In-clinic Functional Measurement and Analysis of Knee Osteoarthritis Patients Undergoing Total Knee Replacement

Prevalence of osteoarthritis is increasing as individuals are remaining active later in life. Since the knee is one of the most commonly affected joints and is involved in almost all daily activities, functional impairment has a substantial impact on overall health. Despite this increase, there currently exists no disease modifying drugs or treatments. Mild cases are managed with physiotherapeutic exercises and common anti-inflammatories but surgical intervention is required for more severe disease progression. Total knee replacement as a treatment for osteoarthritis is a highly successful surgery that is effective at restoring knee function and reducing pain but still requires further refinement. Over 70,000 of these surgeries are performed annually in Canada with 99% for the treatment of degenerative arthritis. Despite improvements to surgical technique and implant designs, studies report up to 20% of patients remain dissatisfied with their knee replacement up to the point of not undergoing the surgery again if it were an option. A singular cause for this dissatisfaction has not been pinpointed but strong influencers are pain, low functional improvement, and unmet expectations. Early detection of functional problems permits further intervention through targeted physiotherapy or additional surgeries before problems escalate and cause patient dissatisfaction or implant revision. Current methods of patient evaluation rely on self-reported measures, which suffer from ceiling and floor effects often masking inter-patient differences. These measures are also influenced from patient expectations and what a patient reports they can\u27\u27 do, is not always representative of their true functional ability. Wearable sensors permit objective functional measurement of the knee as a supplement to patient-reported measures. Instrumented performance tests can measure patient function and compare to similar recoveries to highlight deficiencies or positive recovery traits. This thesis outlines the development of such a wearable system for in-clinic measurement and the extraction of functional parameters to predict future outcomes and give surgeons the earliest indications for intervention. This information can also help surgeons realistically adjust patient expectations for recovery, even before undergoing surgery. It is expected that these individualized assessments to set expectations before surgical intervention will help address the persistently high patient dissatisfaction

Evaluating footwear “in the wild”: Examining wrap and lace trail shoe closures during trail running

Trail running participation has grown over the last two decades. As a result, there have been an increasing number of studies examining the sport. Despite these increases, there is a lack of understanding regarding the effects of footwear on trail running biomechanics in ecologically valid conditions. The purpose of our study was to evaluate how a Wrap vs. Lace closure (on the same shoe) impacts running biomechanics on a trail. Thirty subjects ran a trail loop in each shoe while wearing a global positioning system (GPS) watch, heart rate monitor, inertial measurement units (IMUs), and plantar pressure insoles. The Wrap closure reduced peak foot eversion velocity (measured via IMU), which has been associated with fit. The Wrap closure also increased heel contact area, which is also associated with fit. This increase may be associated with the subjective preference for the Wrap. Lastly, runners had a small but significant increase in running speed in the Wrap shoe with no differences in heart rate nor subjective exertion. In total, the Wrap closure fit better than the Lace closure on a variety of terrain. This study demonstrates the feasibility of detecting meaningful biomechanical differences between footwear features in the wild using statistical tools and study design. Evaluating footwear in ecologically valid environments often creates additional variance in the data. This variance should not be treated as noise; instead, it is critical to capture this additional variance and challenges of ecologically valid terrain if we hope to use biomechanics to impact the development of new products

Prehabilitation for the management of rotator cuff surgery

Rotator cuff tears are a common cause of shoulder pain in the general community. Approximately one-third of patients with rotator cuff tears proceed to surgery following the failure of conservative treatments such as physiotherapy, non-steroidal anti- inflammatory drugs, opioid analgesics, and cortisone injections. However, rotator cuff tears continue to develop over time, and the burden of illness for patients awaiting rotator cuff repair is substantial, resulting in loss of strength, functional status, and poor quality of life. This dissertation proposes a three-stage approach for the management of rotator tears in patients awaiting surgery, which includes an accurate and reliable evaluation of shoulder range of motion (ROM) and strength, a pre-operative intervention to improve function and quality of life, and an appraisal of potential prognostic factors that can lead to better future clinical outcomes. Therefore, the organisation of this thesis is divided into three sections covering shoulder assessment, intervention, and prognosis. Chapter 1 introduces the concept of prehabilitation, a rapid systematic review, evidence gaps in the literature, and the rationale for shoulder prehabilitation. Prehabilitation is defined as enhancing a patient's functional ability before surgery to improve clinical outcomes following surgery. The rapid systematic review included only high-quality studies based on the National Health and Medical Research Council (Australia) evidence guidelines and the Physiotherapy Evidence Database (PEDro) rating scale. Only pre-operative exercise intervention studies for surgical knee and hip populations were identified. To date, no studies have investigated the efficacy of prehabilitation for patients scheduled for shoulder surgery. This finding necessitated a review of the considerable body of research on rotator cuff tears. Chapter 2 provides a synthesis of the current literature regarding shoulder anatomy, biomechanics of the rotator cuff, epidemiology, aetiology and classification of rotator cuff tears, shoulder assessment methods, an overview of management options, evidence for post-operative rehabilitation, and prognostic factors and potential predictors of outcome associated with rotator cuff surgery. Chapter 3 presents a published study examining the intra- and inter-rater reliability of a variety of testing protocols to measure ROM and strength in healthy participants. The objective measurement of ROM and strength is an integral part of the physical examination of patients with rotator cuff tears and is vital in quantifying improvement after conservative or surgical intervention. Correctly evaluating and interpreting objective shoulder measurements informs the clinical reasoning underlying treatment. Since pre- operative ROM and strength are potentially modifiable predictors for rotator cuff repair success, a precise assessment using reliable instruments and testing methods is essential. The outcomes of this study supported the selection of assessment methods for a randomised controlled trial (Chapter 7) on shoulder prehabilitation. Chapter 4 presents a published systematic review and meta-analysis on the reliability of the Kinect and ambulatory motion-tracking devices to measure shoulder ROM. According to our reliability study findings in Chapter 3, existing methods for evaluating shoulder ROM are less reliable. Emerging inertial sensor technologies and optical markerless motion-tracking systems are valid alternatives to standard ROM assessment methods. However, reliability must also be established before this technology can be used routinely in clinical settings. Chapter 5 presents a published validity and reliability study on the HumanTrak system to measure shoulder ROM in healthy subjects. Based on our findings in Chapter 4, we evaluated the clinical potential of using a movement analysis system that combines inertial sensors with the Microsoft Kinect (HumanTrak) to measure shoulder ROM reliably and accurately. Chapter 6 is a systematic review and meta-analysis of prehabilitation for the management of orthopaedic surgery. The initial rapid systematic review in Chapter 1 only identified orthopaedic prehabilitation programmes for patients undergoing lower limb joint arthroplasty, anterior cruciate ligament reconstruction, and spinal surgery. Given the growing research and clinical adoption of prehabilitation over the past decade, we undertook an updated and more comprehensive systematic review to identify and critically appraise the content and reporting of prehabilitation programmes for all orthopaedic surgeries. Exercise therapy is commonly first line treatment for older patients with non-traumatic rotator cuff tears. Despite growing evidence that exercise therapy and surgery can achieve comparable clinical outcomes, there is a paucity of high-quality studies on the impact of pre-operative exercise or education for patients awaiting rotator cuff surgery. Hence, the main aim of this thesis is to investigate the efficacy of a combined pre-operative exercise and education programme on function and quality of life before and after rotator cuff surgery. Chapter 7 is a randomised control trial (RCT) investigating whether the addition of a pre-operative exercise and education programme to usual care for patients awaiting rotator cuff surgery is more effective than usual care alone. Fifty patients with unilateral rotator cuff tears received either an 8-week shoulder exercise and education prehabilitation (SPrEE) programme or usual care (UC). The SPrEE programme compared to UC resulted in superior and statistically significant improvements in the primary outcomes of SPADI, WORC and SF-36 in the pre-operative phase. The SPrEE program was not more effective than UC alone in improving primary outcomes at 3-, 6- or 12 month follow-up timepoints. There were no statistically significant between-group differences in SPrEE and UC secondary outcomes for surgical or non-surgical patients. Chapter 8 investigated any correlations between pre-operative magnetic resonance imaging (MRI) characteristics and patient-reported outcome measures for patients who underwent rotator cuff repair or no surgery and received either prehabilitation or usual care in the RCT (Chapter 7). Prognosis-based prehabilitation can effectively identify patients who will derive the greatest benefit. Chapter 9 summarises thesis findings, strengths, and directions for future research to optimise function and quality of life prior to rotator cuff surgery

pHealth 2021. Proc. of the 18th Internat. Conf. on Wearable Micro and Nano Technologies for Personalised Health, 8-10 November 2021, Genoa, Italy

Smart mobile systems – microsystems, smart textiles, smart implants, sensor-controlled medical devices – together with related body, local and wide-area networks up to cloud services, have become important enablers for telemedicine and the next generation of healthcare services. The multilateral benefits of pHealth technologies offer enormous potential for all stakeholder communities, not only in terms of improvements in medical quality and industrial competitiveness, but also for the management of healthcare costs and, last but not least, the improvement of patient experience. This book presents the proceedings of pHealth 2021, the 18th in a series of conferences on wearable micro and nano technologies for personalized health with personal health management systems, hosted by the University of Genoa, Italy, and held as an online event from 8 – 10 November 2021. The conference focused on digital health ecosystems in the transformation of healthcare towards personalized, participative, preventive, predictive precision medicine (5P medicine). The book contains 46 peer-reviewed papers (1 keynote, 5 invited papers, 33 full papers, and 7 poster papers). Subjects covered include the deployment of mobile technologies, micro-nano-bio smart systems, bio-data management and analytics, autonomous and intelligent systems, the Health Internet of Things (HIoT), as well as potential risks for security and privacy, and the motivation and empowerment of patients in care processes. Providing an overview of current advances in personalized health and health management, the book will be of interest to all those working in the field of healthcare today

A Systematic Review and Meta-Analysis of the Incidence of Injury in Professional Female Soccer

The epidemiology of injury in male professional football is well documented and has been used as a basis to monitor injury trends and implement injury prevention strategies. There are no systematic reviews that have investigated injury incidence in women’s professional football. Therefore, the extent of injury burden in women’s professional football remains unknown. PURPOSE: The primary aim of this study was to calculate an overall incidence rate of injury in senior female professional soccer. The secondary aims were to provide an incidence rate for training and match play. METHODS: PubMed, Discover, EBSCO, Embase and ScienceDirect electronic databases were searched from inception to September 2018. Two reviewers independently assessed study quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement using a 22-item STROBE checklist. Seven prospective studies (n=1137 professional players) were combined in a pooled analysis of injury incidence using a mixed effects model. Heterogeneity was evaluated using the Cochrane Q statistic and I2. RESULTS: The epidemiological incidence proportion over one season was 0.62 (95% CI 0.59 - 0.64). Mean total incidence of injury was 3.15 (95% CI 1.54 - 4.75) injuries per 1000 hours. The mean incidence of injury during match play was 10.72 (95% CI 9.11 - 12.33) and during training was 2.21 (95% CI 0.96 - 3.45). Data analysis found a significant level of heterogeneity (total Incidence, X2 = 16.57 P < 0.05; I2 = 63.8%) and during subsequent sub group analyses in those studies reviewed (match incidence, X2 = 76.4 (d.f. = 7), P <0.05; I2 = 90.8%, training incidence, X2 = 16.97 (d.f. = 7), P < 0.05; I2 = 58.8%). Appraisal of the study methodologies revealed inconsistency in the use of injury terminology, data collection procedures and calculation of exposure by researchers. Such inconsistencies likely contribute to the large variance in the incidence and prevalence of injury reported. CONCLUSIONS: The estimated risk of sustaining at least one injury over one football season is 62%. Continued reporting of heterogeneous results in population samples limits meaningful comparison of studies. Standardising the criteria used to attribute injury and activity coupled with more accurate methods of calculating exposure will overcome such limitations