Effect of isometric quadriceps exercise on local microcirculation of the infrapatellar fat pad in female patients with knee osteoarthritis.

OBJECTIVE: To elucidate the local microcirculation of the infrapatellar fat pad (IFP) in patients with knee osteoarthritis (KOA) by determining the changes in IFP hardness and hemoglobin concentration during isometric quadriceps exercise (IQE). DESIGN: In this observational cross-sectional study, patients diagnosed with bilateral KOA were included in the KOA group (30 knees), healthy older adults in the control group (20 knees), and younger adults in the young group (20 knees). Ultrasonography was performed at rest and during IQE to measure IFP hardness based on shear wave velocity. Near-infrared spectroscopy was performed to measure oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), and total hemoglobin (cHb) in the IFP before (Baseline), during (IQE task), and after IQE (Post). IFP hardness and O2Hb, HHb, and cHb concentration were analyzed using a linear mixed model for the groups and measurement points. RESULTS: During IQE, IFP hardness changes were significantly less in the KOA group than in the other groups (KOA: 95 % confidence intervals (CIs) [-0.854, 0.028]; control: 95 % CI [-0.941, -0.341]; and young: 95 % CI [-2.305, -1.706]). In the KOA group, O2Hb concentration exhibited no significant changes at Post compared with Baseline; however, significant changes were observed in the other groups (KOA: 95 % CI [-1.176, 0.423]; control: 95 % CI [-1.452, -0.276]; and young: 95 % CI [-4.062, -2.102]). CONCLUSIONS: During IQE, changes in hardness and hemoglobin concentration in the IFP were not significant in the KOA group, suggesting impaired local microcirculation of the IFP.

Efficacy of Therapeutic Exercise on Activities of Daily Living and Cognitive Function Among Older Residents in Long-term Care Facilities: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVES: This study aimed to systematically analyze the efficacy of therapeutic exercise on activities of daily living (ADL) and cognitive function among older residents in long-term care facilities. DATA SOURCES: PubMed, Cochrane Central of Register Trials, Physiotherapy Evidence Database, OTseeker, and Ichushi-Web were searched from inception until December 2018. STUDY SELECTION: Databases were searched to identify randomized controlled trials (RCTs) of therapeutic exercise for long-term care facility residents aged 60 years and older, focusing on ADL and cognitive function as outcomes. DATA EXTRACTION: Two independent reviewers extracted the key information from each eligible study. Two reviewers independently screened and assessed all studies for eligibility, extracting information on study participants, details of interventions, outcome characteristics, and significant outcomes. Any discrepancies were resolved by a third reviewer. DATA SYNTHESIS: A total of 11 RCTs with 1280 participants were eligible for analyses. Therapeutic exercise had a significant benefit on ADL (standard mean difference [SMD]=0. 22, 95% confidence interval [CI]: 0.02, 0.42, P=.03). Subgroup analyses indicated that interventions conducted ≥3 days per week [SMD=0.42, 95% CI 0.02, 0.82, P=.04] had a significant benefit on ADL. For cognitive function, group exercise and ≥3 days/week of intervention had a significant benefit (group exercise: mean difference [MD]=3.36, 95% CI 0.91, 5.80, P=.007; ≥3 days/week of intervention: MD=2.28, 95% CI 0.07, 4.49, P=.04). CONCLUSIONS: Therapeutic exercise conducted 3 or more days per week may be effective for improving ADL and cognitive function among older residents in long-term care facilities. This meta-analysis suggested that group exercise for cognitive functions was effective. However, the effective method of intervention delivery for ADL was unclear.

Effects of low-intensity pulsed ultrasound on the infrapatellar fat pad in knee osteoarthritis: a randomized, double blind, placebo-controlled trial.

[Purpose] We investigated the effects of low-intensity pulsed ultrasound (LIPUS) irradiation of the infrapatellar fat pad (IFP) combined with therapeutic exercise for management of knee osteoarthritis (knee OA). [Participants and Methods] The study included 26 patients with knee OA, who were randomized into the LIPUS group (patients underwent LIPUS + therapeutic exercise) and the therapeutic exercise group (patients underwent sham LIPUS + therapeutic exercise). We measured changes in the patellar tendon-tibial angle (PTTA) and in IFP thickness, IFP gliding, and IFP echo intensity after 10 treatment sessions to determine the effects of the aforementioned interventions. We additionally recorded changes in the visual analog scale, Timed Up and Go Test, the Western Ontario and McMaster Universities Osteoarthritis Index, and Kujala scores, as well as range of motion in each group at the same end-point. [Results] Compared with patients in the therapeutic exercise group, those in the LIPUS group showed significant post-treatment improvements in PTTA, VAS, and Kujala scores, as well as in range of motion. [Conclusion] The combined use of LIPUS irradiation of the IFP and therapeutic exercise is a safe and effective modality to reduce IFP swelling, relieve pain, and improve function in patients with knee OA.

Relationship between Tissue Gliding of the Lateral Thigh and Gait Parameters after Trochanteric Fractures.

Trochanteric fractures lead to severe functional deficits and gait disorders compared to femoral neck fractures. This study aims to investigate gait parameters related to gliding between tissues (gliding) after trochanteric fracture (TF) surgery. This study implemented a cross-sectional design and was conducted amongst patients who underwent TF surgery (n = 94) approximately three weeks post-trochanteric fracture surgery. The following parameters were evaluated: (1) gliding between tissues; (2) lateral femoral pain during loading; (3) maximum gait speed; (4) stride time variability and step time asymmetry as measures of gait cycle variability; (5) double stance ratio and single stance ratio for assessment of stance phase, (6) jerk; and (7) Locomotor rehabilitation index as a measure of force changes during gait. The gliding coefficient was significantly correlated with lateral femoral pain (r = 0.517), jerk root mean square (r = -0.433), and initial contact-loading response jerk (r = -0.459). The jerk of the force change value during gait was also effective in understanding the characteristics of the gait in the initial contact-loading response in patients with trochanteric fractures. Additionally, gliding is related not only to impairments such as pain but also to disabilities such as those affecting gait.

Effect of plyometric training on the fascicle length of the gastrocnemius medialis muscle.

[Purpose] The present study aimed to determine the effects of eccentric calf raise exercise, which has the characteristics of plyometric training, on the fascicle length and muscle thickness of the gastrocnemius medialis muscle and range of motion of the ankle using ultrasonography. [Participants and Methods] Twenty-one healthy volunteers were randomly assigned to the eccentric calf raise exercise group or normal calf raise exercise group. Measurements were performed before training and at 3, 6, 9, and 12 weeks after training. [Results] In the eccentric calf raise exercise group, the fascicle length significantly increased after 6 weeks compared to that at baseline and at 3 weeks after training. The dorsiflexion angle and muscle thickness after three weeks significantly increased compared to that at baseline, but the pennation angle was not significantly different. The fascicle length, pennation angle, dorsiflexion angle, and muscle thickness showed no significant difference at all time points in the NCR group. [Conclusion] The results of this study showed that continued stretching of the gastrocnemius medialis muscle during eccentric calf raise exercise enhanced the morphological structures, such as the a fascicle length and muscle thickness. Eccentric calf raise exercise training may aid in injury prevention.

Estimation of the ankle power during the terminal stance of gait using an inertial sensor.

[Purpose] The purpose of this study was to develop an assessment tool that reflects the ankle function during the terminal stance of gait using an inertial sensor. [Participants and Methods] Thirteen healthy males (20 limbs) participated in this study. All the participants were required to perform five straight-line walking trials along a 10-m level walkway. During the terminal stance phase, both the anterior-posterior and vertical accelerations were measured with an inertial sensor mounted on the fibular head. The Pythagorean theorem was used to calculate the acceleration vector. A three-dimensional gait analysis system was used for movement data acquisition. All statistical analyses were performed using IBM SPSS Statistics 24.0 for Windows. [Results] Results were obtained using the following multiple regression equation for the estimation of ankle plantar flexion power: Estimated Ankle Power=-4.689 + 0.269 × vertical acceleration + 0.104 × body weight. [Conclusion] Our novel method for gait analysis using an inertial sensor can assess the ankle power during the terminal stance phase of gait.

The effects of the functional garment on the biomechanics during the single leg drop landing.

INTRODUCTION: A functional biomechanics garment (FBG) may help to prevent injury by improved kinematics during motion such as single leg drop landing (SLDL). The purpose of this study was to investigate the effects of the FBG on the biomechanics of SLDL. METHOD: Seventeen female university basketball players participated. Characteristics of the FBG were designed based on biomechanics during weight-loaded performance of human movement. The average values of lower limb kinematics and kinetics in the sagittal and frontal planes from 3 SLDL with and without FBG were measured and compared. RESULTS: The maximum varus angle of the knee showed a significant difference between the use of FBG (15.3 ± 15.1°) and without the use of FBG (5.9 ± 15.4°), the flexion angular displacement of the hip (with FBG, 21.5 ± 8.1°; without FBG, 24.0 ± 6.7°) between with and without FBG. The moment of the hip with FGB (1.1 ± 0.6 Nm) was significantly smaller than without FGB (1.4 ± 0.8 Nm). DISCUSSION: Regarding function of the FBG, the rigid part of the hip could counter the excessive adduction and flexion of the hip, and the elastic part of the thigh could support the varus moment when the elastic part stretched. Therefore, the subjects with FBG could control the frontal motion of the knee, which has a risk of knee injury, such as the dynamic valgus of the knee during the SLDL. CONCLUSION: Use of the FBG decreases dynamic knee valgus, which reduces risk of knee injury.

Effects of Compression Intervention on the Thigh Using Elastic Bandage on Lateral Femoral Pain After Trochanteric Fractures: A Multicenter Randomized Controlled Trial.

A trochanteric fracture is one type of hip fracture. Management of postoperative pain after trochanteric fracture that is caused by decreased gliding between tissues in the lateral thigh is not established. The aim of this study was to examine the effect of compression of the thigh using an elastic bandage on trochanteric fracture after surgery. Multicenter randomized controlled trial was conducted in collaboration with the Comprehensive Rehabilitation Unit (sub-acute rehabilitation Unit) in two hospitals. Eligible volunteers (n = 34) with trochanteric fractures after surgery were randomly assigned to two groups. In the treatment group, participants practiced standing and walking under compression of the thigh with an elastic bandage. The control group was blinded to the intervention and practiced standing and walking under non-compression of the thigh with an elastic bandage. Both groups underwent a standard physical therapy program 2 times a day, daily. Two-way repeated measures of ANOVA showed significant main effect between the groups for gliding between tissue (p < .001), lateral femoral pain (p < .001), subcutaneous tissue thickness (p = .044). Compression of the thigh with an elastic bandage significantly improved subcutaneous tissue thickness, gliding between tissues, lateral thigh pain. Gait velocity improved with these functional improvements.

Low-intensity resistance training to improve knee extension strength in community-dwelling older adults: Systematic review and meta-analysis of randomized controlled studies.

AIM: The purpose of this systematic review and meta-analysis was to investigate the effects of low-intensity resistance training on knee extension strength with respect to intensity, frequency, duration and training site in community-dwelling older adults. METHODS: A literature search was conducted for articles published up to December 2018 on PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), OTseeker and Ichushi-Web. Randomized controlled trials involving resistance training with <60 % one repetition maximum (1RM) in community-dwelling older adults aged 60 years and older were eligible. RESULTS: In total, 7 studies involving 275 participants were included in the meta-analysis. The results showed significant improvements in knee extension strength with low-intensity resistance training [standardized mean difference (SMD) 0.62, 95 % confidence interval (CI) 0.32 to 0.91]. In subgroup analyses, significant improvements were observed in the group with intensity at 50-60 % 1RM (0.83, 0.46 to 1.19), but not in the group at 40 % or less 1RM (0.30, 95%CI: -0.08 to 0.68). Concerning frequency, there were significant improvements in knee strength for those receiving training three times (0.90, 0.52 to 1.27) and two times (0.36, 0.03 to 0.69) per week, with a significant difference between the groups (p = 0.04). CONCLUSIONS: Low-intensity resistance training should be considered as an effective intervention to improve knee extension strength in community-dwelling older adults. Older adults may show more improvement in knee extension strength if intensity of the training is set at 50-60 % 1RM and frequency of training is three times per week.

Assessment of walking disorder in community-dwelling Japanese middle-aged and elderly women using an inertial sensor.

BACKGROUND: Decreased walking speed has been revealed to be related to many negative events. Several researchers support the importance of triceps surae function as a cause of decreased walking speed. The purpose of this study was to investigate the relationship between walking speed and plantar flexor power during the terminal stance of gait in community-dwelling middle-aged and elderly women using an inertial sensor. METHODS: One hundred thirty-six healthy female middle-aged to elderly community-dwelling women were included in this study. We measured two-step score, grip strength, walking speed and accelerometer data from which we estimated ankle power (estimated ankle power) during walking using an inertial sensor. All participants were classified into the four different age strata, fifties (50-59), sixties (60-69), seventies (70-79) and eighties (80-89). The differences in each parameter between the four age groups were compared using repeated analysis of variance and post-hoc Bonferroni corrections for multiple comparisons to establish significance. Multiple regression analysis was carried out using a stepwise method to determine the correlations with comfortable walking speed. Comfortable walking speed was considered a dependent variable. RESULTS: The normalized estimated ankle power of the eighties group was significantly decreased in comparison with seventies age groups and fifties age groups (P < 0.05), but there were no significant differences in normalized estimated ankle power between the sixties and eighties age-groups. The results of stepwise multiple regression analysis revealed that the normalized estimated ankle power, two-step value and body weight were highly-significant partial regression coefficients (adjusted R 2 = 0.57).

Characteristics of the descending genicular artery blood flow velocity in patients with knee osteoarthritis.

BACKGROUND: In patients with knee osteoarthritis (KOA), the descending genicular artery (DGA) showed abnormal angiogenesis. However, the non-invasive assessment method of DGA remains unclear. The aim of this study was to clarify the characteristics of blood flow velocity of the DGA in patients with KOA and to examine the factors involved in the changes. METHODS: The KOA group included 22 knees of 22 patients with KOA (4 males, 18 females; mean age, 72.3 ± 7.5 years) and the control group included 22 knees (4 males, 18 females; mean age, 71.3 ± 5.4 years) of 22 healthy adults. The peak systolic blood flow velocity (PSV) in each group was measured using ultrasonography. The KOA group was classified into the effusion group and the non-effusion group based on observed effusion, and the PSV was compared between the two groups. The relationships between PSV and suprapatellar bursa intracavitary distance, pain, femorotibial angle, Japanese Knee Osteoarthritis Measure were also investigated. RESULTS: The PSV in the KOA group (51.5 ± 12.9 cm/s) was significantly higher than that in the control group (29.3 ± 4.4 cm/s) (P < 0.01). In the KOA group, PSV in the effusion group (55.5 cm/s (51.2-59.4 cm/s)) was significantly higher than that in the non-effusion group (39.1 cm/s (35.1-44.4 cm/s)) (P < 0.01). The PSV was positively and significantly correlated with both suprapatellar bursa intracavitary distance (r = 0.81: P < 0.01) and pain (r = 0.48: P < 0.05). CONCLUSIONS: The PSV measurement in the DGA is useful for the evaluation of non-invasive synovitis of patients with KOA.

Validity and reproducibility of foot motion analysis using a stretch strain sensor.

BACKGROUND: Multi-segment foot analysis is traditionally challenging to perform while subjects are wearing footwear or a foot orthosis and is difficult to apply in the clinical setting. A recently developed stretch strain sensor (STR), that is thin and highly flexible, may solve this limitation because it does not require observation using a camera and is highly portable. RESEARCH QUESTION: This study aimed to examine the reproducibility and validity of foot motion analysis using the STR during walking and running by comparing it with a conventional motion capture system. METHODS: Twenty-one healthy participants were examined in this study. The STR was placed on the participant's foot in one of two locations in separate experiments (spring ligament; SL and navicular drop; ND methods). Foot kinematic data during walking and running were simultaneously recorded using the STR and a three-dimensional motion capture system. Intra-class correlation (ICC) was used to assess test-retest reproducibility of the STR method. Cross-correlation coefficient evaluated the similarity of the pattern of the signals between the two systems. Pearson and Spearman correlation analysis was used to evaluate the relationships between the STR measurement and angular excursion of the forefoot or hindfoot. RESULTS: The ICCs of the SL method were 0.95 and 0.96, and those of the ND method were 0.93 and 0.71 during walking and running, respectively. In the SL method, the pattern of the signals between the STR and forefoot frontal motion was strongly correlated. The STR measurement was significantly correlated with forefoot eversion excursion (walking: r=-0.67, running: r=-0.64, p < 0.01 each). In the ND method, the STR signal was not associated with forefoot and hindfoot kinematics. SIGNIFICANCE: Our results showed that the STR has acceptable reproducibility and validity of foot motion analysis. This system may enable measurement of foot motion while subjects are wearing shoes and outside the laboratory.

Seated Virtual Reality-Guided Exercise Improved Gait in a Postoperative Hallux Valgus Case.

Virtual reality (VR)-guided exercise therapy using mediVR KAGURA has been reported to improve gait function by extending the arm to spatial targets while sitting. We aimed to investigate toe and trunk-pelvic function and plantar sensation during gait in a postoperative patient with hallux valgus. A 60-year-old woman, whose foot deformities had improved 6 months earlier, participated in the study. The exercise therapy interventions were performed twice weekly for 15 min. This study used an A-B-A design: 1-week pre-phase, 3-week intervention phase, and 2-week post-phase. The plantar pressure distribution and thoracic and pelvic displacements during gait were recorded at the end of each phase. The tactile pressure thresholds of the foot were determined before and after each exercise. The maximum force and impulse under the hallux increased after the intervention. The sensory threshold of the hallux was reduced. The amplitude of the thoracic and pelvic displacement was shortened in lateral and extended in the vertical and progressional directions after the intervention. We found that a 3-week VR-guided exercise improved toe function, plantar sensation, and postural adjustment of the trunk and pelvis during gait in a patient who had undergone surgery for hallux valgus, and the effects continued for 2 weeks.

The Effect of Functional Biomechanics Garment for Walking.

The purpose of this study was to investigate the effects of a functional biomechanics garment (FBG) with a lower extremity assist function. 32 healthy male participants were included in this study. Participants were divided into an FBG with taping function group (FBG group) and a compression garment group (CG group). Cadence (steps/min), step length (m), and usual walking speed (m/s) were measured as spatio-temporal data. Kinetics, kinematics data, and dynamic joint stiffness (DJS) of the lower extremity were calculated using a three-dimensional gait analysis system. The FBG group showed significantly faster walking speed (FBG, 1.54 ± 0.12 m/s; CG, 1.42 ± 0.15 m/s, p < 0.05) and reduced hip DJS in terminal stance (FBG, 0.033 ± 0.014 Nm/kg/degree; CG: 0.049 ± 0.016 Nm/kg/degree, p < 0.05) compared to the CG group. The FBG decreased hip DJS in the terminal stance and affected walking speed. The passive elastic moment generated by the high elasticity part of the hip joint front in the FBG supported the internal hip flexion moment. Therefore, our FBG has a biomechanical effect. The FBG may be useful as a tool to promote health activities.