Ankle instability effects on joint position sense when stepping across the active movement extent discrimination apparatus

CONTEXT: Individuals with and without functional ankle instability have been tested for deficits in lower limb proprioception with varied results. OBJECTIVE: To determine whether a new protocol for testing participants' joint position sense during stepping is reliable and can detect differences between participants with unstable and stable ankles. DESIGN: Descriptive laboratory study. SETTING: University clinical laboratory. PATIENTS OR OTHER PARTICIPANTS: Sample of convenience involving 21 young adult university students and staff. Ankle stability was categorized by score on the Cumberland Ankle Instability Tool; 13 had functional ankle instability, 8 had healthy ankles. INTERVENTION(S): Test-retest of ankle joint position sense when stepping onto and across the Active Movement Extent Discrimination Apparatus twice, separated by an interim test, standing still on the apparatus and moving only 1 ankle into inversion. MAIN OUTCOME MEASURE(S): Difference in scores between groups with stable and unstable ankles and between test repeats. RESULTS: Participants with unstable ankles were worse at differentiating between inversion angles underfoot in both testing protocols. On repeated testing with the stepping protocol, performance of the group with unstable ankles was improved (Cohen d = 1.06, P = .006), whereas scores in the stable ankle group did not change in the second test (Cohen d = 0.04, P = .899). Despite this improvement, the unstable group remained worse at differentiating inversion angles on the stepping retest (Cohen d = 0.99, P = .020). CONCLUSIONS: The deficits on proprioceptive tests shown by individuals with functional ankle instability improved with repeated exposure to the test situation. The learning effect may be the result of systematic exposure to ankle-angle variation that led to movement-specific learning or increased confidence when stepping across the apparatus

Is high intensity laser therapy more effective than other physical therapy modalities for treating knee osteoarthritis? A systematic review and network meta-analysis

BACKGROUND: The use of physical therapy modalities, especially high intensity laser therapy (HILT), for individuals with knee osteoarthritis (KOA) is still controversial. OBJECTIVE: To compare the effects of HILT to other physical therapy modalities on symptoms and function in individuals with KOA. METHODS: Six databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, and PEDro) were searched in March 2022. Included studies were randomized controlled trials involving HILT conducted on individuals with KOA. The end-trial weighted mean difference (WMD) and standard deviations (SD) with 95% confidence intervals (CI) were analyzed. RESULTS: Ten studies with 580 participants were obtained, of which nine were included in the final network meta-analysis. In terms of relieving pain, HILT demonstrated the highest probability of being among the most effective treatments, with surface under the cumulative ranking (SUCRA) = 100%, and compared to a control (placebo laser or exercise or a combination of both) on the visual analog scale (VAS) for pain it demonstrated significant benefits (WMD 1.66, 95% CI 1.48–1.84). For improving self-reported function, as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total scores, the HILT SUCRA value led with 98.9%. When individuals with KOA were treated by HILT, the improvement in stiffness was statistically significant (WMD 0.78, 95% CI 0.52–1.04) but the amount of improvement was smaller than the minimal clinically important difference (MCID). CONCLUSION: The current evidence suggests that HILT may be more effective than other physical therapy modalities for improving pain and function in individuals with KOA. For improving stiffness, however, it may not be clinically effective. SYSTEMATIC REVIEW REGISTRATION: [https://www.researchregistry.com], identifier [1148]

Daily surveillance of falls is feasible and reveals a high incidence of falls among older adults

OBJECTIVE: To ensure accurate data capture for a fall study through a system of daily contact with participants. METHODS: Fifty‐eight adults older than 60 years of age and living independently in the community in Canberra, Australia, were recruited for a prospective fall study. We adopted a system of daily contact with study participants for at least 12 months, either by email or by text, asking whether they had suffered a fall in the previous 24 h. At the final testing session, we asked participants whether they had experienced a fall during the previous twelve months. RESULTS: We found no evidence that the daily reporting regime led to excess participant attrition. Only three participants withdrew over the course of the study, and the burden of responding was not cited as a factor in any of these cases. Of the 55 participants who completed the full twelve‐month study period, 38 (69%) experienced at least one fall. We also identified inconsistencies between recall of falls occurring during the last twelve months of the study and the contemporaneously recorded data. CONCLUSIONS: Previous studies have found that increasing the reporting demands on fall study participants will lead to higher attrition. This study demonstrates that it is possible to maintain participant engagement and minimise attrition with appropriate design of reporting procedures. We confirm existing evidence regarding the unreliability of retrospective recall of falls. The study highlights the importance of comprehensive and accurate data capture and points to the possibility of under‐reporting of fall incidence