Kinematic, kinetic and electromyographic response to customized foot orthoses in patients with tibialis posterior tenosynovitis, pes plano valgus and rheumatoid arthritis

Objective. To describe the effect of customized foot orthoses (FOs) on the kinematic, kinetic and EMG features in patients with RA, tibialis posterior (TP) tenosynovitis and associated pes plano valgus.<p></p> Methods. Patients with RA and US-confirmed tenosynovitis of TP underwent gait analysis, including three-dimensional (3D) kinematics, kinetics, intramuscular EMG of TP and surface EMG of tibialis anterior, peroneus longus, soleus and medial gastrocnemius. Findings were compared between barefoot and shod with customized FO conditions.<p></p> Results. Ten patients with RA with a median (range) disease duration of 3 (1–18) years were recruited. Moderate levels of foot pain and foot-related impairment and disability were present with moderately active disease states. Altered timing of the soleus (P = 0.05) and medial gastrocnemius (P = 0.02) and increased magnitude of tibialis anterior (P = 0.03) were noted when barefoot was compared with shod with FO. Trends were noted for reduced TP activity in the contact period (P = 0.09), but this did not achieve statistical significance. Differences in foot motion characteristics were recorded for peak rearfoot eversion (P = 0.01), peak rearfoot plantarflexion (P < 0.001) and peak forefoot abduction (P = 0.02) in the shod with FOs compared with barefoot conditions. No differences in kinetic variables were recorded.<p></p> Conclusion. This study has demonstrated, for the first time, alterations in muscle activation profiles and foot motion characteristics in patients with RA, pes plano valgus and US-confirmed TP tenosynovitis in response to customized FOs. Complex adaptations were evident in this cohort and further work is required to determine whether these functional alterations lead to improvements in patient symptoms.<p></p&gt

Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials

This project is supported by a European Union Seventh Framework Programme (FP7-PEOPLE-2013-ITN; KNEEMO) under grant agreement number 607510.Peer reviewedPostprin

155?Sex-related differences in muscle co-activation in individuals with knee osteoarthritis

Background: Sex-related differences in muscle function have been well established in healthy individuals. In individuals with knee osteoarthritis (KOA), impairments in muscle function such as muscle weakness and high muscle co-activation have also been demonstrated. Muscle dysfunction has been shown to be a strong contributor to poor physical function and low health-related quality of life in patients with KOA. The purpose of this study was, therefore, to analyse sex and osteoarthritis-related differences in muscle function, to establish to what extent both sex and disease status contribute to muscle dysfunction.Methods: Muscle co-activation was assessed in 77 symptomatic KOA participants (62.5±8.1yrs; 48/29 women/men) and 18 age-matched asymptomatic controls (62.5±10.4yrs; 9/9 women/men), using electromyography (EMG) during a series of walking, stair ascent and descent and sit-to-walk activities. EMG was recorded from 7 sites medial/lateral gastrocnemius, biceps femoris, semitendinosus, vastus lateralis/medialis and normalised to maximal voluntary contraction. Normalised EMG was used to calculate hamstrings-quadriceps and medial-lateral muscle co-activation as (antagonist/agonist) *(antagonist+agonist). The stance phase of walking was split into pre-stance (150ms prior to initial contact), loading (0-15% of stance), early-stance (15-40%), mid-stance (40-60%), late-stance (60-100%) and overall-stance (0-100%). Stairs negotiation was also split into transition (stance phase on the floor) and continuous (stance phase on the second step of the staircase). All participants provided written informed consent and the study was approved by Research Ethics committees (HLS12/86, 13/ws/0146). Independent samples T-tests were performed to assess the differences between KOA and controls. Linear regressions were performed to investigate the relationship between muscle function, sex and disease status, and Bonferroni corrected for multiple comparisons.Results: Individuals with KOA were weaker than controls (P < 0.007). Overall there were very few differences in muscle co-activation between KOA and controls. Women were weaker than men (P ⩽ 0.002) and had higher hamstrings-quadriceps and medial-lateral muscle co-activation across all activities of daily living. In multiple regression analyses sex and muscle weakness, but not age or disease status, predicted high muscle co-activation.Conclusion: High muscle co-activation was associated with female sex and muscle weakness regardless of disease status and age. It has previously been suggested that muscle co-activation acts as a compensatory mechanism for muscle weakness, accommodating for the diminished force generating capabilities to maintain a certain level of function and movement activation patterns. This suggests that muscle weakness may be the main contributing factor for high muscle co-activation which is thought to increase joint loads with detrimental effects on cartilage and joint integrity. This may explain high muscle co-activation in women with muscle weakness and increased risk of incidence and progression of KOA in women

Patients’ and clinicians’ perspectives on the clinical utility of the Rheumatoid Arthritis Foot Disease Activity Index

Although patient-reported outcome measures (PROMs) are recommended in clinical practice, their application in routine care is limited. The Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5) is a validated PROM for assessing foot disease in rheumatoid arthritis (RA). To explore patient and clinician opinions and perceptions of the clinical utility of the Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5), eight RA patients and eight clinicians routinely involved in the management of RA patients participated in one semi-structured remote video-based interview. They provided their perspectives on the barriers and facilitators to clinical implementation of the RADAI-F5. Three global themes were identified; 'Feet are a priority' as the impact of RA on the feet negatively impacted upon patient quality of life. The second theme was 'Need for a clinically feasible foot PROM' as participants recognised the current lack of a clinically feasible tool to determine RA foot disease. The third global theme of ‘Implementation’ was drawn together to form two subordinate themes: ‘Facilitators to RADAI-F5 implementation’ as the tool can promote communication, guide management, help screen foot symptoms, monitor foot disease status and treatments, and promote patient education and; ‘Barriers to RADAI-F5 implementation’ as there were associated practical difficulties, including lack of appointment time, administrative burdens, IT barriers and preference for further RADAI-F5 validation using imaging. The RADAI-F5 has significant potential as a clinical tool to aid foot disease management. However, implementation challenges must be overcome before broad adoption in rheumatology clinics. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00296-022-05147-8

Metatarsophalangeal joint pain in psoriatic arthritis: a cross-sectional study

Methods. Thirty-four consecutive patients with PsA (mean age 45.3 years, 65% female, mean disease duration 9.9 years) and 22 control participants (mean age 37.9 years, 64% female) underwent clinical and US examination to determine the presence of pain, swelling, synovitis, erosions, effusions and submetatarsal bursae at the MTP joints. Mean barefoot peak plantar pressures were determined at each MTP joint. Levels of pain, US-determined pathology and peak pressures were compared between groups. Binary logistic regression was used to identify demographic, clinical examination-derived, US-derived and plantar pressure predictors of pain at the MTP joints in the PsA group. Results. The presence of pain, deformity, synovitis, erosions (P &amp;lt; 0.001) and submetatarsal bursae and peak plantar pressure at MTP 3 (P &amp;lt; 0.05) were significantly higher in the PsA group. MTP joint pain in PsA was independently predicted by high BMI, female gender and the presence of joint subluxation, synovitis and erosion. Conclusion. These results suggest local inflammatory and structural factors, together with systemic factors (gender, BMI), are predominantly responsible for painful MTP joints in PsA, with no clear role for plantar pressure characteristics

Reasons for and outcome of occupational therapy consultation and treatment in the context of multidisciplinary cancer rehabilitation; a historical cohort study

Introduction: The aim of this study was to investigate reasons why people consulted an occupational therapist following cancer treatment, and to examine the outcome of occupational therapy interventions, in the context of multidisciplinary rehabilitation. Methods: Data from 181 patients were collected retrospectively. The International Classification of Human Functioning and Health (ICF) was used to describe the reasons for occupational therapy consultation. Patients had completed the Canadian Occupational Performance Measurement (COPM) before and after the occupational therapy intervention. Change scores were calculated with a 95% confidence interval and a two-sided p-value obtained from a paired t-test. Results: The reasons for occupational therapy consultation were predominantly within the ICF domain “Activities and Participation”. On average, patients improved 3.0 points (95% CI 2.8–3.2) on the performance scale of the COPM, and 3.4 points (95% CI 3.2–3.7) on the satisfaction scale (both: p = <.001). Conclusion: The result of this study supports the added value of occupational therapy to cancer rehabilitation, and emphasise the positive effect of occupational therapy on everyday functioning. Controlled clinical studies are needed to strengthen the evidence