Towards a better understanding of foot and ankle kinematics in rheumatoid arthritis : the effects of walking speed and structural impairments

From an early stage of the disease 40% to 60% of the Rheumatoid arthritis (RA) patients suffer from walking impairments such as pain, diminished mobility and problems with daily activities. With the recent development of optical recording technologies and detailed foot and ankle computer models, typical RA foot and ankle kinematic measures have been assessed and reported. However, the relationships between kinematics and walking impairments or pathological changes of foot and ankle structures are not yet fully understood. Such fundamental knowledge may support the development and evaluation of interventions, which aim to improve or restore normal foot and ankle kinematic function. The aim of this thesis was to improve our understanding of the causes of the alterations in foot and ankle kinematics of patients with RA compared to healthy subjects.\ud Gait of 23 RA patients with various stages of disease severity and gait of 14 healthy age-matched subjects was recorded. Their foot and ankle kinematic measures were assessed by means of a foot and ankle model consisting of segments for the leg, hindfoot, midfoot, forefoot and hallux. In the healthy subjects, strong and consistent coupling of motion was observed between hindfoot inversion and hallux dorsi-flexion motion and also between leg rotation and medial-arch collapse. Such strong motion relationships may explain why a local pathology such as joint erosion has a global effect on segment motion elsewhere in the foot. \ud The healthy subjects walked at comfortable and two lower walking speeds, which matched the walking speeds of the RA subjects. However, the factor walking speed alone was not able to explain all observed differences between RA and healthy subjects walking at comfortable speed. The hallux dorsiflexion, midfoot supination and hindfoot inversion motions were influenced by the factor disease, independent of the walking speed. These three segment motions could be related to clinical scores. Local joint erosion and synovitis influenced hallux motion. Hindfoot alignment as well as pathological changes to Achilles and peroneus tendons influenced midfoot and hindfoot motion, respectively. In conclusion, relationships between kinematics and pathological degeneration of foot and ankle structures were found and improve our understanding of RA gait impairments

Enlightening cyclists:an evaluation study of a bicycle light communication system aimed to support older cyclists in traffic interactions

In the Netherlands, older cyclists run an increased risk of bicyclecrashes. Critical factors are low-speed interactions, stopping, (dis)mounting,and potentially misjudging riding speeds. A Bicycle Light CommunicationSystem (BLCS) was therefore developed that displayed riding speed, braking,and turning intentions. In an experiment, 21 older and 20 younger cyclistsobserved BLCS-signals of a lead cyclist and estimated speeds of anapproaching cyclist, with and without BLCS. Interviews were conducted toassess general opinions on BLCS and its influence on cycling behaviour. In a small follow-up study, twelve older cyclists used a BLCS-bicycle oneweek to explore first user-impressions. The majority evaluated the BLCSpositively, mainly the turning indicator and brake light components, eventhough interpreting the speed signals was difficult. Although the first userimpressions revealed that the direction indicator does not influence selfreported balance (positively or negatively), the majority reported that theywould like to use a BLCS themselves

Flexor Hallucis Longus tendon rupture in RA-patients is associated with MTP 1 damage and pes planus

<p>Abstract</p> <p>Background</p> <p>To assess the prevalence of and relation between rupture or tenosynovitis of the Flexor Hallucis Longus (FHL) tendon and range of motion, deformities and joint damage of the forefoot in RA patients with foot complaints.</p> <p>Methods</p> <p>Thirty RA patients with painful feet were analysed, their feet were examined clinically for the presence of pes planus and range of motion (ROM), radiographs were scored looking for the presence of forefoot damage, and ultrasound examination was performed, examining the presence of tenosyovitis or rupture of the FHL at the level of the medial malleolus. The correlation between the presence or absence of the FHL and ROM, forefoot damage and pes planus was calculated.</p> <p>Results</p> <p>In 11/60(18%) of the feet, a rupture of the FHL was found. This was associated with a limited motion of the MTP1-joint, measured on the JAM (χ²= 10.4, p = 0.034), a higher prevalence of pes planus (χ²= 5.77, p = 0.016) and a higher prevalence of erosions proximal at the MTP-1 joint (χ²= 12.3, p = 0.016), and joint space narrowing of the MTP1 joint (χ²= 12.7, p = 0.013).</p> <p>Conclusion</p> <p>Rupture of the flexor hallucis longus tendon in RA-patients is associated with limited range of hallux motion, more erosions and joint space narrowing of the MTP-1-joint, as well as with pes planus.</p

We should not forget the foot: relations between signs and symptoms, damage, and function in rheumatoid arthritis

We studied rheumatoid arthritis (RA) patients with foot complaints to address the associations between clinical signs and symptoms, radiographic changes, and function in connection with disease duration. Secondly, we describe the contribution of several foot segments to the clinical presentation and function. In 30 RA patients with complaints of their feet, attributed to either signs of arthritis and/or radiographic damage, we compared radiographic, ultrasound, clinical, and functional parameters of the feet and ankle. Pain and swelling of the ankle were correlated weakly but statistically significantly with limitation and disability (0.273 to 0.293) as measured on the 5-Foot Function Index (FFI). The clinical signs of the forefoot joints did not influence any of the functional outcome measures. Radiographic scores for both forefeet (SvdH) and hindfeet (Larsen) were correlated with the total Health Assessment Questionnaire Disability Index (HAQ DI) and the 5-FFI limitation subscale. Pain and disease duration, more than radiographic damage, influence the total HAQ DI significantly. With the progression of time, structural damage and function of the rheumatic foot worsen in RA patients. Pain and swelling of the ankle contribute more to disability than radiographic damage of the foot and ankle

The Importance of Activating Factors in Physical Activity Interventions for Older Adults Using Information and Communication Technologies: Systematic Review

Abstract BackgroundIn an aging population, it is important to activate older adults in taking care of their own health. Increasing physical activity is one way to avoid or lessen age-related physical and mental impairments. Interest in the use of information and communication technology (ICT) tools to promote physical activity among older adults is growing considerably. Such tools are suitable for communicating activation factors—skills, knowledge, and motivation—by integrating a variety of behavior change techniques (BCTs) to enhance physical activity. Although activation factors have been incorporated into physical activity interventions using ICT, little is known about the actual integration methods used in such interventions or about the effects of activation factors on influencing behavior change. ObjectiveThe first aim of this study was to identify which of the activation factors were covered in physical activity–promoting ICT interventions for older adults and which BCTs were used to address them. The second objective was to classify the user interaction interfaces and delivery modes that were used to promote these activation factors. MethodsThe search engines of PubMed, Web of Science, and ScienceDirect were used to search for and identify articles examining the effectiveness of ICT interventions for promoting physical activity in older adults. References and related data were selected, extracted, and reviewed independently by 2 reviewers. The risk of bias was assessed, and any conflict was addressed by a third separate reviewer. Selected articles included older adults aged ≥55 years without pre-existing medical diseases and other physical or mental conditions that could hinder movement. ResultsIn total, 368 records were retrieved, and 13 studies met all inclusion criteria. Articles differed in terms of themes, timescales, user interaction interfaces, and outcome measures; therefore, a quantitative data synthesis was not feasible. Motivation was the most promoted activation factor among all trials (33 times). An app and a smartwatch were used in the majority of intervention groups (7/20, 35%) for tracking physical activity and receiving personalized feedback based on the individual goals. Skills (25 times) and knowledge (17 times) were the next most commonly addressed activation factors. Face-to-face interaction was the most used approach to targeting users’ skills, including providing instructions on how to perform a behavior and exchanging knowledge via education on the health consequences of insufficient physical activity. Overall, integrating all 3 activation factors and using multiple user interaction interfaces with a variety of delivery modes proved the most effective in improving physical activity. ConclusionsThis study highlights commonly used BCTs and preferred modes of their delivery. So far, only a limited number of available BCTs (21/102, 21%) have been integrated. Considering their effectiveness, a larger variety of BCTs that address skills, knowledge, and motivation should be exploited in future ICT interventions