Intra-articular injection of photo-activated platelet-rich plasma in patients with knee osteoarthritis: a double-blind, randomized controlled pilot study

Improvements in knee osteoarthritis (OA) symptoms with platelet-rich plasma (PRP) have been attributed to its ability to modify intra-articular inflammatory processes. Photo-activation of peripheral blood also improves inflammatory mediators associated with OA, however combined photo-activated PRP (PA-PRP) has not been investigated. This pilot study assessed the feasibility, safety and symptomatic and functional change following injections of PA-PRP compared to hyaluronic acid (HA) in people with knee osteoarthritis (OA)

Current ankle sprain prevention and management strategies of netball athletes: a scoping review of the literature and comparison with best-practice recommendations

Background: Ankle sprains are the most commonly reported injury in netball. Approximately four in five netball athletes will sustain an ankle sprain, up to half will go on to sustain recurrent ankle sprains, and nine in ten report perceived ankle instability. Historically, prevention and management strategies of ankle sprains and injuries have been investigated for a variety of sports, however, no literature reviews have investigated these in netball athletes, or compared these with current best-practice within the literature. Therefore, this scoping review aims to understand how netball athletes currently prevent and manage ankle sprains and to compare these approaches with best-practice recommendations. Methods: A literature search was conducted using MEDLINE, CINAHL, and SPORTDiscus databases using keywords to capture studies with data or information related to the prevention and management of ankle sprains and injuries in netball. Results: The search strategy captured 982 studies across all databases, with 30 netball studies included in this scoping review. Studies suggest netball athletes are not commonly referred to health professionals, do not undertake adequate rehabilitation, and almost immediately return to court following an ankle sprain or injury. Current best-practices suggest injury prevention programs and external ankle support effectively reduce ankle sprains and injuries; however, poor compliance and implementation may be a significant barrier. Currently, there is a lack of evidence that netball-specific footwear reduces the risk of ankle sprains. Conclusion: The findings suggest netball athletes do not implement current best-practice prevention and management strategies following an ankle sprain. This is despite evidence of the effectiveness of injury prevention programs, external ankle support, and adequate rehabilitation in reducing ankle sprain rates. Current-best practice prevention and management of ankle sprains should be considered by clinicians, coaches, and athletes to reduce the prevalence and chronicity of ankle sprains in netball

A pilot investigation using global positioning systems into the outdoor activity of people with severe traumatic brain injury

Background: Little is known about the post-discharge outdoor activities of people who have incurred severe traumatic brain injury (TBI). This study used a body-worn global positioning system (GPS) device to determine the outdoor activity per day performed by this population. Additionally, this study examined the association that mobility, time since injury and injury severity had with levels of outdoor physical activity. Findings. Seventeen people with TBI and 15 control subjects wore a GPS device for between 3-7 days to monitor their outdoor activity. Based on the individual's location and speed of movement the outdoor physical activity in minutes per day was derived. Assessments of duration of outdoor activity between groups, and the relationship that duration of outdoor activity had with results on the high-level mobility assessment tool, length of post-traumatic amnesia, and time since injury were performed. No significant (p = 0.153, effect size = 0.26) difference in time spent in outdoor physical activity was observed between the TBI (median[IQR] = 19[3-43]mins) and control (median[IQR] = 50[18-65]mins) group. Interestingly, 35% of TBI subjects performed <10 mins of outdoor activity per day compared to 13% of the control group. The TBI group also recorded three of the four highest values for outdoor physical activity. Higher levels of mobility were associated with more outdoor activity (Spearman's rho = 0.443, p = 0.038). No other significant associations were observed. Conclusions: While preliminary, our results indicate that a sub-group of people with TBI exists who restrict their outdoor activities. GPS has potential as an activity tracking tool, with implications for rehabilitation and exercise prescription. © 2014 Clark et al.; licensee BioMed Central Ltd

Gait variability, stride dynamics and falls risk in community dwelling older women

This thesis investigated measures of walking instability in older adults with the aim to establish if stride dynamics and gait variability can predict falls in active older women. Falls are a major problem for older adults and the majority occur when walking. The identification of markers of walking instability that predict falls, particularly in active and healthy older adults, would help prevent injury, loss of independence and institutionalisation. Three studies were conducted as part of this thesis. These studies investigated the effect of walking protocol on measures of gait variability in healthy adults and examined the relationship between stride dynamics, gait variability and falls in older adults. Women were used in each study due to their higher incidence of falls and falls-related injury (Stevens & Sogolow, 2005). Study 1 and 2 recorded spatial, temporal and gait variability data in older (age range 57 to 79 years) and younger women (age range 19 to 21 years) screened for conditions that might impact upon balance or walking. Gait data were collected with an 8.1m GAITRite mat for 10 trials of discrete single walks and 10 laps of a continuous circuit, presented in random order. Study 1 examined the test-retest reliability and systematic bias of data recorded during repeated single and continuous over-ground walking trials over two separate test sessions that were seven days apart (median REPLACE2 SD, 7REPLACE21.58d). Paired t tests, intraclass correlation coefficients, standard errors of measurement, and coefficients of variation were calculated. Study 2 investigated if gait variability data captured during repeated single over-ground walking differed from variability data captured during continuous over-ground walking.;To quantify variability, standard deviation and coefficients of variation were calculated for each gait parameter, and paired t tests were used to compare the measures of variability recorded for each walking protocol. A major finding from the first two studies was that gait parameters, including gait variability, differed between walking protocols. Study 1 showed that although both continuous and repeated single walking protocols were reliable, the continuous over-ground walking protocol produced less bias (19% of gait parameters) in test-retest spatiotemporal gait data compared to the single trial condition (65% of gait parameters). Between-protocol differences were more apparent for the older than younger women, with 77% of the gait parameters showing bias in the single trial condition. In contrast, no systematic bias was found in the continuous condition for older adults. In study 2, walking protocol differences were found between the gait variability data. Compared with a continuous over-ground walking protocol, a repeated single over ground protocol resulted in increased variability of velocity, step length and stride length data (p<0.01) for the older women. In the younger women, increased variability of velocity (p?0.02), step length (p=0.04), stride time (p?0.02) and step time (p=0.02) were found for the single walking trials. The findings from studies 1 and 2 suggest that a continuous protocol may be more stable and may detect gait changes more readily, especially for older women. Based on the outcomes of study 1 and 2, gait data recorded using a continuous walking protocol were used for the major analyses in study 3 which examined gait variability and stride dynamics. Additionally, data were also recorded from the equivalent number of repeated single walking trials to investigate the influence of walking protocol upon gait variability and falls.;07 years) underwent screening procedures and completed seven minutes of walking around a continuous circuit. Gait data were collected with an 8.1m GAITRiteREPLACE3 mat and with two tri-axial CrossbowREPLACE3 accelerometers. A small subset (n=12, mean age=67.17 + 5.27) of participants also attended on a second visit one week following their initial testing session to evaluate the test-retest reliability of the accelerometer data. Participants were then followed prospectively for one year to record fall incidence. Differences in physical (demographic and screening), balance, gait variability and stride dynamic measures between fallers (one or more falls) and non-fallers were examined using Multivariate Analyses of Variance (MANOVAs) and independent samples t tests. Between-leg differences in stride dynamics were assessed using a paired samples t test. To evaluate the ability of stride dynamics and gait variability to predict future fallers, direct logistic regression was performed. All analyses were repeated with the sample stratified into non-fallers, single fallers (one fall) and multiple fallers (two or more falls), as well as into multiple fallers and a combined group of single and non-fallers, to investigate the effect of multiple falls as an independent variable. Finally, to evaluate whether walking protocol influenced study outcomes, all between-group and prediction analyses were again repeated using data collected from the repeated single walking protocol. The major finding of this study was that inter-limb dynamics were altered in fallers. Specifically, inter-limb differences (p?0.04) were found in the fractal scaling index of fallers (one or more falls) aged over 70 years, and multiple fallers (two or more falls) aged over 55 years, but not in non-fallers, single fallers or the combined group of single and non-fallers.;05) were found in any physical, balance, gait variability or other stride dynamic measures between those who fell in the subsequent year and those who did not fall. Additionally, no gait variable predicted future falls in the sample of active older women. Similar outcomes were found when data from a repeated single walking protocol were used, and when the sample was stratified in non-fallers, single fallers, multiple fallers and a combined group of single and non-fallers. Therefore, despite no observable difference in other common measures of intrinsic falls risk, control of inter-limb dynamics was reduced in active and otherwise healthy older fallers and multiple fallers. This outcome suggests that inter-limb dynamics could provide a clinically sensitive and possible early detection marker of gait instability and falls risk in high functioning older adults prior to evidence of change in other measures of physical, balance or gait function, including gait variability

Clinical assessment and management of foot and ankle osteoarthritis: a review of current evidence and focus on pharmacological treatment

Foot and ankle osteoarthritis (OA) is a common and disabling problem that adversely affects physical function and significantly reduces quality of life. Although the knee was considered to be the lower-limb site most often affected by OA, recent population data showed foot OA is as prevalent as knee OA, and rates increase with advancing years. The most common foot OA sites include the first metatarsophalangeal joint and the midfoot, with the ankle affected less often. Despite the high prevalence and disabling nature of foot and ankle OA, the condition has been neglected by clinical researchers, and there are very few trials investigating non-surgical foot or ankle OA treatment options. There are no accepted clinical diagnostic criteria for foot or ankle OA so imaging remains common. Clinical guidelines based on knee and hip OA research recommend education, exercise, and weight loss in the first instance. Topical non-steroidal anti-inflammatory drugs (NSAIDs) or capsaicin may be used as an adjunct. Failing these approaches, acetaminophen (paracetamol) should be recommended; however, if there is inadequate symptomatic relief, then clinicians should trial an oral NSAID or a cyclo-oxygenase-2 inhibitor. Given that adverse events and co-morbidities are common in the elderly, older patients should be closely monitored. Some studies have investigated intra-articular injections for foot and ankle OA, and there is some evidence to suggest hyaluronic acid may be effective in the short term for ankle OA. With the lack of research on foot or ankle OA treatments, however, robust clinical trials are urgently needed.</p

Cardiovascular fitness is unrelated to mobility limitations in ambulant people with traumatic brain injury

OBJECTIVE:: The aim of this study was to evaluate the relationship between mobility, activity levels, and cardiovascular fitness in patients with traumatic brain injury (TBI) currently undergoing rehabilitation, and to determine whether mobility and cardiovascular fitness differs between people with TBI and matched healthy controls (HCs). DESIGN:: Cross-sectional cohort study. PARTICIPANTS:: Twenty-eight people with TBI and 28 matched HCs. OUTCOME MEASURES:: The primary outcome measure for mobility was the high-level mobility assessment tool. Steps per day was the outcome measure for activity level, and the physical work capacity at 130 (PWC130) submaximal VO2 Monark bike test was the primary outcome measure for cardiovascular fitness. RESULTS:: Results revealed no relationship (P > .05) between mobility, activity levels, and cardiovascular fitness in the TBI cohort. Participants with TBI had significantly reduced capacity for mobility (P < .001) and performed less physical activity (P = .002) than matched HCs; however, there was no significant difference in cardiovascular fitness (P = .094) between groups. CONCLUSIONS:: Despite reduced physical activity and a wide range in capacity to mobilize, no relationship was identified between mobility and cardiovascular fitness following TBI. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins