More Than Just Adolescence: Differences in Fatigue Between Youth With Cerebral Palsy and Typically Developing Peers

Objective To quantify differences in fatigue and disordered sleep between adolescents with cerebral palsy (CP) and their typically developing peers. A secondary aim was to investigate the association between fatigue and disordered sleep in adolescents with CP. Methods A convenience sample of 36 youth with CP aged 10-18 years was matched for age and sex with 36 typically developing peers. The Fatigue Impact and Severity Self-Assessment (FISSA), the Patient-Reported Outcome Measurement Information System (PROMIS) fatigue profile, and the Sleep Disturbance Scale for Children (SDSC) were collected. Results Higher fatigue was reported in participants with CP than in their typically developing peers based on the FISSA total score (mean paired difference=19.06; 99% confidence interval [CI], 6.06-32.1), the FISSA impact subscale (mean paired difference=11.19; 99% CI, 3.96-18.4), and the FISSA Management and Activity Modification subscale (mean paired difference=7.86; 99% CI, 1.1-14.6). There were no differences between groups in the PROMIS fatigue profile (mean paired difference=1.63; 99% CI, -1.57-4.83) or the SDSC total score (mean paired difference=2.71; 99% CI, -2.93-8.35). Conclusion Youth with CP experienced significantly more fatigue than their peers as assessed by a comprehensive measure that considered both general and diagnosis-specific concerns. Sleep did not differ between youth with CP and their typically developing peers. These findings underscore the need to consider the clinical management of fatigue across the lifespan of individuals with CP to prevent the associated deterioration of functional abilities

Patellofemoral joint geometry and osteoarthritis features 3–10 years after knee injury compared with uninjured knees

In this cross-sectional study, we compared patellofemoral geometry in individuals with a youth-sport-related intra-articular knee injury to uninjured individuals, and the association between patellofemoral geometry and magnetic resonance imaging (MRI)-defined osteoarthritis (OA) features. In the Youth Prevention of Early OA (PrE-OA) cohort, we assessed 10 patellofemoral geometry measures in individuals 3–10 years following injury compared with uninjured individuals of similar age, sex, and sport, using mixed effects linear regression. We also dichotomized geometry to identify extreme (&gt;1.96 standard deviations) features and assessed likelihood of having extreme values using Poisson regression. Finally, we evaluated the associations between patellofemoral geometry with MRI-defined OA features using restricted cubic spline regression. Mean patellofemoral geometry did not differ substantially between groups. However, compared with uninjured individuals, injured individuals were more likely to have extremely large sulcus angle (prevalence ratio [PR] 3.9 [95% confidence interval, CI: 2.3, 6.6]), and shallow lateral trochlear inclination (PR 4.3 (1.1, 17.9)) and trochlear depth (PR 5.3 (1.6, 17.4)). In both groups, high bisect offset (PR 1.7 [1.3, 2.1]) and sulcus angle (PR 4.0 [2.3, 7.0]) were associated with cartilage lesion, and most geometry measures were associated with at least one structural feature, especially cartilage lesions and osteophytes. We observed no interaction between geometry and injury. Certain patellofemoral geometry features are correlated with higher prevalence of structural lesions compared with injury alone, 3–10 years following knee injury. Hypotheses generated in this study, once further evaluated, could contribute to identifying higher-risk individuals who may benefit from targeted treatment aimed at preventing posttraumatic OA.</p

Implementing a junior high school-based programme to reduce sports injuries through neuromuscular training (iSPRINT):A cluster randomised controlled trial (RCT)

OBJECTIVE: To evaluate the effectiveness of a junior high school-based sports injury prevention programme to reduce injuries through neuromuscular training (NMT). METHODS: This was a cluster randomised controlled trial. Students were recruited from 12 Calgary junior high schools (2014-2017). iSPRINT is a 15 min NMT warm-up including aerobic, agility, strength and balance exercises. Following a workshop, teachers delivered a 12-week iSPRINT NMT (six schools) or a standard-of-practice warm-up (six schools) in physical education classes. The definition of all recorded injuries included injuries that resulted in participants being unable to complete a sport and recreation (S&R) session, lost time from sport and/or seek medical attention. Incidence rate ratios (IRRs) were estimated based on multiple multilevel Poisson regression analyses (adjusting for sex (considering effect modification) and previous injury, offset by S&R participation hours, and school-level and class-level random effects were examined) for intent-to-treat analyses. RESULTS: 1067 students (aged 11-16) were recruited across 12 schools (6 intervention schools (22 classes), 6 control schools (27 classes); 53.7% female, 46.3% male). The iSPRINT programme was protective of all recorded S&R injuries for girls (IRR=0.543, 95% CI 0.295 to 0.998), but not for boys (IRR=0.866, 95% CI 0.425 to 1.766). The iSPRINT programme was also protective of each of lower extremity injuries (IRR=0.357, 95% CI 0.159 to 0.799) and medical attention injuries (IRR=0.289, 95% CI 0.135 to 0.619) for girls, but not for boys (IRR=1.055, 95% CI 0.404 to 2.753 and IRR=0.639, 95% CI 0.266 to 1.532, respectively). CONCLUSION: The iSPRINT NMT warm-up was effective in preventing each of all recorded injuries, lower extremity injuries and medically treated S&R injuries in female junior high school students. TRIAL REGISTRATION NUMBER: NCT03312504

Establishing outcome measures in early knee osteoarthritis

The classification and monitoring of individuals with early knee osteoarthritis (OA) are important considerations for the design and evaluation of therapeutic interventions and require the identification of appropriate outcome measures. Potential outcome domains to assess for early OA include patient-reported outcomes (such as pain, function and quality of life), features of clinical examination (such as joint line tenderness and crepitus), objective measures of physical function, levels of physical activity, features of imaging modalities (such as of magnetic resonance imaging) and biochemical markers in body fluid. Patient characteristics such as adiposity and biomechanics of the knee could also have relevance to the assessment of early OA. Importantly, research is needed to enable the selection of outcome measures that are feasible, reliable and validated in individuals at risk of knee OA or with early knee OA. In this Perspectives article, potential outcome measures for early symptomatic knee OA are discussed, including those measures that could be of use in clinical practice and/or the research setting

The measurement and influence of body composition phenotype in ageing: an analysis of health -related changes in Irish adults

Ageing is a process associated with adverse effects on nearly every facet of human body composition and is generally accompanied by progressive loss in lean mass (sarcopenia) and bone mineral density (BMD) (osteoporosis) and concomitant increase in total and visceral adiposity (fat obesity). However, body mass index (BMI), the metric commonly used to quantify changes in body composition, does not adequately represent these health-related changes. The technological advance in bone and soft-tissue imaging offered by dual energy X-ray absorptiometry (DXA) provides an accepted criterion measure of body composition into three components (adiposity, lean mass, BMD). Using DXA as the reference method of measurement, this thesis reports a cross-sectional characterisation of body composition in a convenience sample of 1,606 Irish adult men and women age 18-81 years. Interrogation of these data afforded the opportunity to challenge the validity and sensitivity of metrics such as BMI, redefine the criterion reference of adiposity and monitor age-related change and interrelationships between components of body composition. The first study recommends measurement of a body fat mass index (BFMI) for accurate classification of adiposity that is independent of change in fat-free mass. An age-, BMI- and gender-specific reference equation is generated that allows accurate estimation (R2=0.9, SEE=1.1%) of BFMI for use clinically. Additionally, reference ranges of BFMI based on a young adult Z-score and centiles are presented, offering classification of the individual based on adiposity. The second study tracks the age-related change in body composition from the median young adult (18-29y), to middle age (30-49y) and older age (≥50y), observing an increase in BFMI, coinciding with a re-distribution of adiposity from subcutaneous to visceral compartments. A decline in lean mass and BMD was observed to begin at age 30 years in men and women in this cohort. Examining the interrelationships between these parameters, the third study investigates the association between adiposity (BFMI and visceral) on BMD. Adiposity was shown to negatively influence BMD (p<0.05) to a greater extent at the whole body vs. site-specific regions and in younger vs. older adults. Taking a combination of approaches, this thesis defines the criteria that describe ageing in an Irish cohort, and tracks the body compositional changes that may be detrimental to health. These results should form a basis to devise methods that offset the decline in composition that leads to frailty, disability, disease and loss of independence in the elderly, and promote health and functional status for longer

The effect of hydration status on the measurement of lean tissue mass by dual-energy X-ray absorptiometry

Athletes cycle between exercise and recovery. Exercise invokes changes in total body water from thermal sweating, muscle and hepatic glycogen depletion and metabolic water loss. Recovery from exercise results in rehydration, substrate repletion, and possible glycogen supercompensation. Such changes may corrupt the measurement of hydrated tissues, such as lean tissue mass (LTM), by dual-energy X-ray absorptiometry (DXA). The purpose of this study was to determine the effect of exercise and thermal dehydration and subsequent glycogen supercompensation on DXA-based measurement of body composition.Twelve active adult (18-29 years) males exercised at 70% VO2max on a cycle ergometer in a thermal environment (30 A degrees C) to induce a 2.5% reduction in body mass. Participants subsequently underwent a glycogen supercompensation phase, whereby a high carbohydrate diet (8-12 g/kg body mass/day) was consumed for a 48-h period. Whole-body DXA measurement was performed at baseline, following exercise and supercompensation.Following exercise, mean body mass decreased by -1.93 kg (95% CI -2.3, -1.5), while total LTM decreased by -1.69 kg (-2.4, -1.0). Supercompensation induced a mean body mass increase of 2.53 kg (2.0, 3.1) and a total LTM increase of 2.36 kg (1.8, 2.9). No change in total fat mass or bone mineral content was observed at any timepoint.Training regimens that typically induce dehydration and nutrition regimens that involve carbohydrate loading can result in apparent changes to LTM measurement by DXA. Accurate measurement of LTM in athletes requires strict observation of hydration and glycogen status to prevent manipulation of results

What Does the Future Hold? Health-Related Quality of Life 3–12 Years Following a Youth Sport-Related Knee Injury

Knee trauma can lead to poor health-related quality of life (HRQoL) and osteoarthritis. We aimed to assess HRQoL 3–12 years following youth sport-related knee injury considering HRQoL and osteoarthritis determinants. Generic (EQ-5D-5L index, EQ-VAS) and condition-specific (Knee injury and Osteoarthritis Outcome Score quality of life subscale, KOOS QOL) HRQoL were assessed in 124 individuals 3–12 years following youth sport-related knee injury and 129 uninjured controls of similar age, sex, and sport. Linear regression examined differences in HRQoL outcomes by injury group. Multivariable linear regression explored the influence of sex, time-since-injury, injury type, body mass index, knee muscle strength, Intermittent and Constant Osteoarthritis Pain (ICOAP) score, and Godin Leisure-Time Exercise Questionnaire (GLTEQ) moderate-to-strenuous physical activity. Participant median (range) age was 23 years (14–29) and 55% were female. Injury history was associated with poorer KOOS QOL (−8.41; 95%CI −10.76, −6.06) but not EQ-5D-5L (−0.0074; −0.0238, 0.0089) or EQ-VAS (−3.82; −8.77, 1.14). Injury history (−5.14; −6.90, −3.38), worse ICOAP score (−0.40; −0.45, −0.36), and anterior cruciate ligament tear (−1.41; −2.77, −0.06) contributed to poorer KOOS QOL. Worse ICOAP score contributed to poorer EQ-5D-5L (−0.0024; −0.0034, −0.0015) and higher GLTEQ moderate-to-strenuous physical activity to better EQ-VAS (0.10; 0.03, 0.17). Knee trauma is associated with poorer condition-specific but not generic HRQoL 3–12 years post-injury.Medicine, Faculty ofNon UBCPhysical Therapy, Department ofReviewedFacultyResearche

Knee Injury and Osteoarthritis Outcome Score (KOOS) Responder Criteria and Minimal Detectable Change 3–12 Years Following a Youth Sport-Related Knee Injury

The applicability of thresholds that constitute an acceptable score or meaningful change on the Knee injury and Osteoarthritis Outcome Score (KOOS) in cohorts ≥ 5 years following knee injury is not well understood. The primary objective of this study was to evaluate the association between intra-articular knee injury type and two different KOOS pain thresholds (patient acceptable symptom state (PASS) and Englund symptomatic knee criteria) in the Alberta Youth Prevention of Osteoarthritis (PrE-OA) cohort, which includes participants 3–12 years following a youth sport-related knee injury and uninjured controls with similar age, sex and sport characteristics. Analyses accounted for sex, time since injury and the interaction between time since injury and injury type. Secondary objectives were to report proportions meeting thresholds for KOOS outcomes and minimal detectable change (MDC) from published test–retest reliability data, over a 1–4-year follow-up. Two hundred and fifty-three (253) participants (124 injured, 129 controls) were included in analyses, of which 153 (77 injured, 76 controls) had follow-up data. Similar odds were observed for presence of pain (below PASS threshold) in participants with anterior cruciate ligament (ACL)/meniscus injury (odds ratio (OR) 4.2 (97.5% confidence interval (CI): 1.8, 9.9)) and other knee injuries (OR 4.9 (97.5% CI: 1.2, 21.0)), while there were higher odds for presence of Englund “symptomatic knee” criteria in participants with ACL/meniscus injury (OR 13.6 (97.5% CI: 2.9, 63.4)) than other knee injuries (OR 7.3 (97.5% CI: 0.8, 63.7)) compared to controls. After a median 23.4 (8 to 42) month follow-up, 35% of previously injured participants had at least one KOOS sub-scale score that worsened by more than the MDC published threshold. Despite limited research, this study shows that individuals with youth sport knee injuries other than ACL or meniscus injury may also experience significant pain and symptoms 3–12 years following injury. Replication and further follow-up are needed to identify a possible clinical trajectory towards osteoarthritis.Medicine, Faculty ofNon UBCPhysical Therapy, Department ofReviewedFacultyResearche

Muscle strength can better differentiate between gradations of functional performance than muscle quality in healthy 50-70 y women

OBJECTIVE: It is not known which laboratory indices of muscle mass, strength or quality can distinguish functional performance in healthy middle aged women. The aim of this study was to a) examine the association between upper leg lean tissue mass (LTM), knee extensor strength, muscle quality (strength per unit LTM) and functional performance and b) to determine the utility of tertiles of muscle strength and muscle quality to distinguish gradations of functional capacity in healthy 50 – 70y women. METHOD: Using a cross-sectional study design, one hundred and twenty eight healthy 50 – 70y women (age: 60.4 ± 5.1 years) underwent body composition assessment (dual X-ray absorptiometry) and performed a maximal voluntary isometric contraction of the knee extensors (Con-Trex Dynamometer). Functional performance was assessed using a 5 repetition and 30 second chair rise test and 900m gait speed test. RESULTS: Ordered by muscle strength or muscle quality, those in the highest tertile (T1) demonstrated greater functional performance than those in lowest tertile (T3) (P.05). Muscle strength explained a greater proportion of the variance in all functional performance measures relative to muscle quality (P<0.05). CONCLUSION: Upper leg LTM is not associated with physical performance in healthy 50 – 70y women. These results suggest strength relative to the body mass being accelerated distinguishes gradations in functional performance better than muscle quality healthy 50-70y women

Twelve weeks\u27 progressive resistance training combined with protein supplementation beyond habitual intakes increases upper leg lean tissue mass, muscle strength and extended gait speed in healthy older women

The age-related decline in functional capability is preceded by a reduction in muscle quality. The purpose of this study was to assess the combined effects of progressive resistance training (PRT) and protein supplementation beyond habitual intakes on upper leg lean tissue mass (LTM), muscle quality and functional capability in healthy 50–70 years women. In a single-blinded, randomized, controlled design, 57 healthy older women (age 61.1 ± 5.1 years, 1.61 ± 0.65 m, 65.3 ± 15.3 kg) consumed 0.33 g/kg body mass of a milk-based protein matrix (PRO) for 12 weeks. Of the 57 women, 29 also engaged in a PRT intervention (PRO + PRT). In comparison to the PRO group (n = 28), those in the PRO + PRT group had an increase in upper leg LTM [0.04 (95% CI -0.07 to 0.01) kg vs. 0.13 (95% CI 0.08–0.18) kg, P = 0.027], as measured by Dual-energy X-ray absorptiometry; an increase in knee extensor (KE) torque [-1.6 (95% CI -7.3 to 4.4 N m) vs. 10.2 (95% CI 4.3–15.8 N m), P = 0.007], as measured from a maximal voluntary isometric contraction (Con-Trex MJ; CMV AG); and an increase in extended gait speed [-0.01 (95% CI -0.52–0.04) m s-1 vs. 0.10 (95% CI 0.05–0.22) m s-1, P = 0.001] as measured from a maximal 900 m effort. There was no difference between groups in the time taken to complete 5 chair rises or the number of chair rises performed in 30 s (P>0.05). PRT in healthy older women ingesting a dietary protein supplement is an effective strategy to improve upper leg LTM, KE torque and extended gait speed in healthy older women.PUBLISHEDpeer-reviewe