%). CONCLUSION Physical activity did not change at 6 months, and a small to moderate improvement was found at 12 months postsurgery, despite large improvements in quality of life, pain, and physical function. Reasons for the lack of increased PA are unknown but may be behavioral in nature, as a sedentary lifestyle is difficult to change. Changing sedentary behavior should be a future focus of research in this subgroup.
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Affiliation(s)
- Thomas Hammett
- Duke University School of Medicine, Durham, North Carolina
| | - Aram Simonian
- Duke University School of Medicine, Durham, North Carolina
| | - Monica Austin
- Duke University School of Medicine, Durham, North Carolina
| | | | - Kelli D Allen
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill
| | - Leila Ledbetter
- Duke University Medical Center Library, Durham, North Carolina
| | - Adam P Goode
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina
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Innocenti M, Mancini M, Faccio M, Carulli C, Buselli P, Messina S, Quattrone G, Spaggiari P. The Use of a High-Tech Knee Pad for Reduction of the Postoperative Effusion after Total Knee Arthroplasty. JOINTS 2017; 5:7-11. [PMID: 29114623 PMCID: PMC5672854 DOI: 10.1055/s-0037-1601406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Purpose
After total knee arthroplasty (TKA), pain and swelling, especially in older and less cooperative patients, can limit the retrieval of a good range of motion and muscle tone and consequently the achievement of an optimal function outcome. A high-tech knee pad made of metal fibers emitting infrared energy was used in a group of patients undergoing TKA to assess its efficacy in the postoperative period with respect to a group with a placebo.
Methods
Twelve patients used knee pads after surgery for 3 weeks and were evaluated using visual analog scale (VAS), Knee Society Rating Score, Cincinnati Knee Rating Score, and painkillers at specific timings.
Results
At 3 weeks, all scores improved in a significant manner in the treated group compared with the placebo group. At 2 months after surgery, VAS was better in the study group than the control group, whereas other parameters were similar. However, the use of rescue drugs was less in the study group than in the placebo group.
Conclusion
A high-tech knee pad may contribute to a faster recovery within the first week after a knee replacement, limiting the use of painkillers and allowing a quick functional recovery by the control of pain and postoperative effusion.
Level of Evidence
Level II, randomized prospective study with small sample size.
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Affiliation(s)
| | - Michele Mancini
- Department of Orthopaedics, University of Florence, Florence, Italy
| | - Marina Faccio
- Department of Orthopaedics, University of Florence, Florence, Italy
| | | | - Paolo Buselli
- Department of Rehabilitation, Azienda Ospedaliera Istituti Ospitalieri, Cremona, Italy
| | - Sara Messina
- Department of Rehabilitation, Azienda Ospedaliera Istituti Ospitalieri, Cremona, Italy
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Moyer R, Birmingham T, Dombroski C, Walsh R, Giffin JR. Combined versus individual effects of a valgus knee brace and lateral wedge foot orthotic during stair use in patients with knee osteoarthritis. Gait Posture 2017; 54:160-166. [PMID: 28301825 DOI: 10.1016/j.gaitpost.2017.02.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/21/2017] [Accepted: 02/28/2017] [Indexed: 02/02/2023]
Abstract
The aim of this study was to investigate the combined and individual biomechanical effects of a valgus knee brace and a lateral wedge foot orthotic during stair ascent and descent in patients with knee osteoarthritis (OA). Thirty-five patients with varus alignment and medial knee OA were prescribed a custom valgus knee brace and lateral wedge foot orthotic. Knee angles and moments in the frontal and sagittal planes were determined from 3D gait analysis completed under four randomized conditions: (1) control (no knee brace or foot orthotic), (2) knee brace, (3) foot orthotic, and (4) combined knee brace and foot orthotic. Additional measures included the vertical ground reaction force, trunk lean, toe out and gait speed. During the combined use of a knee brace and foot orthotic, significant decreases in the knee adduction angle (2.17, 95%CI: 0.50-3.84, p=0.013) and 2nd peak EKAM (0.35, 95%CI: 0.17-0.52, p<0.001) were observed during stair descent; and significant increases in the EKFM were observed during stair ascent (0.54, 95%CI: 0.30-0.78, p<0.001) and descent (1stpk: 0.48, 95%CI: 0.15-0.80, p=0.005; 2ndpk: 0.55, 95%CI: 0.34-0.76, p<0.001). Fewer gait compensations were observed between conditions during stair descent compared to ascent, except for toe out. Findings suggest greater effects on gait when both knee brace and foot orthotic are used together, resulting in a more normal gait pattern. However, whether or not a true change in knee joint load can be inferred when using these orthoses remains unclear. Further research is required to determine the clinical importance of the observed changes.
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Affiliation(s)
- Rebecca Moyer
- School of Physiotherapy, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Trevor Birmingham
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario, Canada; School of Physical Therapy, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada.
| | - Colin Dombroski
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario, Canada
| | - Robert Walsh
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario, Canada
| | - J Robert Giffin
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario, Canada; Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
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Akbaba YA, Yeldan I, Guney N, Ozdincler AR. Intensive supervision of rehabilitation programme improves balance and functionality in the short term after bilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:26-33. [PMID: 25037985 DOI: 10.1007/s00167-014-3179-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 07/08/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the short-term results of the rehabilitation programme with two different supervision on balance and functionality after simultaneously bilateral total knee arthroplasty (SBTKA) in patients with osteoarthritis and to compare the results with those of healthy individuals. METHODS This study was a single-blind randomized controlled study. Two exercise groups who underwent primary bilateral total knee arthroplasty (Group 1, n = 20 and Group 2, n = 20) and a control group of healthy individuals (Group 3, n = 20) included in the study. Group 1 applied exercise programme with intensive supervision of the physiotherapist for a period of 1 month (2 days/1 week). Group 2 performed exercise programme under the control of same physiotherapist twice monthly (1 day/2 weeks), and the patients were checked every week by telephone interview. Pre-operative and post-operative blind evaluations were made at first and second month. Static balance with single leg stance test, dynamic balance with timed get up & go (TGUG), functionality with walking cadence, stair climbing test (SCT) and Western Ontario McMaster Universities (WOMAC) index were assessed. RESULTS Group 1 improved statistically significantly better in terms of SLST (p = 0.0 (right), p = 0.0 (left)) and WOMAC function (p = 0.0) at first month, and SLST (p = 0.0), TGUG (p = 0.0), SCT (p = 0.0), WOMAC pain (p = 0.0), stiffness (p = 0.0) and function (p = 0.0) at second month. In Group 1, TGUG, walking cadence, SCT, WOMAC pain, stiffness and function results reached the levels of healthy individuals at second month, and SLST was better for two legs as compared to healthy individuals. In Group 2, cadence results were similar to healthy individuals at second month. CONCLUSIONS The osteoarthritis patients who had the applied rehabilitation programme after SBTKA with intensive supervision of the physiotherapist for 1 month have obtained more improvements in balance and functional parameters, and it was demonstrated that their performances approached the healthy control group values. As a clinical relevance of our study, intensive supervision of rehabilitation programme should be provided to the patients after SBTKA surgery to accomplish early balance and functional improvements.
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Affiliation(s)
- Yıldız Analay Akbaba
- Department of Orthopaedics and Traumatology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ipek Yeldan
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Istanbul, Turkey. .,Fizyoterapi ve Rehabilitasyon Bolumu, Saglık Bilimleri Fakultesi, Bakırköy Ruh ve Sinir Hastalıkları Hastanesi Bahçesi içi, Istanbul Universitesi, Demirkapı Cad. Karabal Sk., Bakırköy, 34740, Istanbul, Turkey.
| | - Nejat Guney
- Department of Orthopaedics and Traumatology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Arzu Razak Ozdincler
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Istanbul, Turkey
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Smith JW, Marcus RL, Tracy BL, Foreman KB, Christensen JC, LaStayo PC. Stance time variability during stair stepping before and after total knee arthroplasty: A pilot study. Hum Mov Sci 2015; 45:53-62. [PMID: 26590484 DOI: 10.1016/j.humov.2015.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 11/01/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
The main objectives of this pilot study were to: (1) investigate stance time variability (STV) during stair stepping in older adults with osteoarthritis (OA) before and after total knee arthroplasty (TKA), and compare to an age- and sex-matched group of healthy controls with native knees and (2) evaluate the relationship between quadriceps strength and STV during stair stepping before and after TKA. A prospective, observational, pilot study was carried out on 13 individuals (15% male, mean age 62.71±6.84years) before and after TKA using an instrumented stairway, patient-reported outcomes, timed stair stepping test, and quadriceps strength measures. At 6-months post-operatively, STV during stair descent was significantly greater in the TKA-GROUP compared to the CONTROL-GROUP, but was not significantly different at 12-months compared to controls. There were no significant differences in STV for stair ascent between the pre- and post-operative visits, or compared to controls. There was a trend toward significance for the relationship between quadriceps strength and STV during stair ascent (P=0.059) and descent (P=0.073). Variability during stair stepping may provide an important, short-term rehabilitation target for individuals following TKA and may represent another parameter to predict declines in functional mobility.
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Affiliation(s)
- Jessica W Smith
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA; Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA.
| | - Robin L Marcus
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA; Department of Exercise and Sport Science, University of Utah, Salt Lake City, UT, USA
| | - Brian L Tracy
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - K Bo Foreman
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA; Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Jesse C Christensen
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA; Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Paul C LaStayo
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA; Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA; Department of Orthopedics, University of Utah, Salt Lake City, UT, USA; Department of Exercise and Sport Science, University of Utah, Salt Lake City, UT, USA
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Queen RM, Attarian DE, Bolognesi MP, Butler RJ. Bilateral symmetry in lower extremity mechanics during stair ascent and descent following a total hip arthroplasty: a one-year longitudinal study. Clin Biomech (Bristol, Avon) 2015; 30:53-8. [PMID: 25467379 DOI: 10.1016/j.clinbiomech.2014.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total hip arthroplasty is the standard treatment to reduce pain and improve function in people with advanced hip osteoarthritis; however, persisting asymmetrical gait patterns have been identified in level walking. Therefore, this study evaluated limb asymmetries during stair ascent and descent in patients pre-operatively through 1 year after a hip replacement. It was hypothesized that lower extremity mechanics would improve on the surgical side, but asymmetries would persist through one year. METHODS Kinematics and kinetics were collected during seven ascending and descending trials pre-operatively, 6 weeks, and 1 year post-operatively for 42 hip replacement patients. Data were analyzed using 2 ∗ 3 (Limb ∗ Time) within-subject repeated measures analyses of variance (ANOVAs) to determine significant differences between limbs across time (P<.05). FINDINGS Significant changes across time, independent of limb included: peak hip flexion, extension, and adduction during ascent. Peak hip flexion and extension, hip flexion moment, adduction and abduction moments, and propulsive vertical ground reaction force were different during descent (P<.05). Independent of time, significant asymmetries between limbs were observed in peak hip flexion, hip abduction, and hip extension moments during ascent, and in peak hip abduction moment during descent (P<.05). INTERPRETATION Abnormal movement patterns on the surgical side increase demands on other joints and could lead to permanent joint damage. These side-to-side differences in joint mechanics should be addressed during the early post-operative period through additional interventions in an attempt to normalize the differences and potentially improve long-term joint health throughout the lower extremity.
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Affiliation(s)
- Robin M Queen
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3956, Durham, NC 27710, USA; Michael W. Krzyzewski Human Performance Research Laboratory, DUMC 3435, Duke University Medical Center, Durham, NC 27710, USA.
| | - David E Attarian
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3956, Durham, NC 27710, USA
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3956, Durham, NC 27710, USA
| | - Robert J Butler
- Michael W. Krzyzewski Human Performance Research Laboratory, DUMC 3435, Duke University Medical Center, Durham, NC 27710, USA; Division of Physical Therapy, Department of Orthopaedic Surgery, 2200 West Main St., Durham, NC 27705, USA
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