Validation of the Polish Version of Knee Outcome Survey Activities of the Daily Living Scale in a Group of Patients after Arthroscopic Anterior Cruciate Ligament Reconstruction.

BACKGROUND: The study aimed to assess the reliability, validity, and responsiveness of the Polish version of Knee Outcome Survey Activities of the Daily Living Scale (KOS-ADLS) in a group of patients after arthroscopic reconstruction of the anterior cruciate ligament (ACL). METHODS: The study was a longitudinal study with repeated measures. One hundred and twelve subjects who qualified for arthroscopic ACL reconstruction (mean age = 31.8 years) were initially enrolled in this study. The Polish version of KOS-ADLS and Short Form-36 v. 2.0 (SF-36) were used. RESULTS: The Polish version of KOS-ADLS in subjects after ACL rupture demonstrated excellent internal consistency (Cronbach's alpha for KOS-ADLS- total = 0.91), and test-retest reliability using the intraclass correlation coefficient (ICC-total = 0.98). The standard error of measurement (SEM) value was 0.81 and the minimal detectable change (MDC) was 2.23 for KOS-ADLS-total. The validity analysis showed a moderate and low correlation between KOS-ADLS and different domains of SF-36 from r = 0.354 between KOS-ADLS activity and the physical component scale (PCS) of SF-36: to r = 0.206 between KOS-ADLS activity and the mental component scale (MCS) of SF-36. CONCLUSIONS: The Polish version of KOS-ADLS turned out to be a reliable, valid and responsive self-reported outcome measure, allowing for the self-assessment of symptoms and function related to the knee joint impairment after ACL reconstruction. Therefore, the scale can be applied in clinical practice and research.

Validity of the Gait Deviation Index in children and adolescents with juvenile idiopathic arthritis.

PURPOSE: Effectiveness of the Gait Deviation Index (GDI) in patients with juvenile idiopathic arthritis (JIA) is unknown. The aim of this study was to investigate the validity of the GDI as an outcome measure of gait disturbance children with JIA. METHODS: Fifty children and adolescents with JIA were included into the study. The control group included 50 healthy children without gait disorders, matched for age and gender. The kinematic gait parameters were measured using a 3D movement analysis system. Walking speed, walking distance, cadence, step length and single support time were also evaluated. RESULTS: The findings show a statistically significant difference between the values of GDI for the right leg in the study group and the controls ( p = 0.036). The individuals included in the study group achieved significantly lower values in this parameter (mean 94.92 ± 8.38 vs. mean 100.00 ± 10.00). The GDI value for right and left leg and the mean GDI value showed low (0.3 ≤ |R| <0.5, p <0.005) to moderate (0.5 ≤ |R| <0.7, p<0.001) correlations with the other gait parameters and measures. CONCLUSIONS: The GDI scores were lower in individuals with JIA compared to controls. This difference in the GDI values was only significant for the right leg. The GDI values showed low to moderate correlations with other gait parameters.

Three-dimensional analysis of gait in children and adolescents with juvenile idiopathic arthritis.

PURPOSE: The paper aimed to assess the gait pattern in children and adolescents with juvenile idiopathic arthritis (JIA) treated at the rehabilitation center and to assess changes in this pattern after the end of treatment and 9 months later. METHODS: 50 children with JIA were enrolled into the study. 35 healthy volunteers were enrolled into the study for a comparison. Spatiotemporal and kinematic gait parameters were obtained using a movement analysis system. The Gait Deviation Index (GDI) was calculated. The assessment was performed three times: on the day of admission to the rehabilitation center, after the end of a 4-week treatment period and 9 months later. RESULTS: With regard to the majority of spatiotemporal and kinematic parameters, differences in their distribution were highly statistically significant between the study group and the control group ( p < 0.001). In two subsequent tests, differences were less significant when compared to the control group ( p < 0.01). In the study group, ranges of motion in the sagittal plane in the hip ( p < 0.01), knee ( p < 0.001) and ankle joints ( p < 0.01) increased significantly between tests 1 and 2, and 1 and 3. A significantly lower value of GDI was observed in the study group (right limb; p = 0.036). CONCLUSIONS: The gait pattern of children with JIA is significantly different from the one observed in healthy children. A rehabilitation program significantly improved gait in children with JIA, but differences compared to healthy children were still observed, and it indicates that the abnormal gait pattern became permanent in this group of subjects.

Validity of the gait variability index for individuals after a stroke in a chronic stage of recovery.

BACKGROUND: Increased variability in spatiotemporal variables has been demonstrated in individuals after stroke. Gait Variability Index (GVI) has recently been proposed, potentially to be used as a standardized tool for quantifying gait impairment due to spatiotemporal variables. The experience with the GVI in patients after stroke is unknown. RESEARCH QUESTION: The aim of this study was to investigate the validity of the GVI as an outcome measure of gait disturbance after stroke. METHODS: 50 individuals (mean age 60.9 ± 11.2 years) after stroke at a chronic phase of recovery were included. The control group comprised 50 healthy subjects without gait disorders, matched for age and gender. Data on functional mobility and spatiotemporal gait parameters (BTS Smart system) was collected. RESULTS: The results showed lower mean GVI (mGVI) scores (mean 78.53 ± 6.12), lower GVI for the affected leg (mean 76.32 ± 7.98) and for the unaffected leg (mean 80.74 ± 4.68) in the individuals after stroke compared to the healthy subjects (mean 98.00 ± 6.32). This was significantly different from the control group mean for both mGVI, affected and unaffected leg - p < 0.001. The GVI for the affected leg and unaffected leg as well as the mGVI were significantly correlated with all clinical measures of functional mobility (0.7≤R|<0.9, 0.5≤|R|<0.7, p < 0.001). SIGNIFICANCE: The validity of the GVI appears to be confirmed for individuals after stroke at a chronic stage of recovery. The GVI is lower in individuals after stroke compared to healthy controls. The GVI showed moderate to strong correlations with validated clinical measures of functional mobility. Application of the GVI in the clinical practice will significantly facilitate assessment of gait in individuals after stroke, in comparison to the necessity to interpret a large number of data from 3-dimensional gait analysis. CLINICAL TRIAL REGISTRATION: Data are parts of the following clinical trial: ACTRN12617000436370 (anzctr.org.au).

The use of the Gait Variability Index for the evaluation of individuals after a stroke.

PURPOSE: The Gait Variability Index (GVI) summarizes overall gait quality, taking into account spatiotemporal parameters from a 3-dimensional gait analysis. However, there are no studies evaluating changes in gait patterns after stroke, based on the GVI. The study was designed to assess usefulness of the GVI for evaluation of gait pathology in subjects with stroke, compared to healthy individuals. METHODS: Spatiotemporal gait parameters were examined in a group of 50 subjects at a chronic stage post-stroke and in 50 healthy controls. The GVI was calculated based on the 9 spatiotemporal data. RESULTS: The findings show statistically significant differences between the values of the GVI for paretic and non-paretic limbs ( p < 0.001). Higher values of the index were identified in the case of non-paretic limb: 80.74 vs. 76.32. The GVI scores were decreased for both paretic and non-paretic limbs, compared to the controls - p < 0.001. CONCLUSIONS: The GDI score seems to be a viable tool for quantifying changes in gait pattern during evaluation of subjects with chronic post-stroke hemiparesis. Further studies should be conducted to validate the use of GVI in the post-stroke population.

The paediatric version of Wisconsin gait scale, adaptation for children with hemiplegic cerebral palsy: a prospective observational study.

BACKGROUND: In clinical practice there is a need for a specific scale enabling detailed and multifactorial assessment of gait in children with spastic hemiplegic cerebral palsy. The practical value of the present study is linked with the attempts to find a new, affordable, easy-to-use tool for gait assessment in children with spastic hemiplegic cerebral palsy. The objective of the study is to evaluate the Wisconsin Gait Scale (WGS) in terms of its inter- and intra-rater reliability in observational assessment of walking in children with hemiplegic cerebral palsy. METHODS: The study was conducted in a group of 34 patients with hemiplegic cerebral palsy. At the first stage, the original version of the ordinal WGS was used. The WGS, consisting of four subscales, evaluates fourteen gait parameters which can be observed during consecutive gait phases. At the second stage, a modification was introduced in the kinematics description of the knee and weight shift, in relation to the original scale. The same video recordings were rescored using the new, paediatric version of the WGS. Three independent examiners performed the assessment twice. Inter and intra-observer reliability of the modified WGS were determined. RESULTS: The findings show very high inter- and intra-observer reliability of the modified WGS. This was reflected by a lack of systematically oriented differences between the repeated measurements, very high value of Spearman's rank correlation coefficient 0.9 ≤ |R| < 1, very high value of ICC > 0.9, and low value of CV < 2.5% for the specific physical therapists. CONCLUSIONS: The new, ordinal, paediatric version of WGS, proposed by the authors, seems to be useful as an additional tool that can be used in qualitative observational gait assessment of children with spastic hemiplegic cerebral palsy. Practical dimension of the study lies in the fact that it proposes a simple, easy-to-use tool for a global gait assessment in children with spastic hemiplegic cerebral palsy. However, further research is needed to validate the modified WGS by comparing it to other observational scales and objective 3-dimensional spatiotemporal and kinematic gait parameters. TRIAL REGISTRATION: anzctr.org.au , ID: ACTRN12617000436370 . Registered 24 March 2017.

Assessment of Foot Shape in Children and Adolescents with Intellectual Disability: A Pilot Study.

BACKGROUND Available publications provide little evidence pertaining to assessment of foot shape in children with intellectual disability. The aim of this study was to assess the parameters of foot shape in children and adolescents with intellectual disability and to evaluate the relationship between the degree of disability and these parameters. MATERIAL AND METHODS The study involved 90 individuals aged 7-15 years, including 45 subjects with mild and moderate levels of intellectual disability (study group) and 45 peers with normal intellectual development (control group). Each participant was subjected to photogrammetric assessment of foot shape based on the projection moire effect. RESULTS Analysis of the relationship between the disability level and the assessed parameters showed that the length of the right (p=0.006) and left (p=0.004) foot, as well as Wejsflog's rate for the right (p<0.001) and left (p<0.001) foot, were significantly higher among children with mild disability, whereas GAMMA angle of the right (p=0.028) and left (p=0.006) foot was significantly higher among children with moderate disability. CONCLUSIONS The findings show a significant relationship between the degree of disability and the assessed foot parameters. Significant differences between the subjects with intellectual disability and the control group were identified in the basic parameters defining foot structure.

Evaluation of Selected Gait Parameters in Patients Prior to and at 6 Months Following Early Anterior Cruciate Ligament Reconstruction.

[b]Background. [/b]ACL rupture and reconstruction may lead to impairment of spatiotemporal and kinematic gait parameters. The purpose of this study was to evaluate patient's gait following a complete tear of the ACL and its endoscopic reconstruction.[b]Material and methods.[/b] 3D gait analysis was performed using the BTS Smart optoelectronic system (6 IR cameras, 120 Hz). The study group included 40 patients with complete unilateral ACL rupture and 37 healthy matched subjects. In the study group gait analysis was performed twice, within one to two weeks prior to the ACL reconstruction and the follow-up study six months after surgery. In the control group single gait analysis was performed.[b]Results. [/b]Six months after the ACL reconstruction the duration of the stance phase for the non-operated limb (p&amp;amp;lt;0,0000) and the initial double stance phase for the operated limb (p&amp;amp;lt;0,0000) were reduced. A statistically significant increase in the step length for both lower limbs was observed. Additionally patients gait cadence (p=0,0003) and mean gait speed (p=0,0006) have also increased. Nevertheless, in the second study, these parameters were still significantly different comparing to the control group. Analysing the kinematic parameters of patients" gait after surgery it was demonstrated, that the hip and knee joints range of motion in both limbs has increased in a statistically significant way. The range of motion of the ankle joint of the operated limb has also improved.[b]Conclusions.[/b] 1. Within six months after the ACL reconstruction there was significant improvement and normalization of the patient's gait pattern, though we may still observe significant differences when compared to the control group, which indicates the need for further rehabilitation focused on the re-education of patients gait pattern. 2. Results of our study indicates a need of long-term observation in the group of patients after ACL reconstruction to determine, whether the gait pattern impairment demonstrate further tendency to improve in time.

Dynamics of the increase in strength and girth of quadriceps muscle after the reconstruction of anterior cruciate ligament.

BACKGROUND: Reconstruction is the method of choice in the treatment of ACL rupture. Postoperative rehabilitation is a very important aspect of therapeutic management. One of priority elements is to regain proper strength and function of the quadriceps muscle in a short time. The aim of this study was to estimate the dynamics of the increase in strength and girth of quadriceps after ACL reconstruction. MATERIAL AND METHODS: The examined group consisted of 30 patients who had undergone arthroscopic assisted quadruple bundle dual channel ACL reconstruction surgery in years 2010-2011. The average age of the patients at the time of operation was 31.7 years (range 17-53). Each patient was examined 4 times: before the surgery as well as in the second, sixth and twelfth week after the reconstruction. RESULTS: Examination revealed a significant increase in quadriceps girth, with peak increase rate observed within the two first weeks after the surgery. Between weeks 2 and 6, a decrease in quadriceps girth was observed followed by repeated increase worm week 6 on. The greatest increase in the girth at the thickest point of the muscle was observed in rehabilitation weeks 6 through 12. A significant decrease in muscle strength was observed in the first 2 weeks after the surgery. In the remaining periods, the strength of the quadriceps muscle continued to grow. The average KSS score increased from 109.1 at week 2 to 162.3 at week 12 after the surgery. CONCLUSIONS: Rehabilitation results in a dynamic increase in the strength of quadriceps between weeks 6 and 12 following reconstruction of anterior cruciate ligament. However, the 12-week rehabilitation period is not sufficient to regain full functionality.