ORCID Profile
0000-0003-2024-4945
Current Organisations
Nanyang Technological University
,
Wageningen University and Research Wageningen Environmental Research
,
University College Dublin
,
Australian Catholic University
,
University of Melbourne
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Publications
A rapid review of challenges and opportunities related to diversity and inclusion as experienced by early and mid-career academics in the medicine, dentistry and health sciences fields
Publisher: Springer Science and Business Media LLC
Date: 27-04-2023
DOI: 10.1186/S12909-023-04252-X
Abstract: Early- and mid-career academics in medicine, dentistry and health sciences are integral to research, education and advancement of clinical professions, yet experience significant illbeing, high attrition and limited advancement opportunities. Identify and synthesise published research investigating challenges and opportunities related to ersity and inclusion, as experienced by early and mid-career academics employed in medicine, dentistry and health sciences disciplines. Rapid review. OVID Medline, Embase, APA PsycInfo, CINAHL and Scopus. We systematically searched for peer reviewed published articles within the last five years, investigating challenges and opportunities related to ersity and inclusion, as experienced by early and mid-career academics employed in medicine, dentistry and health sciences. We screened and appraised articles, then extracted and synthesised data. Database searches identified 1162 articles, 11 met inclusion criteria. Studies varied in quality, primarily reporting concepts encompassed by professional identity. There were limited findings relating to social identity, with sexual orientation and disability being a particularly notable absence, and few findings relating to inclusion. Job insecurity, limited opportunities for advancement or professional development, and a sense of being undervalued in the workplace were evident for these academics. Our review identified overlap between academic models of wellbeing and key opportunities to foster inclusion. Challenges to professional identity such as job insecurity can contribute to development of illbeing. Future interventions to improve wellbeing in academia for early- and mid-career academics in these fields should consider addressing their social and professional identity, and foster their inclusion within the academic community. Open Science Framework ( 0.17605/OSF.IO/SA4HX ).
Cross-sectional association between muscle strength and self-reported physical function in 195 hip osteoarthritis patients
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.SEMARTHRIT.2016.08.004
Abstract: This study aimed to evaluate associations between strength of selected hip and knee muscles and self-reported physical function, and their clinical relevance, in men and women with hip osteoarthritis (OA). Cross-sectional data from 195 participants with symptomatic hip OA were used. Peak isometric torque of hip extensors, flexors, and abductors, and knee extensors were measured, along with physical function using the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire. Separate linear regressions in men and women were used to determine the association between strength and physical function accounting for age, pain, and radiographic disease severity. Subsequently, magnitudes of strength associated with estimates of minimal clinically important improvement (MCII) in physical function were estimated according to severity of difficulty with physical function. For men, greater strength of the hip extensors, hip flexors and knee extensors were each associated with better physical function. For women, greater muscle strength of all tested muscles were each associated with better physical function. For men and women, increases in muscle strength between 17-32%, 133-223%, and 151-284% may be associated with estimates of MCII in physical function for those with mild, moderate, and severe physical dysfunction, respectively. Greater isometric strength of specific hip and thigh muscle groups may be associated with better self-reported physical function in men and women. In people with mild physical dysfunction, an estimate of MCII in physical function may be associated with attainable increases in strength. However, in patients with more severe dysfunction, greater and perhaps unattainable strength increases may be associated with an estimate of MCII in physical function. Longitudinal studies are required to validate these observations.
The role of skeletal muscle in the pathophysiology and management of knee osteoarthritis
Publisher: Oxford University Press (OUP)
Date: 16-01-2018
DOI: 10.1093/RHEUMATOLOGY/KEX515
Abstract: The role of skeletal muscle in the pathophysiology of knee OA is poorly understood. To date, the majority of literature has focused on the association of muscle strength with OA symptoms, disease onset and progression. However, deficits or improvements in skeletal muscle strength do not fully explain the mechanisms behind outcome measures in knee OA, such as pain, function and structural disease. This review aims to summarize components of skeletal muscle, providing a holistic view of skeletal muscle mechanisms that includes muscle function, quality and composition and their interactions. Similarly, the role of skeletal muscle in the management of knee OA will be discussed.
Quadriceps muscle strength at 2 years following anterior cruciate ligament reconstruction is associated with tibiofemoral joint cartilage volume
Publisher: Springer Science and Business Media LLC
Date: 07-01-2022
DOI: 10.1007/S00167-021-06853-9
Abstract: Quadriceps strength deficits following anterior cruciate ligament reconstruction (ACLR) are linked to altered lower extremity biomechanics, tibiofemoral joint (TFJ) space narrowing and cartilage composition changes. It is unknown, however, if quadriceps strength is associated with cartilage volume in the early years following ACLR prior to the onset of posttraumatic osteoarthritis (OA) development. The purpose of this cross-sectional study was to examine the relationship between quadriceps muscle strength (peak and across the functional range of knee flexion) and cartilage volume at ~ 2 years following ACLR and determine the influence of concomitant meniscal pathology. The involved limb of 51 ACLR participants (31 isolated ACLR 20 combined meniscal pathology) aged 18-40 years were tested at 2.4 ± 0.4 years post-surgery. Isokinetic knee extension torque generated in 10° intervals between 60° and 10° knee flexion (i.e. 60°-50°, 50°-40°, 40°-30°, 30°-20°, 20°-10°) together with peak extension torque were measured. Tibial and patellar cartilage volumes were measured using magnetic resonance imaging (MRI). The relationships between peak and angle-specific knee extension torque and MRI-derived cartilage volumes were evaluated using multiple linear regression. In ACLR participants with and without meniscal pathology, higher knee extension torques at 60°-50° and 50°-40° knee flexion were negatively associated with medial tibial cartilage volume (p < 0.05). No significant associations were identified between peak concentric or angle-specific knee extension torques and patellar cartilage volume. Higher quadriceps strength at knee flexion angles of 60°-40° was associated with lower cartilage volume on the medial tibia ~ 2 years following ACLR with and without concomitant meniscal injury. Regaining quadriceps strength across important functional ranges of knee flexion after ACLR may reduce the likelihood of developing early TFJ cartilage degenerative changes. III.
Medial knee joint loading during stair ambulation and walking while carrying loads
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.GAITPOST.2012.08.008
Abstract: Carrying loads while walking or using stairs is a common activity of daily living. Knee osteoarthritis is associated with increased external knee adduction moment (KAM) during walking, so understanding how the additional challenges of stairs and carrying loads impact these moments is of value. Sixteen healthy in iduals performed three types of MOTION (walking, stair ascent, stair descent) under three LOAD conditions (no load, carrying a 13.6kg front load, carrying 13.6kg load in a backpack). Three-dimensional gait analysis was used to measure KAM. Results of ANOVA showed a significant main effect of both MOTION and LOAD on peak KAM (p<0.001), but no significant MOTION×LOAD interaction (p=0.250). Peak KAM during stair ascent was about two-times those seen in stair descent (p<0.001) and was significantly higher than those seen in walking (p<0.001). Conditions with LOAD generated significantly greater KAM as compared to the no-LOAD conditions (p<0.001). These findings suggest that carrying a load of moderate magnitude while climbing stairs significantly increases the peak KAM - a risk factor associated with knee osteoarthritis.
No abatement of steroid injections for tennis elbow in Australian General Practice: A 15-year observational study with random general practitioner sampling
Publisher: Public Library of Science (PLoS)
Date: 20-07-2017
Knee biomechanics during jogging after arthroscopic partial meniscectomy: A longitudinal study
Publisher: SAGE Publications
Date: 18-04-2017
Abstract: Altered knee joint biomechanics is thought to play a role in the pathogenesis of knee osteoarthritis and has been reported in patients after arthroscopic partial meniscectomy (APM) while performing various activities. Longitudinally, understanding knee joint biomechanics during jogging may assist future studies to assess the implications of jogging on knee joint health in this population. To investigate knee joint biomechanics during jogging in patients 3 months after APM and a healthy control group at baseline and 2 years later at follow-up. Controlled laboratory study. Seventy-eight patients who underwent medial APM and 38 healthy controls underwent a 3-dimensional motion analysis during barefoot overground jogging at baseline. Sixty-four patients who underwent APM and 23 controls returned at follow-up. External peak moments (flexion and adduction) and the peak knee flexion angle during stance were evaluated for the APM leg, non-APM leg (nonoperated leg), and control leg. At baseline, the peak knee flexion angle was 1.4° lower in the APM leg compared with the non-APM leg ( P = .03). No differences were found between the moments in the APM leg compared with the control leg (all P .05). However, the normalized peak knee adduction moment was 35% higher in the non-APM leg compared with the control leg ( P = .008). In the non-APM leg, the normalized peak knee adduction and flexion moments were higher compared with the APM leg by 16% and 10%, respectively, at baseline ( P ≤ .004). Despite the increase in the peak knee flexion moment in the APM leg compared with the non-APM leg ( P .001), there were no differences in the peak knee flexion moment or any other parameter assessed at 2-year follow-up between the legs ( P .05). Comparing the APM leg and control leg, no differences in knee joint biomechanics during jogging for the variables assessed were observed. Higher knee moments in the non-APM leg may have clinical implications for the noninvolved leg. Kinematic differences were small (~1.4°) and therefore of questionable clinical relevance. These results may facilitate future clinical research regarding the implications of jogging on knee joint health in middle-aged, overweight patients after APM.
Effects of adding a diet intervention to exercise on hip osteoarthritis pain: protocol for the ECHO randomized controlled trial
Publisher: Springer Science and Business Media LLC
Date: 05-03-2022
DOI: 10.1186/S12891-022-05128-9
Abstract: Hip osteoarthritis (OA) is a leading cause of musculoskeletal pain. Exercise is a core recommended treatment. Despite some clinical guidelines also recommending weight loss for hip OA, there is no evidence from randomised controlled trials (RCT) to substantiate these recommendations. This superiority, 2-group, parallel RCT will compare a combined diet and exercise program to an exercise only program, over 6 months. One hundred people with symptomatic and radiographic hip OA will be recruited from the community. Following baseline assessment, participants will be randomly allocated to either, i) diet and exercise or ii) exercise only. Participants in the diet and exercise group will have six consultations with a dietitian and five consultations with a physiotherapist via videoconferencing over 6 months. The exercise only group will have five consultations with a physiotherapist via videoconferencing over 6 months. The exercise program for both groups will include prescription of strengthening exercise and a physical activity plan, advice about OA management and additional educational resources. The diet intervention includes prescription of a ketogenic very low-calorie diet with meal replacements and educational resources to support weight loss and healthy eating. Primary outcome is self-reported hip pain via an 11-point numeric rating scale (0 = ‘no pain’ and 10 = ‘worst pain possible’) at 6 months. Secondary outcomes include self-reported body weight (at 0, 6 and 12 months) and body mass index (at 0, 6 and 12 months), visceral fat (measured using dual energy x-ray absorptiometry at 0 and 6 months), pain, physical function, quality of life (all measured using subscales of the Hip Osteoarthritis Outcome Scale at 0, 6 and 12 months), and change in pain and physical activity (measured using 7-point global rating of change Likert scale at 6 and 12 months). Additional measures include adherence, adverse events and cost-effectiveness. This study will determine whether a diet intervention in addition to exercise provides greater hip pain-relief, compared to exercise alone. Findings will assist clinicians in providing evidence-based advice regarding the effect of a dietary intervention on hip OA pain. ClinicalTrials.gov . Identifier: NCT04825483 . Registered 31st March 2021.
A longitudinal study of strength and gait after arthroscopic partial meniscectomy
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2013
The impact of financial incentives on physical activity in adults: A systematic review protocol
Publisher: Springer Science and Business Media LLC
Date: 25-01-2018
The effects of neuromuscular exercise on medial knee joint load post-arthroscopic partial medial meniscectomy: ‘SCOPEX’ a randomised control trial protocol
Publisher: Springer Science and Business Media LLC
Date: 27-11-2012
Abstract: Meniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group. Therefore, post-surgical rehabilitation or interventions that reduce medial knee joint loading have the potential to reduce the risk of developing or progressing osteoarthritis. The primary purpose of this randomised, assessor-blind controlled trial is to determine the effects of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during functional tasks in people who have recently undergone a partial medial meniscectomy. 62 people aged 30–50 years who have undergone an arthroscopic partial medial meniscectomy within the previous 3 to 12 months will be recruited and randomly assigned to a neuromuscular exercise or control group using concealed allocation. The neuromuscular exercise group will attend 8 supervised exercise sessions with a physiotherapist and will perform 6 exercises at home, at least 3 times per week for 12 weeks. The control group will not receive the neuromuscular training program. Blinded assessment will be performed at baseline and immediately following the 12-week intervention. The primary outcomes are change in the peak external knee adduction moment measured by 3-dimensional analysis during normal paced walking and one-leg rise. Secondary outcomes include the change in peak external knee adduction moment during fast pace walking and one-leg hop and change in the knee adduction moment impulse during walking, one-leg rise and one-leg hop, knee and hip muscle strength, electromyographic muscle activation patterns, objective measures of physical function, as well as self-reported measures of physical function and symptoms and additional biomechanical parameters. The findings from this trial will provide evidence regarding the effect of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during various tasks in people with a partial medial meniscectomy. If shown to reduce the knee adduction moment, neuromuscular exercise has the potential to prevent the onset of osteoarthritis or slow its progression in those with early disease. Australian New Zealand Clinical Trials Registry reference: ACTRN12612000542897
A longitudinal study of impact and early stance loads during gait following arthroscopic partial meniscectomy
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.JBIOMECH.2014.07.029
Abstract: People following arthroscopic partial medial meniscectomy (APM) are at increased risk of developing knee osteoarthritis. High impact loading and peak loading early in the stance phase of gait may play a role in the pathogenesis of knee osteoarthritis. This was a secondary analysis of longitudinal data to investigate loading-related indices at baseline in an APM group (3 months post-surgery) and a healthy control group, and again 2 years later (follow-up). At baseline, 82 participants with medial APM and 38 healthy controls were assessed, with 66 and 23 re-assessed at follow-up, respectively. Outcome measures included: (i) heel strike transient (HST) presence and magnitude, (ii) maximum loading rate, (iii) peak vertical force (Fz) during early stance. At baseline, maximum loading rate was lower in the operated leg (APM) and non-operated leg (non-APM leg) compared to controls (p ≤ 0.03) and peak Fz was lower in the APM leg compared to non-APM leg (p ≤ 0.01). Over 2 years, peak Fz increased in the APM leg compared to the non-APM leg and controls (p ≤ 0.01). Following recent APM, people may adapt their gait to protect the operated knee from excessive loads, as evidenced by a lower maximum loading rate in the APM leg compared to controls, and a reduced peak Fz in the APM leg compared to the non-APM leg. No differences at follow-up may suggest an eventual return to more typical gait. However, the increase in peak Fz in the APM leg may be of concern for long-term joint health given the compromised function of the meniscus.
Effect of a valgus brace on medial tibiofemoral joint contact force in knee osteoarthritis with varus malalignment: A within-participant cross-over randomised study with an uncontrolled observational longitudinal follow-up
Publisher: Public Library of Science (PLoS)
Date: 03-06-2022
DOI: 10.1371/JOURNAL.PONE.0257171
Abstract: Previous investigations on valgus knee bracing have mostly used the external knee adduction moment. This is a critical limitation, as the external knee adduction moment does not account for muscle forces that contribute substantially to the medial tibiofemoral contact force (MTCF) during walking. The aims of this pilot study were to: 1) determine the effect of a valgus knee brace on MTCF 2) determine whether the effect is more pronounced after 8 weeks of brace use 3) assess the feasibility of an 8-week brace intervention. Participants with medial radiographic knee OA and varus malalignment were fitted with an Össur Unloader One © brace. Participants were instructed to wear the brace for 8 weeks. The MTCF was estimated via an electromyogram-assisted neuromuscular model with and without the knee brace at week 0 and week 8. Feasibility outcomes included change in symptoms, quality of life, confidence, acceptability, adherence and adverse events. Of the 30 (60% male) participants enrolled, 28 (93%) completed 8-week outcome assessments. There was a main effect of the brace (p .001) on peak MTCF and MTCF impulse, but no main effect for time (week 0 and week 8, p = 0.10), and no interaction between brace and time (p = 0.62). Wearing the brace during walking significantly reduced the peak MTCF (-0.05 BW 95%CI [-0.10, -0.01]) and MTCF impulse (-0.07 BW.s 95%CI [-0.09, -0.05]). Symptoms and quality of life improved by clinically relevant magnitudes over the 8-week intervention. Items relating to confidence and acceptability were rated relatively highly. Participants wore the brace on average 6 hrs per day. Seventeen participants reported 30 minor adverse events over an 8-week period. Although significant, reductions in the peak MTCF and MTCF while wearing the knee brace were small. No effect of time on MTCF was observed. Although there were numerous minor adverse events, feasibility outcomes were generally favourable. Australian and New Zealand Clinical Trials Registry (12619000622101).
Trunk, pelvis and lower limb walking biomechanics are similarly altered in those with femoroacetabular impingement syndrome regardless of cam morphology size
Publisher: Elsevier BV
Date: 2021
Do Moments and Strength Predict Cartilage Changes following Partial Meniscectomy?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2014
Knee extensor strength gains mediate symptom improvement in knee osteoarthritis: secondary analysis of a randomised controlled trial
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.JOCA.2018.01.018
Abstract: To determine if an increase in knee extensor strength mediates the effect of a 12-week knee extensor strength training program on pain and physical function improvement in people with knee osteoarthritis (OA). Secondary analysis from a randomised controlled trial comparing the effects of a 12-week knee extensor strengthening exercise program to a control group with no intervention. Data from participants with complete data (n = 97) enrolled in a previous clinical trial were analysed. Baseline and 12-week follow-up assessments included peak isometric knee extensor strength, pain and physical function. Peak knee extensor strength (Nm/kg) was assessed on an isokinetic dynamometer and subscales of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index were used to assess pain and physical function. Twelve-week change in pain and physical function were regressed separately, on 12-week change in knee extensor strength and group allocation. Covariates included baseline pain or physical function as appropriate, and baseline knee extensor strength, age, sex and knee alignment (stratification variable). Improved knee extensor strength mediated the effect of the strengthening program on both pain relief (mediated effect size = 0.69, 95% confidence intervals (CI) 0.05-1.33, P = 0.03), and improved physical function (mediated effect size = 1.86, 95% CI 0.08-3.64, P = 0.04), at 12 weeks. Increased knee extensor strength partially mediates the effect of a knee extensor strength training program on pain and physical function improvement in people with knee OA.
Muscle Forces during Weight-Bearing Exercises in Medial Knee Osteoarthritis and Varus Malalignment: A Cross-Sectional Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-05-2022
DOI: 10.1249/MSS.0000000000002943
Abstract: This study aimed to test the hypothesis that common weight-bearing exercises generate higher lower-limb muscle forces but do not increase medial tibiofemoral contact force (MTCF) when compared with walking in people with medial knee osteoarthritis and varus malalignment. Twenty-eight participants 50 yr or older with medial knee osteoarthritis and varus malalignment were recruited from the community. Three-dimensional lower-body motion, ground reaction forces, and surface EMG from 12 lower-limb muscles were acquired during five squat, lunge, single-leg heel raise, and walking trials, performed at self-selected speeds. An EMG-informed neuromusculoskeletal model with subject-specific bone geometry was used to estimate muscle forces (N) and body weight (BW)–normalized MTCF. The peak forces for muscle groups (knee extensors, knee flexors, ankle plantar flexors, and hip abductors) and peak MTCF were compared with walking using a multivariate analysis of variance model. There was a significant main effect ( P 0.001). Post hoc tests (mean difference (95% confidence intervals)) showed that, compared with walking, participants generated higher peak knee extensor and flexor forces during squatting (extensor: 902 N (576 to 1227 N), flexor: 192 N (9.39 to 375 N)) and lunging (extensor: 917 N (604 to 1231 N), flexor: 496 N (198 to 794 N)), and lower peak hip abductor force during squatting (−1975 N (−2841 to −1108 N)) and heel raises (−1217 N (−2131 to −303 N)). Compared with walking, MTCF was lower during squatting (−0.79 BW (−1.04 to −0.53 BW)) and heel raises (−0.27 BW (−0.50 to −0.04 BW)). No other significant differences were observed. Participants generated higher peak knee flexor and extensor forces during squatting and lunging but did not increase peak MTCF compared with walking. Clinicians can use these findings to reassure themselves and patients that weight-bearing exercises in these positions do not adversely increase forces within the osteoarthritic joint compartment.
Effect of functional weightbearing versus non-weightbearing quadriceps strengthening exercise on contact force in varus-malaligned medial knee osteoarthritis: A secondary analysis of a randomized controlled trial
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.KNEE.2022.09.001
Abstract: Knee osteoarthritis progression may be related to altered knee loads, particularly in those with varus malalignment. Using randomized controlled trial data, this secondary analysis of complete datasets (n = 67) compared the effects of a functional weightbearing (WB) and non-weightbearing quadriceps strengthening exercise (NWB) program on measures of medial tibiofemoral joint contact force (MTCF) during walking. Participants aged ≥50 years and with medial knee osteoarthritis and varus malalignment were randomly allocated to a 12-week, home-based, physiotherapist-prescribed exercise program comprised of WB exercises (n = 31), or NWB exercise (n = 36). Three-dimensional lower-body motion, ground reaction forces, and surface electromyograms from six lower-limb muscles were acquired during walking at baseline and at 12-weeks follow-up. An electromyogram-informed neuromusculoskeletal model estimated bodyweight (BW) normalized MTCF (peak and impulse), including external and muscular contributions to MTCF. There was no between-group difference in the change in peak MTCF (-0.02 [-0.12, 0.09] BW) or MTCF impulse (-0.01 [-0.06, 0.03] BW·s). There was a between-group difference in the muscle contribution to peak MTCF (-0.08 [-0.15, -0.00] BW) and MTCF impulse (-0.04 [-0.08, -0.00] BW·s), whereby the muscle contribution reduced more in the NWB group over time compared to the WB group. There was also a between group-difference in the external contribution to peak MTCF (0.09 [0.01, 0.18] BW), but this reduced more in the WB group than in the NWB group. Our findings suggest no difference in MTCF between the two exercise programs, but differences in the contribution to MTCF between the two exercise programs were observed in those with medial knee osteoarthritis and varus malalignment.
Knee Extensor Muscle Strength in Middle‐Aged and Older Individuals Undergoing Arthroscopic Partial Meniscectomy: A Systematic Review and Meta‐Analysis
Publisher: Wiley
Date: 26-08-2015
DOI: 10.1002/ACR.22581
Abstract: People with meniscal tears are at high risk to develop or progress to knee osteoarthritis. Knee extensor weakness is considered a risk factor for osteoarthritis and is often reported in these in iduals. The purpose of this systematic review and meta-analysis was to investigate knee extensor strength in people undergoing an arthroscopic partial meniscectomy (APM). Six databases (Medline, CINAHL, SPORTDiscus, Embase, PEDro, and AMED) were searched up to June 22, 2014. Studies that measured knee extensor muscle strength in people age ≥30 years undergoing APM for a meniscal tear and used either a healthy control group or the contralateral leg to compare knee extensor muscle strength were included. Methodological quality was assessed using guidelines from the Centre for Reviews and Dissemination. Eleven studies, in which participants were predominantly male, were included (n = 596). A moderate reduction in muscle strength was observed prior to APM compared to controls (standardized mean difference [SMD] 0.58, 95% confidence interval [95% CI] 0.04, 1.13) and continued up to 6 months postsurgery (SMD range -2.42 to -0.47). There was no difference in muscle strength at 2 years post-APM (SMD -0.01 [95% CI -0.36, 0.35]), while a moderate reduction was again apparent at 4 years post-APM (SMD -0.56, [95% CI -1.20, 0.08]) compared to controls. Our findings suggest that middle-aged and older in iduals undergoing APM have reduced knee extensor muscle strength in the operated leg compared to control data. As meniscus pathology and knee extensor muscle weakness are risk factors for osteoarthritis, these results highlight the clinical importance of addressing muscle weakness in these in iduals.
Effects of adding aerobic physical activity to strengthening exercise on hip osteoarthritis symptoms: protocol for the PHOENIX randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 18-04-2022
DOI: 10.1186/S12891-022-05282-0
Abstract: Hip osteoarthritis (OA) is a leading cause of musculoskeletal pain. Exercise is a core recommended treatment. Most evidence is based on muscle-strengthening exercise, but aerobic physical activity has potential to enhance clinical benefits. The primary aim of this study is to test the hypothesis that adding aerobic physical activity to a muscle strengthening exercise leads to significantly greater reduction in hip pain and improvements in physical function, compared to a lower-limb muscle strengthening exercise program alone at 3 months. This is a superiority, 2-group, parallel randomised controlled trial including 196 people with symptomatic hip OA from the community. Following baseline assessment, participants are randomly allocated to receive either i) aerobic physical activity and muscle strengthening exercise or ii) muscle strengthening exercise only. Participants in both groups receive 9 consultations with a physiotherapist over 3 months. Both groups receive a progressive muscle strengthening exercise program in addition to advice about OA management. The aerobic physical activity plan includes a prescription of moderate intensity aerobic physical activity with a goal of attaining 150 min per week. Primary outcomes are self-reported hip pain assessed on an 11-point numeric rating scale (0 = ‘no pain’ and 10 = ‘worst pain possible’) and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale) at 3 months. Secondary outcomes include other measures of self-reported pain (assessed at 0, 3, 9 months), self-reported physical function (assessed at 0, 3, 9 months), performance-based physical function (assessed at 0, 3 months), joint stiffness (assessed at 0, 3, 9 months), quality of life (assessed at 0, 3, 9 months), muscle strength (assessed at 0, 3 months), and cardiorespiratory fitness (assessed at 0, 3 months). Other measures include adverse events, co-interventions, and adherence. Measures of body composition, serum inflammatory biomarkers, quantitative sensory measures, anxiety, depression, fear of movement and self-efficacy are included to explore causal mechanisms. Findings will assist to provide an evidence-based recommendation regarding the additional effect of aerobic physical activity to lower-limb muscle strengthening on hip OA pain and physical function. Australian New Zealand Clinical Trials Registry reference: ACTRN 12619001297112. Registered 20th September 2019.
Hip joint kinematics and segment coordination variability according to pain and structural disease severity in hip osteoarthritis
Publisher: Wiley
Date: 31-01-2020
DOI: 10.1002/JOR.24609
Abstract: This study aimed to evaluate hip joint kinematic variability and segment coordination variability during walking according to pain and radiographic disease severity in people with hip osteoarthritis. Fifty-five participants with hip osteoarthritis had pain severity assessed during walking using an item on the Western Ontario and McMasters Universities Osteoarthritis Index (no pain = 10 mild pain = 28 moderate pain = 17). Radiographic disease severity was graded by Kellgren and Lawrence scale (KL2 = 29 KL3 = 21 KL4 = 5). Hip kinematics variability was estimated as the curve coefficient of variation. Vector coding was used to calculate coordination variability for select joint couplings. One-way analysis of variances with planned adjusted post hoc comparisons were used to compare hip kinematics variability and coordination variability of select segment couplings (pelvis sagittal vs thigh sagittal pelvis frontal vs thigh frontal pelvis transverse vs thigh transverse thigh sagittal vs shank sagittal thigh frontal vs shank sagittal thigh transverse vs shank sagittal) according to pain and radiographic disease severity. No main effect of pain severity was observed for sagittal or transverse plane hip kinematic variability (P ≥ .266), and although there was a main effect for frontal plane hip kinematic variability (P = .035), there were no significant differences when comparing between levels of pain severity (P > .006). There was no main effect of radiographic disease severity on hip kinematic variability in the sagittal (P = .539) or frontal (P = .307) plane. No significant differences in coordination of variability of segment couplings were observed (all P ≥ .229). Movement variability as assessed in this study did not differ according to pain severity during walking or radiographic disease severity.
Editorial: neuromechanics of hip osteoarthritis
Publisher: Frontiers Media SA
Date: 10-11-2021
Absence of Improvement With Exercise in Some Patients With Knee Osteoarthritis: A Qualitative Study of Responders and Nonresponders
Publisher: Wiley
Date: 18-02-2023
DOI: 10.1002/ACR.25085
Abstract: To compare the perceptions of patients about why they did, or did not, respond to a physical therapist–supported exercise and physical activity program. This was a qualitative study within a randomized controlled trial. Twenty‐six participants (of 40 invited) with knee osteoarthritis s led according to response (n = 12 responders, and 14 nonresponders based on changes in both pain and physical function at 3 and 9 months after baseline) to an exercise and physical activity intervention. Semistructured in idual interviews were conducted. Inductive thematic analysis was undertaken within each subgroup using grounded theory principles. A deductive approach compared themes and subthemes across subgroups. Findings were triangulated with quantitative data. (Sub)themes common to responders and nonresponders included the intervention components that facilitated engagement, personal attitudes and expectations, beliefs about osteoarthritis and exercise role, importance of adherence, and perceived strength gains with exercise. In contrast to responders who felt empowered to self‐manage, nonresponders accepted responsibility for lack of improvement in pain and function with exercise, acknowledging that their adherence to the intervention was suboptimal (confirmed by quantitative adherence data). Nonresponders believed that their excess body weight (supported by quantitative data) contributed to their outcomes, encountered exercise barriers (comorbidities, stressors, and life events), and perceived that the trial measurement tools did not adequately capture their response to exercise. Responders and nonresponders shared some similar perceptions of exercise. However, along with perceived limitations in trial outcome measurements, nonresponders encountered challenges with excess weight, comorbidities, stressors, and life events that led to suboptimal adherence and collectively were perceived to contribute to nonresponse.
Gluteal tendinopathy and hip osteoarthritis: Different pathologies, different hip biomechanics
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.GAITPOST.2018.02.011
Abstract: Gluteal tendinopathy (GT) and hip osteoarthritis (OA) are the most common causes of hip pain and associated disability in older adults. Pain and altered walking biomechanics are common to both conditions. This study aimed to compare three-dimensional walking biomechanics between in iduals with unilateral, symptomatic GT and HOA. Sixty in iduals with symptomatic unilateral GT confirmed by magnetic-resonance-imaging and 73 in iduals with symptomatic unilateral HOA (Kellgren-Lawrence Grade ≥ 2) underwent three-dimensional gait analysis. Maximum and minimum values of the external sagittal hip moment, the first peak, second peak and mid-stance minimum of the hip adduction moment (HAM), sagittal plane hip excursion and hip joint angles, pelvic obliquity and trunk lean, at the three HAM time points during stance phase of walking were compared between groups. Compared to in iduals with HOA, those with GT exhibited a greater hip peak extension moment (P < 0.001) and greater HAM throughout the stance phase of walking (P = 0.01-P < 0.001), greater hip adduction (P < 0.001) and internal rotation (P < 0.01-P < 0.001) angles and lower hip flexion angles and excursion (P = 0.02 - P < 0.001). In iduals with HOA exhibited a greater forward trunk lean (P ≤ 0.001) throughout stance, and greater ipsilateral trunk lean in the frontal plane (P < 0.001) than those with GT. Despite presence of pain in both conditions, hip kinematics and kinetics differ between in iduals with symptomatic unilateral GT and those with symptomatic unilateral HOA. These condition-specific impairments may be targets for optimization of management of HOA and GT.
Effect of Information Content and General Practitioner Recommendation to Exercise on Treatment Beliefs and Intentions for Knee Osteoarthritis: An Online Multi‐Arm Randomized Controlled Trial
Publisher: Wiley
Date: 29-11-2023
DOI: 10.1002/ACR2.11513
Abstract: To evaluate effects of general osteoarthritis (OA) information in addition to a treatment option grid and general practitioner (GP) recommendation to exercise on treatment beliefs and intentions. An online randomized trial of 735 people 45 years old or older without OA who were recruited from a consumer survey network. Participants read a hypothetical scenario about visiting their GP for knee problems and were randomized to the following: i) ‘general information', ii) ‘option grid' (general information plus option grid), or iii) ‘option grid plus recommendation' (general information plus option grid plus GP exercise recommendation). The primary outcome was an agreement that exercise is the best management option (0‐10 numeric rating scale higher scores indicating higher agreement that exercise is best). The secondary outcomes were beliefs about other management options and management intentions. Linear regression models estimated the mean (95% confidence interval [CI]) between‐group difference in postintervention scores, adjusted for baseline. Option grid plus recommendation led to higher agreement that exercise is the best management by a mean of 0.4 units (95% CI: 0.1‐0.6) compared with general information. There were no other between‐group differences for the primary outcome. Option grid led to higher agreement that surgery was best, and x‐rays were necessary, compared with general information (mean between‐group differences: 0.7 [CI: 0.2‐1.1] and 0.5 [CI: 0.1‐1.0], respectively) and option grid plus recommendation (0.5 [CI: 0.1‐0.9] and 0.9 [CI: 0.4‐1.3]). Addition of an option grid and GP exercise recommendation to general OA information led to more favorable views that exercise was best for the hypothetical knee problem. However, differences were small and of unclear clinical importance.
Comparative effectiveness of exercise programs for psychological well-being in knee osteoarthritis: a systematic review and network meta-analysis
Publisher: Elsevier BV
Date: 10-2021
Effects of long-term exercise therapy on knee joint structure in people with knee osteoarthritis: A systematic review and meta-analysis
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.SEMARTHRIT.2018.10.014
Abstract: To investigate effects of long-term exercise therapy for people with knee osteoarthritis (OA) on radiographic disease severity and cartilage integrity (primary outcomes) as well as severity of bone marrow lesions (BMLs), synovitis and/or effusion (secondary outcomes). We sourced randomized controlled trials in people with clinical and/or radiographic OA investigating the effect of land-based exercise therapy of > 6 months on radiographic disease severity and magnetic resonance imaging outcomes of cartilage integrity (morphology or composition) as well as BML, synovitis and/or effusion severity, when compared to no exercise. Two independent reviewers extracted data and assessed risk of bias. Random-effects meta-analysis was used to pool standardised mean differences (SMD) (95% confidence intervals (CI)) or odds ratios (OR) (95% CI) and estimate heterogeneity (I Meta-analysis showed moderate quality evidence of no treatment effect on tibiofemoral radiographic disease severity ((SMD) 95% (CI): 0.06 (-0.07, 0.20), I Long-term exercise therapy did not change tibiofemoral radiographic disease severity, cartilage morphology or synovitis/effusion, but may slightly increase the likelihood for increased BML severity. Overall, meta-analysis findings were limited in directness and precision and restricted to relatively imprecise effect estimates in people who were obese on average. Limited evidence suggested some protective effects on patellar cartilage composition.
Does frontal knee kinematics predict treatment outcomes? Exploratory analyses from the Intensive Diet and Exercise for Arthritis (IDEA) trial
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.GAITPOST.2018.04.045
Abstract: Pain is a cardinal symptom of knee osteoarthritis (OA) and although conservative treatments such as exercise and diet related interventions can reduce pain, effects are modest and can be improved. Frontal plane knee joint motion has been associated with knee pain, and is suggested as a patient-specific characteristic on which to tailor interventions. Does the association between baseline frontal plane knee joint kinematics and pain-relief differ among overweight and obese people with knee OA who underwent an intervention from the Intensive Diet and Exercise for Arthritis (IDEA) clinical trial: diet-only, exercise-only, and combined diet and exercise intervention? 323 participants with knee OA were included in the analysis (77% females 66 ± 6 years 33.5 ± 3.7 kg/m The interaction terms between the intervention and measures of frontal plane knee joint kinematics were not statistically significant (all P ≥ 0.05). We found no evidence to suggest that 18-months of either exercise, diet, or a combination of diet and exercise could be more effective than the other to improve pain based on frontal plane measures of knee kinematics.
A most painful knee does not induce interlimb differences in knee and hip moments during gait in patients with knee osteoarthritis
Publisher: Elsevier BV
Date: 10-2021
DOI: 10.1016/J.CLINBIOMECH.2021.105455
Abstract: Patients with knee osteoarthritis can adapt their gait to unload the most painful knee joint in order to try to reduce pain and improve physical function. However, these gait adaptations can cause higher loads on the contralateral joints. The aim of the study was to investigate the interlimb differences in knee and hip frontal plane moments during gait in patients with knee osteoarthritis and in healthy controls. Forty patients with knee osteoarthritis and 19 healthy matched controls were measured during comfortable treadmill walking. Frontal plane joint moments were obtained of both hip and knee joints. Differences in interlimb moments within each group were assessed using statistical parametric mapping and discrete gait parameters. No interlimb differences were observed in patients with knee osteoarthritis and control subjects at group level. Furthermore, the patients presented similar interlimb variability as the controls. In a small subgroup (n = 12) of patients, the moments in the most painful knee were lower than in the contralateral knee, while the other patients (n = 28) showed higher moments in the most painful knee compared to the contralateral knee. However, no interlimb differences in the hip moments were observed within the subgroups. Patients with knee osteoarthritis do not have interlimb differences in knee and hip joint moments. Patients and healthy subjects demonstrate a similar interlimb variability in the moments of the lower extremities. In this context, differences in knee pain in patients with knee osteoarthritis did not induce any interlimb differences in the frontal plane knee and hip moments.
Footwear and Cadence Affect Gait Variability in Runners with Patellofemoral Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-02-2020
DOI: 10.1249/MSS.0000000000002267
Abstract: To examine the effects of increased cadence and minimalist footwear on lower-limb variability in runners with patellofemoral pain (PFP). Fifteen (12 female, 3 male) runners with PFP ran on an instrumented treadmill with three-dimensional motion capture in three randomly ordered conditions: (i) standard shoe at preferred cadence, (ii) standard shoe +10% cadence, and (iii) minimalist shoe at preferred cadence. Vector coding was used to calculate coordination variability between strides for select lower-limb joint couplings. Approximate entropy was calculated to assess continuous variability for segment kinematic and kinetic data and compared between conditions using repeated-measures ANOVA. One-dimensional statistical parametric mapping repeated-measures ANOVA was performed on the coordination variability data. Cohen’s d effect size was calculated for all comparisons. Larger approximate entropy values (i.e., greater variability) were observed for the standard shoe +10% cadence versus the standard shoe at preferred cadence for hip flexion/extension ( P 0.001 d = 1.12), hip adduction/abduction ( P 0.001 d = 0.99) and ankle dorsiflexion lantarflexion ( P 0.001 d = 1.37) kinematics, and knee flexion/extension moments ( P 0.001 d = 0.93). Greater variability was also observed in the minimalist shoe versus the standard shoe at preferred cadence for hip internal/external rotation moments ( P 0.001 d = 0.76), knee adduction/abduction moments ( P 0.001 d = 0.51), and knee internal/external rotation moments ( P 0.001 d = 1.02). One-dimensional statistical parametric mapping repeated-measures ANOVA revealed no significant differences in coordination variability between running conditions. Greater hip and knee kinematic and kinetic variability observed with either increased cadence or minimalist footwear may be beneficial for those with PFP.
The influence of cadence and shoes on patellofemoral joint kinetics in runners with patellofemoral pain
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.JSAMS.2017.09.593
Abstract: To determine the effect of a combination of a minimalist shoe and increased cadence on measures of patellofemoral joint loading during running in in iduals with patellofemoral pain. Within-participant repeated measures with four conditions presented in random order: (1) control shoe at preferred cadence (2) control shoe with +10% cadence (3) minimalist shoe at preferred cadence (4) minimalist shoe with +10% cadence. Fifteen recreational runners with patellofemoral pain ran on an instrumented treadmill while three-dimensional motion capture data were acquired. Peak patellofemoral joint stress, joint reaction force, knee extensor moment and knee joint angle during the stance phase of running were calculated. One-way repeated measures ANOVA was used to compare the control condition (1) to the three experimental conditions (2-4). Running in a minimalist shoe at an increased cadence reduced patellofemoral stress and joint reaction force on average by approximately 29% (p<0.001) compared to the control condition. Running in a minimalist shoe at preferred cadence reduced patellofemoral joint stress by 15% and joint reaction force by 17% (p<0.001), compared to the control condition. Running in control shoes at an increased cadence reduced patellofemoral joint stress and joint reaction force by 16% and 19% (p<0.001), respectively, compared to the control condition. In in iduals with patellofemoral pain, running in a minimalist shoe at an increased cadence had the greatest reduction in patellofemoral joint loading compared to a control shoe at preferred cadence. This may be an effective intervention to modulate biomechanical factors related to patellofemoral pain.
Hip joint moments during walking in people with hip osteoarthritis: a systematic review and meta-analysis
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.JOCA.2018.03.011
Abstract: This systematic review and meta-analysis investigated surrogate measures of hip joint loading during walking in people with hip osteoarthritis (OA). Five databases were searched up to January 14 Thirteen studies with 1,141 participants were eligible and suitable for meta-analyses. Overall, people with hip OA had lower sagittal (SMD -0.55 (95% confidence interval (CI) -1.00 to -0.10) and frontal plane moments (SMD -0.63 (95% CI -0.92, -0.34) compared to controls. However, substantial heterogeneity was observed (I Hip joint loading may be dependent on disease stage. People with end-stage hip OA under-loaded compared to controls, while those who were not awaiting hip joint replacement had comparable hip joint loads to controls.
Diet-induced weight loss alone or combined with exercise in overweight or obese people with knee osteoarthritis: A systematic review and meta-analysis
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.SEMARTHRIT.2018.06.005
Abstract: The purposes were to (i) determine the effect of diet-only treatments and combined diet and exercise treatments on pain and physical function and (ii) explore the effect of these treatments on inflammatory biomarkers in overweight and obese adults with knee osteoarthritis. Five electronic databases were searched until March 2017. Randomised controlled trials investigating the effect of non-surgical non-pharmacological weight loss treatment, with or without exercise, on self-reported pain and/or physical function and/or inflammatory biomarkers were selected. Two review authors independently extracted data and assessed risk of bias for each study. Standardised mean differences (SMD) of outcomes were pooled as appropriate, using a random effects approach. 2676 articles were identified, 19 met review criteria and 9 met criteria for meta-analyses. Diet-only treatments did not reduce pain (SMD -0.13 95% confidence interval, CI: -0.37, 0.10 I Overall, moderate pain-relief is achievable with a combination of diet and exercise, but potentially not with diet-only treatments. Findings support that either diet-only treatments or combined diet and exercise treatments moderately improve physical function. Overall, treatment effects on inflammatory biomarkers are questionable.
Effect of exercise on knee joint contact forces in people following medial partial meniscectomy: A secondary analysis of a randomised controlled trial
Publisher: Elsevier BV
Date: 06-2020
The effects of behavioural counselling on the determinants of health behaviour change in adults with chronic musculoskeletal conditions making lifestyle changes: A systematic review and meta‐analysis
Publisher: Wiley
Date: 02-08-2019
DOI: 10.1002/MSC.1410
Abstract: A systematic review and meta-analysis of controlled trials was carried out to examine the effect of behavioural counselling on determinants of behaviour change in adults with chronic, painful musculoskeletal conditions. Seven databases were searched up to January 2019. Two reviewers independently screened title/abstracts and full texts. Eligible trials included those including participants over 18 years of age with a chronic, painful musculoskeletal condition, a measurement of at least one behavioural determinant and lifestyle behaviour, and where behavioural counselling was the distinguishing intervention. Two reviewers independently extracted data and assessed for risk of bias using the Cochrane Risk of Bias Tool. Meta-analyses were conducted, using standardized mean differences and 95% confidence intervals (CIs) when at least two trials examined the same outcome. The quality of the evidence was evaluated using the Grades of Recommendation, Assessment, Development and Evaluation approach. Fourteen unique trials, reported in 16 publications, were included. Low-quality evidence showed that behavioural counselling has a small effect on increasing self-reported physical activity (standardized mean difference 0.26 95% CI 0.00, 0.53). Very-low-quality evidence showed that behavioural counselling has a moderate effect on self-efficacy related to physical activity (standardized mean difference 0.69 95% CI 0.19, 1.18). Low-quality evidence suggested that behavioural counselling has no effect on symptoms of depression and anxiety. Behavioural counselling may help to increase self-reported physical activity levels in adults with chronic painful musculoskeletal conditions. Self-efficacy may be a behavioural determinant in an underlying causal pathway explaining positive lifestyle change.
Forward lunge knee biomechanics before and after partial meniscectomy
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.KNEE.2015.03.005
Abstract: Patients following meniscectomy are at increased risk of developing knee osteoarthritis in the tibiofemoral compartment and at the patellofemoral joint. As osteoarthritis is widely considered a mechanical disease, it is important to understand the potential effect of arthroscopic partial meniscectomy (APM) on knee joint mechanics. The purpose of this study was to evaluate changes in knee joint biomechanics during a forward lunge in patients with a suspected degenerative meniscal tear from before to three months after APM. Twenty-two patients (35-55 years old) with a suspected degenerative medial meniscal tear participated in this study. Three dimensional knee biomechanics were assessed on the injured and contralateral leg before and three months after APM. The visual analogue scale was used to assess knee pain and the Knee Injury Osteoarthritis Outcome Score was used to assess sport/recreation function and knee-related confidence before and after APM. The external peak knee flexion moment reduced in the APM leg compared to the contralateral leg (mean difference (95% CI)) -1.08 (-1.80 to -0.35) (Nm/(BW × HT)%), p = 0.004. Peak knee flexion angle also reduced in the APM leg compared to the contralateral leg -3.94 (-6.27 to -1.60) degrees, p = 0.001. There was no change in knee pain between the APM leg and contralateral leg (p=0.118). Self-reported sport/recreation function improved (p = 0.004). Although patients self-reported less difficulty during strenuous tasks following APM, patients used less knee flexion, a strategy that may limit excessive patellar loads during forward lunge in the recently operated leg.
Body weight support through a walking cane in inexperienced users with knee osteoarthritis
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.GAITPOST.2018.09.021
Abstract: Walking canes are a self-management strategy recommended for people with knee osteoarthritis (OA) by clinical practice guidelines. Ensuring that an adequate amount of body-weight support (%BWS) is taken through the walking cane is important as this reduces measures of knee joint loading. 1) How much body weight support do people with knee OA place through a cane? 2) Do measures of body weight support increase following a brief simple training session? Seventeen in iduals with knee pain who had not used a walking cane before were recruited. A standard-grip aluminum cane was then used for 1 week with limited manufacturer instructions. Following this, participants were evaluated using an instrumented force-measuring cane to assess body weight support (% total body weight) through the cane. Force data were recorded during a 430-metre walk undertaken twice once before 10 min of cane training administered by a physiotherapist, and once immediately after training. Measures of BWS (peak force, average force, impulse equal to the average cane force times duration, and cane-ground contact duration) were extracted. Using bathroom scales, training aimed to take at least 10% body weight support through the cane. Before training, the average peak BWS was 7.2 ± 2.5% of total body weight. Following 10 min of training, there was a significant increase in average peak BWS by 28%, average BWS by 25%, and BWS impulse by 54% (p < 0.05). However, in idual BWS responses to training were variable. Duration of cane placement increased by 22% after training (p = 0.02). Timing of peak BWS through the cane occurred at 51% of contact phase before training, and at 53% after training (p = 0.05). A short training session can increase the transfer of body weight through a walking cane. However, more sophisticated feedback may be needed to achieve target levels of BWS.
Exercise & Sports Science Australia (ESSA) updated Position Statement on exercise and physical activity for people with hip/knee osteoarthritis
Publisher: Elsevier BV
Date: 2023
How do middle-aged and older adults with chronic hip pain view their health problem and its care? A protocol for a systematic review and qualitative evidence synthesis
Publisher: BMJ
Date: 11-2021
DOI: 10.1136/BMJOPEN-2021-053084
Abstract: Chronic hip pain in middle-aged and older adults is common and disabling. Patient-centred care of chronic hip pain requires a comprehensive understanding of how people with chronic hip pain view their health problem and its care. This paper outlines a protocol to synthesise qualitative evidence of middle-aged and older adults' views, beliefs, expectations and preferences about their chronic hip pain and its care. We will perform a qualitative evidence synthesis using a framework approach. We will conduct this study in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and the Enhancing Transparency in Reporting the synthesis of Qualitative research checklist. We will search MEDLINE, CINAHL, The Cochrane Central Register of Controlled Trials, EMBASE and PsycINFO using a comprehensive search strategy. A priori selection criteria include qualitative studies involving s les with a mean age over 45 and where 80% or more have chronic hip pain. Two or more reviewers will independently screen studies for eligibility, assess methodological strengths and limitations using the Critical Appraisal Skills Programme qualitative studies checklist, perform data extraction and synthesis and determine ratings of confidence in each review finding using the Grading of Recommendations Assessment, Development and Evaluation—Confidence in the Evidence from Reviews of Qualitative research approach. Data extraction and synthesis will be guided by the Common-Sense Model of Self-Regulation. All authors will contribute to interpreting, refining and finalising review findings. This protocol is registered on PROSPERO and reported according to the PRISMA Statement for Protocols (PRISMA-P) checklist. Ethics approval is not required for this systematic review as primary data will not be collected. The findings of the review will be disseminated through publication in an academic journal and scientific conferences. PROSPERO registration number: CRD42021246305.
Is the relationship between increased knee muscle strength and improved physical function following exercise dependent on baseline physical function status?
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Protocol for a multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapy-led care for femoroacetabular impingement (FAI): the Australian FASHIoN trial
Publisher: Springer Science and Business Media LLC
Date: 26-09-2017
Immediate effect of valgus bracing on knee joint moments in meniscectomised patients: An exploratory study
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.JSAMS.2016.03.005
Abstract: Patients undergoing medial arthroscopic partial meniscectomy are at increased risk of developing and/or progressing knee osteoarthritis, with increased medial compartment load being a potential contributor. The aim of this study was to evaluate the immediate effect of a valgus unloader knee brace on knee joint moments in patients following medial arthroscopic partial meniscectomy. Within-participant design. Twenty-two patients (age 35-55 years) who had undergone medial arthroscopic partial meniscectomy within the previous 8-15 months completed three-dimensional analysis of gait, forward lunge and one-leg rise during two conditions: with and without a valgus unloader knee brace. Outcome measures included the peak and impulse of the knee adduction moment and the peak knee flexion moment. The peak knee flexion moment increased during brace condition for forward lunge (mean difference [95% CI]) 0.54 [0.27-0.82] (Nm/(BW×HT)%), p<0.001 and one-leg rise (mean difference 0.45 [95% CI 0.08-0.82] (Nm/(BW×HT)%), p=0.022). No other significant differences were found between conditions in any of the included tasks. A significant effect of the knee brace was detected in terms of an increase in peak knee flexion moment during the more demanding tasks such as forward lunge and one-leg rise. This increase implies enhanced stability of the knee provided by the brace, which may induce increased knee function and knee-related confidence during strenuous tasks. Future research is required to explore the structural implications.
Trunk, pelvis and hip biomechanics in individuals with femoroacetabular impingement syndrome: Strategies for step ascent
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.GAITPOST.2018.01.005
Abstract: Femoroacetabular impingment (FAI) syndrome is common among young active adults and a proposed risk factor for the future development of hip osteoarthritis. Pain is dominant and drives clinical decision-making. Evidence for altered hip joint function in this patient population is inconsistent, making the identification of treatment targets challenging. A broader assessment, considering adjacent body segments (i.e. pelvis, trunk) and in idual movement strategies, may better inform treatment programs. This exploratory study aimed to compare trunk, pelvis, and hip biomechanics during step ascent between in iduals with and without FAI syndrome. Fifteen participants diagnosed with symptomatic cam-type or combined (cam plus pincer) FAI who were scheduled for arthroscopic surgery, and 11 age-, and sex-comparable pain- and disease-free in iduals, underwent three-dimensional motion analysis during a step ascent task. Trunk, pelvis and hip biomechanics were compared between groups. Participants with FAI syndrome exhibited altered ipsilateral trunk lean and pelvic rise towards the symptomatic side during single-leg support compared to controls. Alterations were not uniformly adopted across all in iduals with FAI syndrome those who exhibited more pronounced alterations to frontal plane pelvis control tended to report pain during the task. There were minimal between-group differences for hip biomechanics. Exploratory data suggest biomechanics at the trunk and pelvis during step ascent differ between in iduals with and without FAI syndrome. Those with FAI syndrome implement a range of proximal strategies for task completion, some of which may have relevance for rehabilitation. Longitudinal investigations of larger cohorts are required to evaluate hypothesized clinical and structural consequences.
Clinimetric properties of observer-assessed impairment tests used to evaluate hip and groin impairments: A systematic review
Publisher: Wiley
Date: 28-09-2012
DOI: 10.1002/ACR.21707
Abstract: To recommend the most suitable observer-assessed impairment tests in people with hip and/or groin pathologies by conducting a systematic review of the clinimetric properties of these tests. Electronic searches were performed in the Cochrane, PubMed, CINAHL, Embase, SPORTDiscus, and PsycINFO databases up to August 2011. Two reviewers independently rated the measurement properties of clinical tests of impairments, defined by the International Classification of Functioning, Disability and Health as problems in body structure or body function, using the Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN). "Best evidence synthesis" was made using COSMIN outcomes and the quality of findings was assessed using a purpose criteria system. Fifteen of 2,588 publications were eligible for inclusion. Impairments evaluated were range of motion (ROM 9 studies), muscle strength (6 studies), tenderness (3 studies), leg length discrepancy (2 studies), balance (2 studies), and muscle length (2 studies) in people with hip osteoarthritis (OA), hip fractures, and mixed hip/groin pathologies. Measurement properties evaluated included reliability, measurement error, construct validity, and criterion validity. Responsiveness and interpretability were not assessed. Intrarater reliability of ROM tests (intraclass correlation coefficient [ICC] 0.82-0.97) and strength tests (ICC 0.84-0.98) for hip OA and of strength tests (ICC 0.66-0.86) and balance tests (ICC 0.73-0.94) for hip fractures was demonstrated. This systematic review highlighted a paucity of literature evaluating the clinimetric properties of impairment tests for people with hip and/or groin pathology. A large number of inconclusive findings were found and as such, many clinical impairment tests should be used with caution in people with hip and/or groin pathologies until further clinimetric evidence becomes available.
Neuromuscular Exercise post Partial Medial Meniscectomy
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2015
Running-related muscle activation patterns and tibial acceleration across puberty
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.JELEKIN.2019.102381
Abstract: This study examined whether differences exist in tibial acceleration transients and electromyography (EMG) variables during running across female pubertal development. Sixty-four girls classified as pre- (n = 19), early/mid- (n = 22) and late ost-pubertal development (n = 23) ran in a laboratory whilst EMG data were recorded from quadriceps, hamstring and calf muscle groups, and acceleration transients from a triaxial accelerometer. The late ost-pubertal girls exhibited delayed vastus lateralis onset (mean difference (MD) = 0.02, 95% CI = 0.008, 0.34 ms)) compared to pre-pubertal girls, lower vastus lateralis pre-activation (MD = 7.02, 95% CI = 12.63, 1.42%) compared to early/mid-pubertal girls, and longer time to peak (TTP) anterior osterior (A/P) tibial acceleration compared to pre-pubertal girls (MD = 0.02, 95% CI = 0.006, 0.03 s). By contrast, late ost-pubertal girls demonstrated earlier semitendinosus onset compared to both early/mid- (MD = 0.02, 95% CI = 0.03, 0.005 ms) and pre-pubertal girls (MD = 0.02, 95% CI = 0.04, 0.007 ms). No other between-group differences were found for peak A/P, vertical and TTP vertical tibial acceleration (p > 0.05). Subsequently, regression analysis revealed that EMG variables accounted for approximately 34% (R
Hip Contact Force Magnitude and Regional Loading Patterns Are Altered in Those with Femoroacetabular Impingement Syndrome
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-06-2022
DOI: 10.1249/MSS.0000000000002971
Abstract: The magnitude and location of hip contact force influence the local mechanical environment of the articular tissue, driving remodeling. We used a neuromusculoskeletal model to investigate hip contact force magnitudes and their regional loading patterns on the articular surfaces in those with femoroacetabular impingement (FAI) syndrome and controls during walking. An EMG-assisted neuromusculoskeletal model was used to estimate hip contact forces in eligible participants with FAI syndrome ( n = 41) and controls ( n = 24), walking at self-selected speed. Hip contact forces were used to determine the average and spread of regional loading for femoral and acetabular articular surfaces. Hip contact force magnitude and region of loading were compared between groups using statistical parametric mapping and independent t -tests, respectively ( P 0.05). All of the following findings are reported compared with controls. Those with FAI syndrome walked with lower-magnitude hip contact forces (mean difference, −0.7 N·BW −1 P 0.001) during first and second halves of stance, and with lower anteroposterior, vertical, and mediolateral contact force vector components. Participants with FAI syndrome also had less between-participant variation in average regional loading, which was located more anteriorly (3.8°, P = 0.035) and laterally (2.2°, P = 0.01) on the acetabulum but more posteriorly (−4.8°, P = 0.01) on the femoral head. Participants with FAI syndrome had a smaller spread of regional loading across both the acetabulum (−1.9 mm, P = 0.049) and femoral head (1 mm, P 0.001) during stance. Compared with controls, participants with FAI syndrome walked with lower-magnitude hip contact forces that were constrained to smaller regions on the acetabulum and femoral head. Differences in regional loading patterns might contribute to the mechanobiological processes driving cartilage maladaptation in those with FAI syndrome.
Effect of exercise on pain processing and motor output in people with knee osteoarthritis: a systematic review and meta-analysis
Publisher: Elsevier BV
Date: 12-2020
Muscle activity amplitudes and co-contraction during stair ambulation following anterior cruciate ligament reconstruction
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.JELEKIN.2015.01.007
Abstract: The purpose of this study was to compare muscle activity litudes and co-contraction in those with anterior cruciate ligament (ACL) reconstruction to healthy controls during stair negotiation. Eighteen participants with unilateral ACL reconstruction and 17 healthy controls performed stair ascent and descent while surface electromyography was recorded from knee and hip musculature. During stair ascent, the ACL group displayed higher gluteus maximus activity (1-50% stance, p = 0.02), higher vastus lateralis:biceps femoris co-contraction (51-100% stance, p = 0.01), and higher vastus lateralis:vastus medialis co-contraction (51-100% stance, p = 0.05). During stair descent, the ACL group demonstrated higher gluteus maximus activity (1-50% stance, p = 0.01 51-100% stance, p < 0.01), lower rectus femoris activity (1-50% stance, p = 0.04), higher semimembranosus activity (1-50% stance, p=0.01), higher gluteus medius activity (51-100% stance, p = 0.01), and higher vastus medialis:semimembranosus co-contraction (1-50% stance, p = 0.02). While the altered muscle activity strategies observed in the ACL group may act to increase joint stability, these strategies may alter joint loading and contribute to post-traumatic knee osteoarthritis often observed in this population. Our results warrant further investigation to determine the longterm effects of altered muscle activity on the knee joint following ACL reconstruction.
Medial Longitudinal Arch Deformation during Walking and Stair Navigation While Carrying Loads
Publisher: SAGE Publications
Date: 06-2011
Abstract: Understanding the biomechanics of the medial longitudinal arch (MLA) may provide insights into injury risk and prevention, as well as function of the arch-supporting structures. Our understanding of MLA deformation is currently limited to sit-to-stand, walking, and running. Three-dimensional deformation of the MLA of the right foot was characterized in 17 healthy participants during several simulated activities of daily living. MLA deformation was quantified by both changes in arch length and navicular displacement during the stance phase of three motions: walking, stair ascent, and stair descent. Three levels of load were also evaluated: no load, a front load (13.6 kg), and a backpack load (13.6 kg). Force platforms and an eight-camera motion capture system were used to collect relevant lower extremity kinetic and kinematic data. Motion type had a significant ( p 0.05) effect on navicular displacement and arch length elongation with navicular displacement being greatest during stair descent, while the walking and stair descent conditions showed the greatest increase in arch length. External load did not significantly affect either of these two measures ( p 0.05). Differences in the MLA deformation variables resulting from varied dynamic activities of daily living can be greater than those during walking and should be considered. Detailing the mechanics of the MLA may aid in further understanding injuries associated with the MLA, and the results of the current study indicate that these mechanics change based on activity.
Hip joint moments in symptomatic vs. asymptomatic people with mild radiographic hip osteoarthritis
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.JBIOMECH.2019.109347
Abstract: Our primary objective was to examine external hip joint moments during walking in people with mild radiographic hip osteoarthritis (OA) with and without symptoms and disease-free controls. Three groups were compared (symptomatic with mild radiographic hip OA, n = 12 asymptomatic with mild radiographic hip OA, n = 13 OA-free controls, n = 20). Measures of the external moment (peak and impulse) in the sagittal, frontal and transverse plane during walking were determined. Variables were compared according to group allocation using mixed linear regression models that included in idual gait trials, with group allocation as fixed effect and walking speed as a random effect. Participants with evidence of radiographic disease irrespective of symptoms walked 14-16% slower compared to disease-free controls (p = 0.002). Radiographic disease without symptoms was not associated with any altered measures of hip joint moment compared to asymptomatic OA-free controls once speed was taken into account (p ≥ 0.099). People with both mild radiographic disease and symptoms had lower external peak hip adduction moment (p = 0.005) and lower external peak internal rotation moment (p < 0.001) accounting for walking speed. Among angular impulses, only the presence of symptoms was associated with a reduced hip internal rotation impulse (p = 0.002) in the symptomatic group. Collectively, our observations suggest that symptoms have additional mechanical associations from radiographic disease alone, and provide insight into potential early markers of hip OA. Future research is required to understand the implications of modifying walking speed and/or the external hip adduction and internal rotation moment in people with mild hip OA.
Gait retraining versus foot orthoses for patellofemoral pain: a pilot randomised clinical trial
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.JSAMS.2017.09.187
Abstract: To determine the feasibility of a clinical trial that compares a 6-week, physiotherapist-guided gait retraining program with a foot orthoses intervention in runners with patellofemoral pain. Pilot randomised controlled trial. Runners aged 18-40 years with clinically diagnosed patellofemoral pain were randomly allocated to either a 6-week gait retraining intervention of increasing cadence and use of a minimalist shoe or prefabricated foot orthoses. Outcomes at baseline and 12-weeks included recruitment, retention, adherence, adverse events, global improvement, anterior knee pain scale, worst and average pain on a 100mm visual analogue scale. Of the 16 randomised participants, two withdrew prior to commencing treatment due to non-trial related matters (n=1 from each group) and 14 completed the pilot trial. Minor calf muscle soreness was reported by 3 participants in the gait retraining group while no adverse events were reported in the foot orthoses group. There were no deviations from the treatment protocols. There was a large between-group difference favouring gait retraining at 12-weeks in the anterior knee pain scale and the worst pain in the past week, which was reflected in the number needed-to-treat of 2. This study supports the feasibility of a trial comparing gait retraining with foot orthoses and provides point estimates of effect that informs the design and planning of a larger clinical trial. It appears that a 6-week gait retraining program has a clinically meaningful effect on runners with patellofemoral pain when compared to an evidence-based treatment of foot orthoses.
Does meniscal pathology alter gait knee biomechanics and strength post-ACL reconstruction?
Publisher: Springer Science and Business Media LLC
Date: 14-12-2015
DOI: 10.1007/S00167-015-3908-X
Abstract: In iduals following anterior cruciate ligament reconstruction (ACLR) with concomitant meniscal pathology have a higher risk of developing knee osteoarthritis (OA) compared to those with isolated ACLR. Knee extensor weakness and altered dynamic knee joint biomechanics have been suggested to play a role in the development of knee OA following ACLR. This study investigated whether these factors differ in people following ACLR who have concomitant meniscal pathology compared to patients with isolated ACLR. Thirty-three patients with isolated ACLR and 34 patients with ACLR and meniscal pathology underwent strength and gait assessment 12-24 months post-operatively. Primary measures were peak isometric knee extensor torque and knee adduction moment (peak and impulse). Secondary measures included peak knee flexion moment and knee kinematics (sagittal and transverse). There were no between-group differences in knee extensor strength [mean difference (95 % CI) 0.09 (-0.23 to 0.42) Nm/kg, n.s.], peak knee adduction moment [-0.02 (-0.54 to 0.49) Nm/(BW × HT) %, n.s.] or knee adduction moment impulse [0.01 (-0.15 to 0.17) Nm/(BW × HT) %, p = n.s.]. No between-group differences were found for any secondary measures. No evidence was found to suggest that the higher prevalence of OA in patients with ACLR and meniscal pathology compared to patients with isolated ACLR is attributed to reduced knee muscle strength or altered knee joint biomechanics assessed 1-2 years post-surgery. Given that there is a higher incidence of knee OA in patients with concomitant meniscal pathology and ACLR, further investigation is needed so that population-specific rehabilitation protocols can be developed. III.
How does hip osteoarthritis differ from knee osteoarthritis?
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.JOCA.2021.09.010
Abstract: Hip and knee osteoarthritis (OA) are leading causes of global disability. Most research to date has focused on the knee, with results often extrapolated to the hip, and this extends to treatment recommendations in clinical guidelines. Extrapolating results from research on knee OA may limit our understanding of disease characteristics specific to hip OA, thereby constraining development and implementation of effective treatments. This review highlights differences between hip and knee OA with respect to prevalence, prognosis, epigenetics, pathophysiology, anatomical and biomechanical factors, clinical presentation, pain and non-surgical treatment recommendations and management.
Tibiofemoral contact force differences between flat flexible and stable supportive walking shoes in people with varus-malaligned medial knee osteoarthritis: A randomized cross-over study
Publisher: Public Library of Science (PLoS)
Date: 02-06-2022
DOI: 10.1371/JOURNAL.PONE.0269331
Abstract: To compare the effect of stable supportive to flat flexible walking shoes on medial tibiofemoral contact force (MTCF) in people with medial knee osteoarthritis and varus malalignment. This was a randomized cross-over study. Twenty-eight participants aged ≥50 years with medial knee osteoarthritis and varus malalignment were recruited from the community. Three-dimensional full-body motion, ground reaction forces and surface electromyograms from twelve lower-limb muscles were acquired during six speed-matched walking trials for flat flexible and stable supportive shoes, tested in random order. An electromyogram-informed neuromusculoskeletal model with subject-specific geometry estimated bodyweight (BW) normalized MTCF. Waveforms were analyzed using statistical parametric mapping with a repeated measures analysis of variance model. Peak MTCF, MTCF impulse and MTCF loading rates (discrete outcomes) were evaluated using a repeated measures multivariate analysis of variance model. Statistical parametric mapping showed lower MTCF in stable supportive compared to flat flexible shoes during 5–18% of stance phase (p = 0.001). For the discrete outcomes, peak MTCF and MTCF impulse were not different between the shoe styles. However, mean differences [95%CI] in loading impulse (-0.02 BW·s [-0.02, 0.01], p .001), mean loading rate (-1.42 BW·s -1 [-2.39, -0.45], p = 0.01) and max loading rate (-3.26 BW·s -1 [-5.94, -0.59], p = 0.02) indicated lower measure of loading in stable supportive shoes compared to flexible shoes. Stable supportive shoes reduced MTCF during loading stance and reduced loading impulse/rates compared to flat flexible shoes and therefore may be more suitable in people with medial knee osteoarthritis and varus malalignment. Australian and New Zealand Clinical Trials Registry ( 12619000622101 ).
Factors Influencing Cane Use for the Management of Knee Osteoarthritis: A Cross-Sectional Survey
Publisher: Wiley
Date: 04-09-2018
DOI: 10.1002/ACR.23494
Abstract: To investigate demographic, symptom-related, and cognitive determinants of cane use for knee osteoarthritis (OA) and prioritize the factors that could facilitate cane use in people with no previous cane use. A survey of people ages ≥45 years with a clinical diagnosis of knee OA was conducted. The survey consisted of the following two sections: 1) demographic and cognitive determinants of cane use assessed via subscales of the Cane Cognitive Mediator Scale, and 2) 19 statements, underpinned by the Behaviour Change Wheel theoretical framework, relating to factors that could facilitate regular cane use. Logistic regression was used to examine determinants of cane use, while a priority pairwise ranking activity (1000minds software) determined the rank order of the 19 statements that could facilitate cane use. A total of 529 people completed Part 1 (80% females 35% cane users) and 231 people completed Part 2. Age (odds ratio [OR] 1.06, 95% confidence interval [95% CI] 1.03- 1.09), body mass index (BMI) (OR 1.03, 95% CI 1.01-1.06), knee pain ≥3 years (OR 2.62, 95% CI 1.63-4.21) and numeric rating scale pain level while walking (OR 1.19, 95% CI 1.09-1.30) were significant independent determinants of cane use. In people who had never used a cane, statements relating to cane-use technique, fitting, knowledge of benefits, and motivation were ranked highest overall. Independent determinants of cane use include older age, higher BMI, greater pain duration, and greater severity of knee pain. Strategies targeting an in idual's capability and motivation to use a cane may increase cane use among people with knee OA.
Osteoarthritis year in review 2015: Rehabilitation and outcomes
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.JOCA.2015.07.028
Abstract: The purpose of this narrative review was to highlight recent research in the rehabilitation of people with osteoarthritis (OA) by summarizing findings from selected key systematic reviews and randomized controlled trials (RCTs). A systematic search was conducted using the PubMed, Physiotherapy Evidence Database (PEDro) and Cochrane databases from April 1st 2014 to March 31st 2015. A selection of these is discussed based on study quality, relevance, contribution to new knowledge or controversial findings. Methodological quality of RCTs was assessed using guidelines from PEDro. From 274 articles, 74 were deemed to meet the eligibility criteria including 24 systematic reviews and 50 studies reporting on findings from RCTs. Overall the methodological quality of the RCTs was moderate. The studies were grouped into several themes covering evidence of rehabilitation outcomes in less studied joints including the hand and hip new insights into exercise in knee OA effects of biomechanical treatments on symptoms and structure in knee OA and effects of acupuncture. Exercise was the most common treatment evaluated. Although little evidence supported benefit of exercise for hand OA, exercise has positive effects for hip and knee OA symptoms and these benefits may depend upon patient phenotypes. The first evidence that a brace can influence knee joint structure emerged. The latest evidence suggests that acupuncture has, at best, small treatment effects on knee OA pain of unlikely clinical relevance.
Frontal plane hip joint loading according to pain severity in people with hip osteoarthritis
Publisher: Wiley
Date: 19-12-2018
DOI: 10.1002/JOR.23816
Abstract: The primary objective was to examine the hip adduction moment during walking in people with hip osteoarthritis (OA) according to pain severity. Sixty-eight participants with unilateral symptomatic hip OA were included. Pain during walking was assessed on a 5-point Likert item within the Western Ontario and McMaster Universities Index (no pain = 12 mild pain n = 37 moderate pain n = 19). Measures of the external hip adduction moment (peaks, Nm/BW × BH (%) and impulse, Nm.s/BW × BH (%)) were determined. Other measures included frontal plane hip, pelvis and trunk kinematics, walking speed and peak isometric hip abductor strength. Variables were compared according to pain severity using linear models and biomechanical variables were examined. Participants with moderate pain had a significantly higher second peak hip adduction moment and impulse compared to those with less pain. There was no difference in any measure of hip adduction moment between those with mild pain and no pain. There were no differences in kinematics across pain severity categories. Participants with moderate pain had a significantly slower walking speed compared to participants with mild and no pain. Participants with moderate pain had weaker peak isometric hip abductor strength compared to those with mild pain and no pain. The hip adduction moment during walking, hip abduction strength and walking speed differs according to pain severity during walking in people with hip OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1637-1644, 2018.
Mechanisms underpinning longitudinal increases in the knee adduction moment following arthroscopic partial meniscectomy
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.CLINBIOMECH.2014.07.002
Abstract: Knee osteoarthritis is common following arthroscopic partial meniscectomy and a higher external peak knee adduction moment is believed to be a contributor. The peak knee adduction moment has been shown to increase over 2 years (from 3-months post-arthroscopic partial meniscectomy). The aim of this study was to evaluate mechanisms underpinning the increase in peak knee adduction moment over 2 years observed in people 3-months following arthroscopic partial meniscectomy. Sixty-six participants with medial arthroscopic partial meniscectomy were assessed at baseline and again 2 years later. Parameters were evaluated at time of peak knee adduction moment as participants walked barefoot at their self-selected normal and fast pace for both time points. For normal pace walking, an increase in frontal plane ground reaction force-to-knee lever arm accounted for 30% of the increase in peak knee adduction moment (B=0.806 [95% CI 0.501-1.110], P<0.001). For fast pace walking, an increase in the frontal plane ground reaction force magnitude accounted for 21% of the increase in peak knee adduction moment (B=2.343 [95% CI 1.219-3.468], P<0.001) with an increase in tibia varus angle accounting for a further 15% (B=0.310 [95% CI 0.145-0.474], P<0.001). Our data suggest that an increase in lever arm and increase in frontal plane ground reaction force magnitude are contributors to the increased knee adduction moment observed over time in people following arthroscopic partial meniscectomy.
Immediate effects of valgus knee bracing on tibiofemoral contact forces and knee muscle forces
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.GAITPOST.2018.11.009
Abstract: Background Valgus knee braces have been reported to reduce the external knee adduction moment during walking. However, mechanistic investigations into the effects of valgus bracing on medial compartment contact forces using electromyogram-driven neuromusculoskeletal models are limited. Research question What are the immediate effects of valgus bracing on medial tibiofemoral contact forces and muscular loading of the tibiofemoral joint? Methods Sixteen (9 male) healthy adults (27.7 ± 4.4 years) performed 20 over-ground walking trials at self-selected speed both with and without an Ossür Unloader One® brace. Assessment order (i.e., with or without brace) was randomised and counterbalanced to prevent order effects. While walking, three-dimensional lower-body motion, ground reaction forces, and surface electromyograms from eight lower-limb muscles were acquired. These data were used to calibrate an electromyogram-driven neuromusculoskeletal model of muscle and tibiofemoral contact forces (N), from which muscle and external load contributions (%) to those contact forces were determined. Results Although walking with the brace resulted in no significant changes in peak tibiofemoral contact forces at the group-level, in idual responses were variable and non-uniform. At the group-level, wearing the brace resulted in a 2.35% (95% CI 0.46-4.24 p = 0.02) greater relative contribution of muscle to lateral compartment contact loading (54.2 ± 11.1%) compared to not wearing the brace (51.8 ± 12.1%) (p < 0.05). Average relative contributions of muscle and external loads to medial compartment loading were comparable between brace and no brace conditions (p ≥ 0.05). Significance Wearing a valgus knee brace did not immediately reduce peak tibiofemoral contact forces in healthy adults during normal walking. It appears this population may modulate muscle activation patterns to support brace-generated valgus moments, thereby maintaining normal walking knee moments and tibiofemoral contact forces. Future investigations are warranted to better understand effects of valgus knee brace in people with medial knee osteoarthritis using an electromyogram-driven neuromusculoskeletal model.
How Do Nonsurgical Interventions Improve Pain and Physical Function in People With Osteoarthritis? A Scoping Review of Mediation Analysis Studies
Publisher: Wiley
Date: 31-10-2022
DOI: 10.1002/ACR.24983
Abstract: Nonsurgical interventions are recommended for osteoarthritis (OA). However, how interventions change pain and physical function is unclear. Therefore, the objectives of this scoping review were to 1) identify what potential mediators of nonsurgical interventions on pain and physical function have been evaluated and 2) summarize the findings according to intervention, joint, and outcome. We searched Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and Scopus databases. Studies were included if they conducted a mediation analysis on a randomized controlled trial evaluating a nonsurgical intervention on OA of any joint. Outcomes were pain and physical function. Nine knee OA studies, evaluating diet plus exercise, exercise, unloading shoes, high‐expectation communication during acupuncture, and telephone‐based weight loss plus exercise were identified. Except for weight loss and self‐efficacy, putative mediators (knee muscle perfusion/extensor strength/adduction moment, systemic inflammatory biomarkers, physical activity, dietary intake, and pain beliefs) were evaluated by single studies. Ten mediators partially mediated intervention (diet plus exercise, exercise, high‐expectation communication) effects on pain and physical function. Eight mediators were common to pain and function (reduced weight, increased knee extensor strength, and increased self‐efficacy). Constant knee flexor muscle perfusion partially mediated exercise effects on pain, and knee pain relief partially mediated exercise effects on function. In knee OA, some evidence suggests that the benefits of 1) diet and exercise are mediated through changes in body weight, systemic inflammation, and self‐efficacy 2) exercise is mediated through changes in knee muscle strength and self‐efficacy and 3) high‐expectation communication style is mediated through changes in self‐efficacy.
Alterations in medial-lateral postural control after anterior cruciate ligament reconstruction during stair use
Publisher: Elsevier BV
Date: 03-2020
Measurement properties of performance-based measures to assess physical function in hip and knee osteoarthritis: a systematic review
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.JOCA.2012.08.015
Abstract: To systematically review the measurement properties of performance-based measures to assess physical function in people with hip and/or knee osteoarthritis (OA). Electronic searches were performed in MEDLINE, CINAHL, Embase, and PsycINFO up to the end of June 2012. Two reviewers independently rated measurement properties using the consensus-based standards for the selection of health status measurement instrument (COSMIN). "Best evidence synthesis" was made using COSMIN outcomes and the quality of findings. Twenty-four out of 1792 publications were eligible for inclusion. Twenty-one performance-based measures were evaluated including 15 single-activity measures and six multi-activity measures. Measurement properties evaluated included internal consistency (three measures), reliability (16 measures), measurement error (14 measures), validity (nine measures), responsiveness (12 measures) and interpretability (three measures). A positive rating was given to only 16% of possible measurement ratings. Evidence for the majority of measurement properties of tests reported in the review has yet to be determined. On balance of the limited evidence, the 40 m self-paced test was the best rated walk test, the 30 s-chair stand test and timed up and go test were the best rated sit to stand tests, and the Stratford battery, Physical Activity Restrictions and Functional Assessment System were the best rated multi-activity measures. Further good quality research investigating measurement properties of performance measures, including responsiveness and interpretability in people with hip and/or knee OA, is needed. Consensus on which combination of measures will best assess physical function in people with hip/and or knee OA is urgently required.
The Impact of Financial Incentives on Physical Activity: A Systematic Review and Meta-Analysis
Publisher: SAGE Publications
Date: 16-07-2020
Abstract: To evaluate the effects of financial incentives on physical activity (PA). MEDLINE, Embase, 7 other databases, and 2 trial registries until July 17, 2019. Randomized controlled trials with adults aged ≥18 years assessing the effect of financial incentives on PA. Any comparator was eligible provided the only difference between groups was the incentive strategy. Two independent reviewers extracted data and assessed study quality. Of 5765 records identified, 57 records (51 unique trials n = 17 773 participants) were included. Random-effects models pooling data for each of the 5 PA domains. Financial incentives increase leisure time PA (gym or class attendance standardized mean difference [95% CI], 0.46 [0.28-0.63], n = 5057) and walking behavior (steps walked 0.25 [0.13-0.36], n = 3254). No change in total minutes of PA (0.52 [−0.09 to 1.12], n = 968), kilocalories expended (0.19 [−0.06 to 0.44], n = 247), or the proportion of participants meeting PA guidelines (risk ratio [95% CI] 1.53 [0.53-4.44], n = 650) postintervention was observed. After intervention has ceased, incentives sustain a slight increase in leisure time PA (0.10 [0.02-0.18], n = 2678) and walking behavior (0.11 [0.00-0.22], n = 2425). Incentives probably improve leisure time PA and walking at intervention end, and small improvements may be sustained over time once incentives have ceased. They lead to little or no difference in kilocalories expended or minutes of PA. It is uncertain whether incentives change the likelihood of meeting PA guidelines because the certainty of the evidence is low.
Multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapist-led care for femoroacetabular impingement (FAI) syndrome on hip cartilage metabolism: the Australian FASH
Publisher: Springer Science and Business Media LLC
Date: 16-08-2021
DOI: 10.1186/S12891-021-04576-Z
Abstract: Arthroscopic surgery for femoroacetabular impingement syndrome (FAI) is known to lead to self-reported symptom improvement. In the context of surgical interventions with known contextual effects and no true sham comparator trials, it is important to ascertain outcomes that are less susceptible to placebo effects. The primary aim of this trial was to determine if study participants with FAI who have hip arthroscopy demonstrate greater improvements in delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index between baseline and 12 months, compared to participants who undergo physiotherapist-led management. Multi-centre, pragmatic, two-arm superiority randomised controlled trial comparing physiotherapist-led management to hip arthroscopy for FAI. FAI participants were recruited from participating orthopaedic surgeons clinics, and randomly allocated to receive either physiotherapist-led conservative care or surgery. The surgical intervention was arthroscopic FAI surgery. The physiotherapist-led conservative management was an in idualised physiotherapy program, named Personalised Hip Therapy (PHT). The primary outcome measure was change in dGEMRIC score between baseline and 12 months. Secondary outcomes included a range of patient-reported outcomes and structural measures relevant to FAI pathoanatomy and hip osteoarthritis development. Interventions were compared by intention-to-treat analysis. Ninety-nine participants were recruited, of mean age 33 years and 58% male. Primary outcome data were available for 53 participants (27 in surgical group, 26 in PHT). The adjusted group difference in change at 12 months in dGEMRIC was -59 ms (95%CI − 137.9 to - 19.6) ( p = 0.14) favouring PHT. Hip-related quality of life (iHOT-33) showed improvements in both groups with the adjusted between-group difference at 12 months showing a statistically and clinically important improvement in arthroscopy of 14 units (95% CI 5.6 to 23.9) ( p = 0.003). The primary outcome of dGEMRIC showed no statistically significant difference between PHT and arthroscopic hip surgery at 12 months of follow-up. Patients treated with surgery reported greater benefits in symptoms at 12 months compared to PHT, but these benefits are not explained by better hip cartilage metabolism. Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549 . Trial registered 2/11/2015.
The associations of knee extensor muscle steadiness with maximal voluntary torque and physical function in patients with knee osteoarthritis
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.CLINBIOMECH.2022.105736
Abstract: Muscle weakness is characteristic of knee osteoarthritis. Muscle steadiness may be an important adjunct to knee muscle strength in improving physical function in knee osteoarthritis. However, the role of muscle steadiness is uncertain. To determine the associations of knee extensor muscle steadiness with maximal voluntary torque and physical function in patients with knee osteoarthritis. Baseline data from 177 patients in a randomized clinical trial were used. Isokinetic knee extension torque was processed into maximal voluntary torque [Nm]. Muscle steadiness was expressed as the coefficient of variance [%] and as peak power frequency [Hz]. Physical function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, the Get-Up-and-Go and Stair-climb tests. Associations were determined using regression analyses and adjusted for confounders. Lower muscle steadiness (i.e., higher coefficient of variance and peak power frequency) was associated with lower maximal voluntary torque (B = - 7.38, [-10.8, -3.95], R Low muscle steadiness was weakly associated with low muscle strength and poorer self-reported physical function. Muscle steadiness and muscle strength seem to be different attributes of muscle function. There is no convincing evidence that muscle steadiness is an important adjunct in studying physical function in patients with knee osteoarthritis.
Poor knee function after ACL reconstruction is associated with attenuated landing force and knee flexion moment during running
Publisher: Springer Science and Business Media LLC
Date: 28-02-2023
DOI: 10.1007/S00167-017-4810-5
Abstract: Poor knee function after anterior cruciate ligament reconstruction (ACLR) may increase the risk of future knee symptoms and knee osteoarthritis via abnormal knee joint loading patterns, particularly during high-impact activity. This study aimed to assess the relationship between poor self-reported or clinically measured knee function and knee moments/vertical ground reaction force (vGRF) in in iduals following ACLR. 61 participants (mean 16.5 ± 3 months following ACLR, 23 women) completed a patient-reported knee function questionnaire and three hop tests (% of uninvolved limb). Participants were ided into satisfactory and poor knee function groups (poor < 85% patient-reported knee function and/or < 85% hop test symmetry). The knee biomechanics of both groups were assessed with three-dimensional motion analysis during the stance phase of overland running at self-selected speeds, and the association between knee function and knee moments was assessed using analysis of covariance with running speed as a covariate. Participants with poor knee function (n = 30) ran with significantly smaller peak knee flexion moments (moderate effect size 0.7, p = 0.03) and significantly smaller peak vGRFs (large effect size 1.0, p = 0.002) compared to those with satisfactory knee function (n = 31). No significant differences were observed for knee adduction and knee external rotation moments or knee kinematics. In iduals following ACLR with poor self-reported knee function and/or hop test performance demonstrate knee moments during running that may be associated with lower knee joint contact forces. These findings provide greater understanding of the relationship between knee biomechanics during running and clinical assessments of knee function. III. Cross-sectional study.
Effect of gait retraining on segment coordination and joint variability in individuals with patellofemoral pain
Publisher: Elsevier BV
Date: 12-2020
Knee Muscle Strength After Recent Partial Meniscectomy Does Not Relate to 2-year Change in Knee Adduction Moment
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
Reliability and measurement error of the Osteoarthritis Research Society International (OARSI) recommended performance-based tests of physical function in people with hip and knee osteoarthritis
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.JOCA.2017.06.006
Abstract: To estimate the reliability and measurement error of performance-based tests of physical function recommended by the Osteoarthritis Research Society International (OARSI) in people with hip and/or knee osteoarthritis (OA). Prospective repeated measures between independent raters within a session and within-rater over a week interval. Relative reliability was estimated for 51 people with hip and/or knee OA (mean age 64.5 years, standard deviation (SD) 6.21 years 47% females 36 (70%) primary knee OA) on the 30s Chair Stand Test (30sCST), 40m Fast-Paced Walk Test (40mFPWT), 11-Stair Climb Test (11-step SCT), Timed Up and Go (TUG), Six-Minute Walk Test (6MWT), 10m Fast-Paced Walk Test (10mFPWT) and 20s Stair Climb Test (20sSCT) using intra-class correlation coefficients (ICC). Absolute reliability was calculated using standard error of measurement (SEM) and minimal detectable change (MDC). Measurement error was acceptable (SEM 0.9, lower 1-sided 95% CI > 0.7) for the 40mFPWT, 6MWT and 10mFPWT sufficient (ICC >0.8, lower 1-sided 95% CI > 0.7) for 30sCST, 20sSCT unacceptable (lower 1-side 95% CI < 0.7) for 11-step SCT and TUG. Within-rater reliability was optimal for 40mFPWT, and 6MWT sufficient for 30sCST and 10mFPWT and unacceptable for 11-step SCT, TUG and 20sSCT. The 30sCST, 40mFPWT, 6MWT and 10mFPWT, demonstrated, at minimum, acceptable levels of both between and within-rater reliability and measurement error. All tests demonstrated sufficiently small measurement error indicating they are adequate for measuring change over time in in iduals with knee/hip OA.
Walking-related knee contact forces and associations with knee pain across people with mild, moderate and severe radiographic knee osteoarthritis: a cross-sectional study
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.JOCA.2022.02.619
Abstract: To investigate knee contact forces (KCFs), and their relationships with knee pain, across grades of radiographic knee osteoarthritis (OA) severity. Cross-sectional exploratory analysis of 164 participants with medial knee OA. Radiographic severity was classified as mild (grade 2), moderate (grade 3) or severe (grade 4) using the Kellgren & Lawrence (KL) scale. Walking knee pain was assessed using an 11-point numerical rating scale. External knee adduction moment (external KAM) and internal muscle forces were used to calculate medial, lateral and total KCFs using a musculoskeletal computational model. Force-time series across stance phase of gait were compared across KL grades using Statistical Parametric Mapping. Associations between KCFs and pain across KL grades were assessed using linear models. Medial KCFs during early and middle stance were higher in participants with KL3 and KL4 compared to those with KL2. In contrast, lateral KCFs were higher in those with KL2 compared to KL3 and KL4 in middle to late stance. The external loading component (i.e., KAM) of the medial KCF during middle to late stance was also greater in participants with KL3 and KL4 compared to those with KL2, whereas the internal (i.e., muscle) component was greater in those with KL3 and KL4 compared to KL3 during early stance. There were no associations between medial KCF and knee pain in any KL grade. Medial and lateral KCFs differ between mild, moderate and severe radiographic knee OA but are not associated with knee pain severity for any radiographic OA grade.
What is real change in submaximal cardiorespiratory fitness in older adults? Retrospective analysis of a clinical trial
Publisher: Springer Science and Business Media LLC
Date: 28-04-2022
DOI: 10.1186/S40798-022-00447-6
Abstract: To assess the test–retest reliability of submaximal cardiorespiratory fitness in healthy active older adults. This was a retrospective analysis of 41 adults enrolled in a clinical trial [mean (sd) aged 59 yrs (7) 29% females and body mass index 24.5 kg/m 2 (3.3)]. Cardiorespiratory fitness was assessed using a cycle ergometer 6 weeks apart. The initial workload was 1 W per kilogram of free fat mass (W/kg FFM) and increased by 0.5 W/kg FFM every 3 min until participants could not maintain the speed at ≥ 60 rpm, they reached a rating of perceived exertion of 15–17, and/or obtained a respiratory exchange ratio (RER) of 1.000. Reliability of $${V}{\\text{O}}_{2}$$ V O 2 , heart rate and RER was assessed for each workload, and for $${V}{\\text{O}}_{2}$$ V O 2 , when RER reached 1.00. Reliability was examined as the intraclass correlation coefficient (ICC (2,1) ), Bland–Altman plots, standard error of measurement (SEM and SEM%), and the minimal detectable change (MDC). Test–retest agreement ranged between (ICC (2,1) 0.44–0.84) with no discernible systematic differences between assessments. The SEM% for absolute and relative $${V}{\\text{O}}_{2}$$ V O 2 ranged between 13.0 to 20.2%, and 13.8 to 26.3%, respectively . The MDC 90 % for absolute and relative $${V}{\\text{O}}_{2}$$ V O 2 ranged between 30.4% to 47.1%, and 32.2% to 61.4%, respectively. The lowest SEMs% and MDCs% for both absolute and relative $${V}{\\text{O}}_{2}$$ V O 2 were observed for workloads at 2.5 W kg/FFM (~ 13% and ~ 31%, respectively). Although at least modest relative reliability was consistently demonstrated, the smaller measurement error associated with absolute and relative $${V}{\\text{O}}_{2}$$ V O 2 at 2.5 W kg/FFM may indirectly suggest that submaximal cardiorespiratory fitness can be monitored more confidently at higher workloads. Findings provide critical information to determine how much change is considered ‘real change’ in repeated measures of cardiorespiratory fitness using a submaximal graded exercise testing protocol in healthy active older adults.
Gait analysis post anterior cruciate ligament reconstruction: Knee osteoarthritis perspective
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.GAITPOST.2012.01.003
Abstract: In iduals with anterior cruciate ligament (ACL) reconstruction are at increased risk to develop knee osteoarthritis (OA). Gait analysis describing kinetics of the lower extremity during walking and stair use (stair ascent and stair descent) can provide insight to everyday dynamic knee joint loading. In this study, we compared lower extremity gait patterns of those with ACL reconstruction (>1 year) to a control group. Fifteen ACL reconstructed in iduals and 17 healthy controls participated in this study. Knee extensor and flexor strength were assessed. Using inverse dynamics, lower extremity moments were calculated during the stance phase of walking and during two steps of stair ascent and descent. Univariate ANOVA was used to test for main effects between (1) injured leg and control group and (2) non-injured leg and control group. Student paired t-tests were used to determine differences between the injured and non-injured leg. Those with ACL reconstruction exhibited reduced initial knee flexion angles during stair descent, reduced knee extension moments during stair descent and stair ascent (second step), and increased hip extension moments during stair ascent (second step) and walking as compared to controls. Knee flexor strength was significantly reduced in the ACL group, but no differences were found in knee extensor strength. No kinematic or kinetic differences were observed between the injured and non-injured leg of the ACL group. Walking and stair ambulation highlight altered joint loading in those with ACL reconstruction surgery. In iduals appeared to compensate for lower knee extension moments by increasing hip extension moments. Furthermore, the load distribution on the articular cartilage is likely shifted as evidenced by reduced knee flexion angles in the ACL reconstructed leg.
Comparison of Walking Biomechanics After Physical Therapist–Led Care or Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Secondary Analysis From a Randomized Controlled Trial
Publisher: SAGE Publications
Date: 13-09-2022
DOI: 10.1177/03635465221120388
Abstract: Femoroacetabular impingement syndrome is characterized by chondrolabral damage and hip pain. The specific biomechanics used by people with femoroacetabular impingement syndrome during daily activities may exacerbate their symptoms. Femoroacetabular impingement syndrome can be treated nonoperatively or surgically however, differential treatment effects on walking biomechanics have not been examined. To compare the 12-month effects of physical therapist–led care or arthroscopy on trunk, pelvis, and hip kinematics as well as hip moments during walking. Secondary analysis of multi-centre, pragmatic, two-arm superiority randomized controlled trial subs le Level of evidence, 1. A subs le of 43 participants from the Australian Full randomised controlled trial of Arthroscopic Surgery for Hip Impingement versus best cONventional (FASHIoN trial) underwent gait analysis and completed the International Hip Outcome Tool (iHOT-33) at both baseline and 12 months after random allocation to physical therapist–led care (personalized hip therapy n = 22 mean age 35 41% female) or arthroscopy (n = 21 mean age 36 48% female). Changes in trunk, pelvis, and hip biomechanics were compared between treatment groups across the gait cycle using statistical parametric mapping. Associations between changes in iHOT-33 and changes in hip kinematics across 3 planes of motion were examined. As compared with the arthroscopy group, the personalized hip therapy group increased its peak hip adduction moments (mean difference = 0.35 N·m/body weight·height [%] [95% CI, 0.05-0.65] effect size = 0.72 P = .02). Hip adduction moments in the arthroscopy group were unchanged in response to treatment. No other between-group differences were detected. Improvements in iHOT-33 were not associated with changes in hip kinematics. Peak hip adduction moments were increased in the personalized hip therapy group and unchanged in the arthroscopy group. No biomechanical changes favoring arthroscopy were detected, suggesting that personalized hip therapy elicits greater changes in hip moments during walking at 12-month follow-up. Twelve-month changes in hip-related quality of life were not associated with changes in hip kinematics.
The knee adduction moment and knee osteoarthritis symptoms: relationships according to radiographic disease severity
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.JOCA.2016.08.014
Abstract: To investigate relationships between external knee adduction moment parameters (KAM) and osteoarthritis (OA) symptoms according to disease severity. 164 participants with symptomatic medial knee OA were included. Radiographic severity was graded by (1) Kellgren & Lawrence (KL) scale (Grade 2, n = 49 Grade, n = 52 Grade 4, n = 63) and (2) medial tibiofemoral joint space narrowing (JSN) (Grade 1, n = 47 Grade 2, n = 50 Grade 3, n = 67). KAM-related parameters (peak KAM, KAM impulse and cumulative load) were determined from three-dimensional gait analysis and pedometry. Cumulative load was determined by multiplying KAM impulse by the average number of steps/day recorded over at least 5 days. Symptoms were assessed via numeric rating scale ((NRS), pain) and Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index (pain and physical function). Relationships between KAM parameters (independent variables) and symptoms (dependent variables) were evaluated by radiographic severity using linear models, adjusting for covariates. In mild disease (either KL Grade 2 or JSN Grade 1), there were no associations between KAM and symptoms. In moderate disease of KL Grade 3, higher KAM impulse was associated with greater WOMAC pain. In severe disease (KL Grade 4), higher KAM impulse was associated with less WOMAC pain (KL Grade 4), while higher peak KAM was associated with better function (KL Grade 4). Higher cumulative knee adduction load was associated with less pain on both NRS and WOMAC (JSN Grade 3) as well as better function (both JSN Grade 3 and KL Grade 4). Relationships between KAM-related parameters and symptoms differ according to underlying radiographic OA severity.
Sex-specific walking kinematics and kinetics in individuals with unilateral, symptomatic hip osteoarthritis: A cross sectional study
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.GAITPOST.2018.07.179
Abstract: Hip osteoarthritis (OA) is a significant cause of disability, with hip pain and reduced external hip moments during walking being key features of the condition. The external hip adduction moment is greater in healthy women than men, however these between-sex differences are not evident in those with end-stage hip OA. Whether sex-specific hip kinetics are associated with early-midstage hip OA has not been investigated and may be a potential target for directed treatment. Thirty-eight women and twenty-eight men with a diagnosis of symptomatic, unilateral, mild-to-moderate hip OA (Kellegren-Lawrence Grade 2 or 3) underwent three-dimensional gait analysis of normal walking gait using Vicon motion capture. Hip joint, trunk and pelvic angles and hip moments were calculated using the Plug-in-Gait model. The external peak flexion moment, and the first peak, second peak and mid-stance minimum of the hip adduction moment during the stance phase of walking as well as hip, trunk and pelvic kinematics occurring at the three moment time points were compared between groups using an analysis of covariance. Women with hip OA exhibited a greater external hip adduction moment (mean difference 0.8-1.3 N m/BW.Ht(%), P < 0.05) and greater hip adduction angles (mean difference 2.8-4.9 degrees, P < 0.05) throughout stance than men. Men walked with a greater forward trunk lean than women during early to midstance (mean difference 2.9-3.5 degrees, P < 0.05) than women. In contrastto late stage hip OA, between-sex difference in hip joint kinematics and kinetics are preserved in early-midstage hip OA.
Hip biomechanics during stair ascent and descent in people with and without hip osteoarthritis
Publisher: Wiley
Date: 07-04-2017
DOI: 10.1002/JOR.23407
Abstract: Hip osteoarthritis (OA) is often associated with pain and impaired function. Understanding biomechanical alterations in patients with hip OA during challenging activities such as stair use is important to inform treatments. The aim of this study was to determine whether kinematics and kinetics during stair ambulation differed between people with hip OA and healthy controls. Fifteen participants with symptomatic and radiographic hip OA and 15 asymptomatic healthy controls underwent 3-D motion analysis during stair ascent and descent. Trunk, pelvis, and hip kinematics as well as hip kinetics were evaluated. Analyses were performed unadjusted and adjusted for speed and leg length. In both the unadjusted and adjusted analyses, participants with hip OA ascended stairs with less hip range of motion in all three planes and a lower peak external rotation moment compared to controls. In the unadjusted analysis, hip OA participants descended stairs with greater ipsilateral trunk lean, less sagittal plane range of motion, lower peak extension moment, lower peak external rotation moment, and greater hip adduction moment impulse compared to controls. In the adjusted results, peak internal rotation moment and hip adduction moment impulse were greater in hip OA participants compared to controls. Findings show that in iduals with hip OA display limited range of hip joint movement, particularly during stair ascent, and overall indicate the use of strategies (e.g., trunk lean lower peak external rotation moment higher adduction moment impulse) that implicate altered hip abductor function. Future research is required to further understand the implications of these findings on hip OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1505-1514, 2017.
Mechanisms underpinning the peak knee flexion moment increase over 2-years following arthroscopic partial meniscectomy
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.CLINBIOMECH.2015.09.006
Abstract: Knee osteoarthritis is common in people who have undergone partial meniscectomy, and a higher external knee flexion moment during gait may be a potential contributor. Although the peak external knee flexion moment has been shown to increase from 3 months to 2 years following partial meniscectomy, mechanisms underpinning the increase in the peak knee flexion moment are unknown. Sixty-six participants with partial meniscectomy completed three-dimensional gait (normal and fast pace) and quadriceps strength assessment at baseline (3 months following partial meniscectomy) and again 2 years later. Variables included external knee flexion moment, vertical ground reaction force, knee flexion kinematics, and quadriceps peak torque. For normal pace walking, the main significant predictors of change in peak knee flexion moment were an increase in peak vertical ground reaction force (R(2)=0.55), mostly due to an increase in walking speed, and increase in peak knee flexion angle (R(2)=0.19). For fast pace walking, the main significant predictors of change in peak knee flexion moment were an in increase in peak vertical ground reaction force (R(2)=0.51) and increase in knee flexion angle at initial contact (R(2)=0.17). Change in peak vertical force was mostly due to an increase in walking speed. Findings suggest that increases in vertical ground reaction force and peak knee flexion angle during stance are predominant contributors to the 2-year change in peak knee flexion moment. Future studies are necessary to refine our understanding of joint loading and its determinants following meniscectomy.
Data-driven prognosis: a multi-physics approach verified via balloon burst experiment
Publisher: The Royal Society
Date: 04-2015
Abstract: A multi-physics formulation for data-driven prognosis (DDP) is developed. Unlike traditional predictive strategies that require controlled offline measurements or ‘training’ for determination of constitutive parameters to derive the transitional statistics, the proposed DDP algorithm relies solely on in situ measurements. It uses a deterministic mechanics framework, but the stochastic nature of the solution arises naturally from the underlying assumptions regarding the order of the conservation potential as well as the number of dimensions involved. The proposed DDP scheme is capable of predicting onset of instabilities. Because the need for offline testing (or training) is obviated, it can be easily implemented for systems where such a priori testing is difficult or even impossible to conduct. The prognosis capability is demonstrated here via a balloon burst experiment where the instability is predicted using only online visual observations. The DDP scheme never failed to predict the incipient failure, and no false-positives were issued. The DDP algorithm is applicable to other types of datasets. Time horizons of DDP predictions can be adjusted by using memory over different time windows. Thus, a big dataset can be parsed in time to make a range of predictions over varying time horizons.
Microplastics in freshwaters and drinking water: Critical review and assessment of data quality
Publisher: Elsevier BV
Date: 05-2019
Related Organisations
Wageningen University And Research Wageningen Environmental Research
Location: Netherlands
Related Funding Activities
No related grants have been discovered for MICHELLE HALL.