Telerehabilitation Feasibility in Total Joint Replacement

Despite documented benefits, many Total Joint Replacement (TJR) patients find it difficult to access rehabilitation following discharge from hospital. One solution to improve access for TJR patients is telerehabilitation. This study aimed to assess the feasibility of introducing a telerehabilitation program for TJR patients.   TJR patients at QEII Jubilee Hospital were invited to complete a questionnaire regarding their access, feelings towards and preferences in using technology. Seventy-five patients were recruited. Most patients had computer access (72%) and internet (69%) at home. Sixty-five percent of participants were willing to participate in telerehabilitation. A significant difference was found between older and younger patients. Watching videos on an electronic device was the preferred method for a technology-based home exercise program and phone call the preferred method of communication.  Results indicate telerehabilitation in the TJR population is feasible from the perspective of access to, feelings toward, and preferences for technology.Keywords: Hip replacement, Knee replacement, Telerehabilitation, Telemedicine, Total joint replacemen

Neuromotor control during stair ambulation in individuals with patellofemoral osteoarthritis compared to asymptomatic controls

Patellofemoral OA is characterized by PF pain during activities that load a flexed knee. Stair stepping ability is frequently impaired, yet little is known of the muscular recruitment strategies utilized during this task. Altered recruitment strategies may provide targets for clinical interventions. We aimed to determine if people with PFOA ascend and descend stairs with different muscular recruitment strategies compared to similar aged healthy individuals.Twenty-two people with PFOA and 20 controls were recruited. Electromyographic recordings from gluteus maximus and medius, medial and lateral hamstrings, vastus medialis and lateralis, medial and lateral gastrocnemius and soleus were acquired during stair ascent and descent. Force plate data was acquired to determine timing of foot placements and characterize dynamic stability.Seventeen people with PFOA (59 ± 10 years, 73 ± 13 kg, 167 ± 9 cm) and 15 controls (57 ± 10 years, 73 ± 16 kg, 171 ± 11 cm) had complete data. People with PFOA demonstrated: longer vastii activation duration during descent (lateralis: p = 0.01; medialis: p = 0.02); earlier onset of vastus lateralis for ascent (p

Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis

Background: Hip and groin injuries are common in many sports. Understanding the factors differentiating athletes with hip/groin pain from those without these injuries could facilitate management and prevention. Objective: Conduct a systematic review and meta-analysis of the literature on factors differentiating athletes with and without hip/groin pain. Methods: The review was registered as PROSPERO CRD42014007416 and a comprehensive, systematic search was conducted in June 2014. Inclusion criteria were: cross-sectional, cohort or case-control study designs of n>10 that examined outcome measures differentiating athletes with and without hip/groin pain. Two authors independently screened search results, assessed study quality, and performed data extraction. Methodological heterogeneity was determined and data pooled for meta-analysis when appropriate. A best evidence synthesis was performed on the remaining outcome measures. Results: Of 2251 titles identified, 17 articles were included of which 10 were high quality. Sixty two different outcome measures were examined, 8 underwent meta-analysis. Pooled data showed strong evidence that athletes with hip/groin pain demonstrated: pain and lower strength on the adductor squeeze test, reduced range of motion in hip internal rotation and bent knee fall out; however, hip external rotation range was equivalent to controls. Strong evidence was found that lower patient-reported outcome (PRO) scores, altered trunk muscle function, and moderate evidence of bone oedema and secondary cleft sign were associated with hip/groin pain. Conclusions: PROs, pain and reduced strength on the adductor squeeze test, reduced range of motion in internal rotation and bent knee fall out are the outcome measures that best differentiate athletes with hip/groin pain from those without this pain

What fooled us in the knee may trip us up in the hip: Lessons from arthroscopy

EditorialC

Greater understanding of normal hip physical function may guide clinicians in providing targeted rehabilitation programmes

Objectives: This study investigated tests of hip muscle strength and functional performance. The specific objectives were to: (i) establish intra- and inter-rater reliability; (ii) compare differences between dominant and non-dominant limbs; (iii) compare agonist and antagonist muscle strength ratios; (iv) compare differences between genders; and (v) examine relationships between hip muscle strength, baseline measures and functional performance. Design: Reliability study and cross-sectional analysis of hip strength and functional performance. Methods: In healthy adults aged 18-50. years, normalised hip muscle peak torque and functional performance were evaluated to: (i) establish intra-rater and inter-rater reliability; (ii) analyse differences between limbs, between antagonistic muscle groups and genders; and (iii) associations between strength and functional performance. Results: Excellent reliability (intra-rater ICC = 0.77-0.96; inter-rater ICC = 0.82-0.95) was observed. No difference existed between dominant and non-dominant limbs. Differences in strength existed between antagonistic pairs of muscles: hip abduction was greater than adduction (p < 0.001) and hip ER was greater than IR (p < 0.001). Men had greater ER strength (p = 0.006) and hop for distance (p < 0.001) than women. Strong associations were observed between measures of hip muscle strength (except hip flexion) and age, height, and functional performance. Conclusions: Deficits in hip muscle strength or functional performance may influence hip pain. In order to provide targeted rehabilitation programmes to address patient-specific impairments, and determine when individuals are ready to return to physical activity, clinicians are increasingly utilising tests of hip strength and functional performance. This study provides a battery of reliable, clinically applicable tests which can be used for these purposes