Gait function improvements, using Cardiff Classifier, are related to patient-reported function and pain following hip arthroplasty

Summarizing results of three-dimensional (3D) gait analysis into a comprehensive measure of overall gait function is valuable to discern to what extent gait function is affected, and later recovered after surgery and rehabilitation. This study aimed to investigate whether preoperative gait function, quantified and summarized using the Cardiff Classifier, can predict improvements in postoperative patient-reported activities of daily living, and overall gait function 1 year after total hip arthroplasty (THA). Secondly, to explore relationships between pre-to-post surgical change in gait function versus changes in patient-reported and performance-based function. Thirty-two patients scheduled for THA and 25 nonpathological individuals were included in this prospective cohort study. Patients were evaluated before THA and 1 year postoperatively using 3D gait analysis, patient-reported outcomes, and performance-based tests. Kinematic and kinetic gait parameters, derived from 3D gait analysis, were quantified using the Cardiff Classifier. Linear regressions investigated the predictive value of preoperative gait function on postoperative outcomes of function, and univariate correlations explored relationships between pre-to-post surgical changes in outcome measures. Preoperative gait function, by means of Cardiff Classifier, explained 35% and 30% of the total variance in change in patient-reported activities of daily living, and in gait function, respectively. Moderate-to-strong correlations were found between change in gait function and change in patient-reported function and pain, while no correlations were found between change in gait function and performance-based function. Clinical significance: Preoperative gait function predicts postsurgical function to a moderate degree, while improvements in gait function after surgery are more closely related to how patients perceive function than their maximal performance of functional tests

Rationale, design and protocol of a longitudinal study assessing the effect of total knee arthroplasty on habitual physical activity and sedentary behavior in adults with osteoarthritis

Background: Physical activity levels are decreased and sedentary behaviour levels are increased in patients with knee osteoarthritis (OA). However, previous studies have shown that following total knee arthroplasty (TKA), objectively measured physical activity levels do not change compared to before the surgery. Very few studies have objectively assessed sedentary behaviour following TKA. This study aims to assess patterns of objective habitual physical activity and sedentary behaviour in patients with knee OA and to determine whether these change following TKA. Methods: Patients diagnosed with knee osteoarthritis and scheduled for unilateral primary total knee arthroplasty will be recruited from the Orthopaedic Division at the Charlotte Maxeke Johannesburg Academic Hospital. Eligible participants will have assessments completed one week before the scheduled arthroplasty, six weeks, and six months post-operatively. The primary outcomes are habitual physical activity and sedentary behaviour which will be measured using accelerometry (Actigraph GTX3+ and activPal monitors) at the specific time points. The secondary outcomes will be improvements in osteoarthritis-specific quality of life measures using the following questionnaires: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Knee Society Clinical Rating System (KSS), UCLA activity index; subjective pain scores, and self reported sleep quality.Discussion: The present study will contribute to the field of musculoskeletal health by providing a rich detailed description of the patterns of accumulation of physical activity and sedentary behaviour in patients with knee OA. These data will contribute to existing knowledge using an objective measurement for the assessment of functional ability after total knee arthroplasty. Although studies have used accelerometry to measure physical activity in knee OA patients, the data provided thus far have not delved into the detailed patterns of how and when physical activity is accumulated before and after TKA. Accurate assessment of physical activity is important for physical activity interventions that target special populations

Mapping current research trends on neuromuscular risk factors of non-contact ACL injury.

The aim of this systematic review was (i) to identify neuromuscular markers that have been predictive of a primary non-contact ACL injury, (ii) to assess whether proposed risk factors have been supported or refuted in the literature from cohort and case-control studies, and (iii) to reflect on the body of research that aims at developing field based tools to assess risk through an association with these risk factors. Electronic searches were undertaken, of PubMed, SCOPUS, Web of Science, CINAHL and SPORTDiscus examining neuromuscular risk factors associated with ACL injury published between January 1990 and July 2015. The evidence supporting neuromuscular risk factors of ACL injury is limited where only 4 prospective cohort studies were found. Three of which looked into muscular capacity and one looked into muscular activation patterns but none of the studies found strong evidence of how muscular capacity or muscular activation deficits are a risk factor for a primary non-contact ACL injury. A number of factors associated to neural control and muscular capacity have been suggested to be related to non-contact ACL injury risk but the level of evidence supporting these risk factors remains often elusive, leaving researchers and practitioners uncertain when developing evidence-based injury prevention programs

Mapping current research trends on anterior cruciate ligament injury risk against the existing evidence: In vivo biomechanical risk factors.

BACKGROUND: Whilst many studies measure large numbers of biomechanical parameters and associate these to anterior cruciate ligament injury risk, they cannot be considered as anterior cruciate ligament injury risk factors without evidence from prospective studies. A review was conducted to systematically assess the in vivo biomechanical literature to identify biomechanical risk factors for non-contact anterior cruciate ligament injury during dynamic sports tasks; and to critically evaluate the research trends from retrospective and associative studies investigating non-contact anterior cruciate ligament injury risk. METHODS: An electronic literature search was undertaken on studies examining in vivo biomechanical risk factors associated with non-contact anterior cruciate ligament injury. The relevant studies were assessed by classification; level 1 - a prospective cohort study, level 2 - a retrospective study or level 3 - an associative study. FINDINGS: An initial search revealed 812 studies but this was reduced to 1 level 1 evidence study, 20 level 2 evidence studies and 175 level 3 evidence studies that met all inclusion criteria. Level 1 evidence showed that the knee abduction angle, knee abduction moment and ground reaction force were biomechanical risk factors. Nine level 2 studies and eighty-three level 3 studies used these to assess risk factors in their study. Inconsistencies in results and methods were observed in level 2 and 3 studies. INTERPRETATION: There is a lack of high quality, prospective level 1 evidence related to biomechanical risk factors for non-contact anterior cruciate ligament injury. More prospective cohort studies are required to determine risk factors and provide improved prognostic capability

EFFECTS OF PROGRESSIVE RESISTANCE TRAINING PRIOR TO TOTAL HIP ARTHROPLASTY – ONE YEAR OUTCOME OF A RANDOMIZED CONTROLLED TRIAL

Objective: To investigate one-year postoperative effect of preoperative resistance training (RT) in patients undergoing total hip arthroplasty (THA) on patient-reported outcomes on activity and function and objective outcomes on muscle strength and physical performance. Design: A 3-12 months follow-up of a randomized controlled trial. Patients scheduled for THA were randomized into: RT-group, twice a week for 10 weeks prior to THA, or ‘care as usual’ (CG). Primary endpoint is HOOS-ADL at 12 months follow-up. Secondary outcome measures are; other HOOS subscales, knee- and hip muscle strength plus function (gait, ascending/descending stairs, and sit-to-stand) at 3 and/or 12 months. The present data set contains raw anonymous data for the complete randomized controlled trail for baseline, prior to surgery, 3 months following surgery, 6 months following surgery, 9 months following surgery and 12 months following surgery. ClinicalTrials.gov: NCT0116411

EFFECTS OF PROGRESSIVE RESISTANCE TRAINING PRIOR TO TOTAL HIP ARTHROPLASTY – ONE YEAR OUTCOME OF A RANDOMIZED CONTROLLED TRIAL

Objective: To investigate one-year postoperative effect of preoperative resistance training (RT) in patients undergoing total hip arthroplasty (THA) on patient-reported outcomes on activity and function and objective outcomes on muscle strength and physical performance. Design: A 3-12 months follow-up of a randomized controlled trial. Patients scheduled for THA were randomized into: RT-group, twice a week for 10 weeks prior to THA, or ‘care as usual’ (CG). Primary endpoint is HOOS-ADL at 12 months follow-up. Secondary outcome measures are; other HOOS subscales, knee- and hip muscle strength plus function (gait, ascending/descending stairs, and sit-to-stand) at 3 and/or 12 months. The present data set contains raw anonymous data for the complete randomized controlled trail for baseline, prior to surgery, 3 months following surgery, 6 months following surgery, 9 months following surgery and 12 months following surgery. ClinicalTrials.gov: NCT0116411