Comparison of programs for determining temporal-spatial gait variables from instrumented walkway data: PKmas versus GAITRite

BACKGROUND: Measurement of temporal-spatial gait variables is common in aging research with several methods available. This study investigated the differences in temporal-spatial gait outcomes derived from two different programs for processing instrumented walkway data. METHOD: Data were collected with GAITRite® hardware from 86 healthy older people and 44 older people four months following surgical repair of hip fracture. Temporal-spatial variables were derived using both GAITRite® and PKmas® processing programs from the same raw footfall data. RESULTS: The mean differences between the two programs for most variables were negligible, including for Speed (mean difference 0.3 ± 0.6 cm/sec, or 0.3% of the mean GAITRite® Speed). The mean absolute percentage difference for all 18 gait variables examined ranged from 0.04% for Stride Duration to 66% for Foot Angle. The ICCs were almost perfect (≥0.99) for all variables apart from Base Width, Foot Angle, Stride Length Variability, Step Length Variability, Step Duration Variability and Step Width Variability, which were all never-the-less above 0.84. There were systematic differences for Base Width (PKmas® values 1.6 cm lower than GAITRite®) and Foot Angle (PKMAS® values 0.7° higher than GAITRite®). The differences can be explained by the differences in definitions and calculations between the programs. CONCLUSIONS: The study demonstrated that for most variables the outcomes from both programs can be used interchangeably for evaluation of gait among older people collected with GAITRite® hardware. However, validity and reliability for Base Width and Foot Angle derived by PKMAS® would benefit from further investigation

Design, Delivery, Maintenance, and Outcomes of Peer-to-Peer Online Support Groups for People With Chronic Musculoskeletal Disorders: Systematic Review

Background: Online support groups (OSGs) are one way for people with chronic diseases, their family or friends, and health professionals to communicate, gain information, and provide social support. As the number of peer-to-peer OSGs for chronic musculoskeletal conditions grows, it is important to gain insight into the different designs of groups available, who is accessing them, if and how they may be effective, and what strategies are being used to implement or increase consumer engagement. Objective: The objectives of this systematic review of people with musculoskeletal conditions were to (1) describe the design features (functions, usage options, moderation, and expert input) of peer-to-peer OSGs, (2) describe the characteristics of the individuals using peer-to-peer OSGs, (3) synthesize the evidence on outcomes of participation, and (4) identify strategies used in the delivery and maintenance of OSGs. Methods: A search comprising terms related to the population (people with musculoskeletal disorders) and the intervention (peer-to-peer OSGs) was conducted in 6 databases. Results were filtered from 1990 (internet inception) to February 2019. Studies identified in the search were screened according to predefined eligibility criteria using a 2-step process. Quantitative studies were appraised by 2 reviewers using the Risk Of Bias In Non-Randomized Studies of Interventions tool. Qualitative studies were appraised by 2 different reviewers using the Critical Appraisal Skills Programme checklist. Extracted data were synthesized narratively. Results: We examined 21 studies with low to moderate risk of bias. Of these studies, 13 studies included OSGs hosted on public platforms, 11 studies examined OSGs that were conducted in English, and 6 studies used moderators or peer leaders to facilitate engagement. Studies either reported the number of OSG members (n=1985 across all studies) or the number of posts (range: 223-200,000). The majority of OSG members were females who were not full-time employees and with varied levels of education. There were no randomized controlled trials measuring the efficacy of OSGs. Qualitative and quantitative studies identified empowerment, social support, self-management behavior, and health literacy as primary constructs to measure OSG efficacy. Neutral or marginal improvement was reported in these constructs. Sharing experiences and a greater level of engagement appeared to have an important influence on OSGs efficacy. The extent to which members posted on the website influenced engagement. Conclusions: Across a diverse range of designs, languages, included features, and delivery platforms, peer-to-peer OSGs for chronic musculoskeletal conditions attract predominantly female participants of all ages and education levels. The level of participation of a member appears to be related to their perceived benefit, health literacy, and empowerment. Future studies are needed to identify which design and maintenance strategies have superior efficacy and whether there are concomitant improvements in health outcomes for people with chronic musculoskeletal conditions resulting from participation in OSGs

Effectiveness of a new model of primary care management on knee pain and function in patients with knee osteoarthritis: Protocol for THE PARTNER STUDY

© 2018 The Author(s). Background: To increase the uptake of key clinical recommendations for non-surgical management of knee osteoarthritis (OA) and improve patient outcomes, we developed a new model of service delivery (PARTNER model) and an intervention to implement the model in the Australian primary care setting. We will evaluate the effectiveness and cost-effectiveness of this model compared to usual general practice care. Methods: We will conduct a mixed-methods study, including a two-arm, cluster randomised controlled trial, with quantitative, qualitative and economic evaluations. We will recruit 44 general practices and 572 patients with knee OA in urban and regional practices in Victoria and New South Wales. The interventions will target both general practitioners (GPs) and their patients at the practice level. Practices will be randomised at a 1:1 ratio. Patients will be recruited if they are aged =45 years and have experienced knee pain =4/10 on a numerical rating scale for more than three months. Outcomes are self-reported, patient-level validated measures with the primary outcomes being change in pain and function at 12 months. Secondary outcomes will be assessed at 6 and 12 months. The implementation intervention will support and provide education to intervention group GPs to deliver effective management for patients with knee OA using tailored online training and electronic medical record support. Participants with knee OA will have an initial GP visit to confirm their diagnosis and receive management according to GP intervention or control group allocation. As part of the intervention group GP management, participants with knee OA will be referred to a centralised multidisciplinary service: the PARTNER Care Support Team (CST). The CST will be trained in behaviour change support and evidence-based knee OA management. They will work with patients to develop a collaborative action plan focussed on key self-management behaviours, and communicate with the patients' GPs. Patients receiving care by intervention group GPs will receive tailored OA educational materials, a leg muscle strengthening program, and access to a weight-loss program as appropriate and agreed. GPs in the control group will receive no additional training and their patients will receive usual care. Discussion: This project aims to address a major evidence-to-practice gap in primary care management of OA by evaluating a new service delivery model implemented with an intervention targeting GP practice behaviours to improve the health of people with knee OA. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12617001595303, date of registration 1/12/2017

Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol

<p>Abstract</p> <p>Background</p> <p>Hip osteoarthritis (OA) is a common condition leading to pain, disability and reduced quality of life. There is currently limited evidence to support the use of conservative, non-pharmacological treatments for hip OA. Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA. The aim of this randomised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function.</p> <p>Methods</p> <p>The trial will be conducted at the University of Melbourne Centre for Health, Exercise and Sports Medicine. 128 participants with hip pain greater or equal to 40/100 on visual analogue scale (VAS) and evidence of OA on x-ray will be recruited. Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region. The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice. The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel. The participants and the study assessor will be blinded to the treatment allocation. Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) immediately after the 12 week intervention. Participants will also be followed up at 36 weeks post baseline.</p> <p>Conclusions</p> <p>The trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice. The findings from this randomised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA.</p> <p>Trial Registration</p> <p>Australian New Zealand Clinical Trials Registry reference: ACTRN12610000439044</p

Immediate effect of physical activity on the postural stability of older people

Understanding the predisposing factors for older people falling is imperative as falls can lead to considerable medical and societal costs, loss of independence and reduced quality of life. In particular, it is important to understand more about the many possible intrinsic and extrinsic reasons why older people sometimes fail to maintain their postural stability and fall. Older people are increasingly being encouraged to maintain or increase their daily physical activity levels. Healthy older adults have been shown to have altered postural stability following high intensity physical activity; however it is not known whether postural stability is compromised during everyday levels of physical activity. If it were, it could expose them to greater risk of falling. The overall aim of this series of investigations was to determine whether postural stability was detrimentally affected immediately after moderate intensity physical activity. Five studies were undertaken. Study 1 was carried out to determine the typical duration of activity periods that occur during the daily lives of community-living older people. In this study, the activity period durations of older people living either at home or in an aged care facility were recorded over a continuous 72 hour period using an activity monitoring device. Study 2 determined the effect of an activity protocol, designed to be representative of routine daily activity of community-living older people, on clinical indicators of fatigue. These indicators included maximal voluntary torque from the knee extensor and hip abductor muscles, subjective feelings of fatigue and temporal and spatial gait variables. The physical activity protocol involved a series of tasks carried out continuously for 14 minutes, self-paced at moderate intensity. Tasks included walking, step-ups, mini-lunges and avoiding obstacles. The final three studies compared postural stability before and immediately after the moderate intensity physical activity protocol. Study 3 recorded centre of pressure (COP) displacement during quiet standing with feet together. Study 4 recorded forces and postural electromyographic (EMG) activity during a rapid forward step-up task. Study 5 recorded postural responses to a lateral waist-pull perturbation large enough to elicit a step response. Studies 2, 3 and 4 compared healthy young adults with healthy older and balance-impaired older adults, whilst the final study compared healthy young and old adults. Community-living older people were found to have a wide range of activity period durations and those living in aged care had significantly shorter activity periods compared to those living independently at home. As a result of the findings, an activity period duration of 14 minutes was considered representative of community-living older people’s physical activity exposure. In Study 2, immediately following the physical activity protocol, young, healthy old and balance-impaired older adults all showed no changes in leg strength. All groups felt generally tired and had sensations of local leg muscle fatigue but only the balance-impaired adults were still reporting feelings of fatigue 20 minutes after the activity ceased. This group were also the only group to show altered gait after the activity. Their cadence was reduced compared with before activity and remained reduced 20 minutes later. In quiet standing, all groups demonstrated larger COP displacement in the mediolateral direction following the physical activity. For the step-up task, all groups showed small improvements immediately following the physical activity. These included reductions in the duration of the weight-shift phase, lateral COP displacement during weight-shift and the stance leg hip abductor muscle onset times. Participants also showed a shift in COP position towards the stance side prior to the step following the physical activity. In the final study, the older participants used a cross-over step in response to the lateral perturbation more frequently after the activity than before. This response is a less optimal response compared with a faster and more stable single outward step. When older and younger participants did perform outward steps following the physical activity, they performed them as well as they did before activity. Small changes to some of the measures of postural stability were found during quiet standing, voluntary stepping and to the responses after a lateral perturbation following moderate intensity physical activity. These changes may have been due to the impact of subjective feelings of tiredness experienced by participants. The increased use of a cross-over step strategy to regain balance after a lateral perturbation among healthy older people may mean that older people are at greater risk of falling after physical activity. However, the findings from this series of studies do not convincingly support a clinically significant detrimental effect on older people’s postural stability immediately following routine daily physical activity. This thesis has begun to investigate the effect of physical activity at daily levels on older people’s postural stability, however further investigations are recommended