Effects of exercise therapy on joint instability in patients with osteoarthritis of the knee: A systematic review.

Objective: Abnormal load stress caused by joint instability has been reported to be one of the factors responsible for the development of osteoarthritis (OA). However, few studies have investigated the efficacy of exercise therapy for patients with knee instability-induced OA, and there are no specific treatment guidelines or effects for this form of OA. Therefore, the purpose of this study was to examine the effect of exercise treatments for joint instability in patients with knee OA by a systematic review. Design: Systematic review. Results: Searches in three databases, PubMed, Cochrane, and the Physiotherapy Evidence Database, yielded 14 articles that were scrutinized, and 6 articles that met the inclusion criteria were selected. Conclusions: Exercise therapy focusing on joint instability, including muscle maintenance and strength training, and specific training targeting knee instability have no additional beneficial effects on knee joint instability. However, because of the benefits of treatment protocols based on patient attributes in exercise treatment focused on joint instability, it is necessary to investigate the effects in more detail in the future.

Altered sagittal plane kinematics and kinetics during sit-to-stand in individuals with knee osteoarthritis: A systematic review and meta-analysis.

Knee osteoarthritis (OA) progression is associated with an increase in peak external knee flexion torque (EKFT) during gait. However, the difference in the peak EKFT between individuals with knee OA and age-matched subjects was unclear. Therefore, to understand the kinematics, kinetics, and electromyogram characteristics in individuals with knee OA, we conducted a systematic review and meta-analysis of sagittal plane-dominant sit-to-stand (STS) motion. PubMed, PEDro, CINAHL, and Cochrane CENTRAL were used. Fourteen articles (knee-OA group: n = 323, mean age = 65.0 years, mean weight = 79.2 kg; control group: n = 224, mean age = 64.4 years, mean weight = 70.4 kg) were included, and the pooled standardized mean differences (SMDs) were calculated using a random-effects model. Meta-analysis showed that individuals with knee OA present significantly lower peak EKFT (pooled SMD: -1.62; 95% confidence interval [CI]: -2.36 to -0.88), significantly large trunk flexion angle (pooled SMD: 1.04; 95% CI: 0.69 to 1.39), and no significantly lower peak external knee adduction torque despite the significantly larger lateral-lean angle to the less affected side (pooled SMD: 1.04; 95% CI: 0.69 to 1.39). The quality of evidence for all outcomes was very low. The descriptive synthesis indicates that STS motion in individuals with knee OA might be an unsuitable motion strategy for knee muscle activity, force utilization from multiple joints to the knee joint, and their influence on knee joint cartilage, despite their lower peak EKFT. This information can help to better understand movement strategies and to optimize treatment approaches for individuals with knee OA.

Adaptive changes in foot placement for split-belt treadmill walking in individuals with stroke.

BACKGROUND: Adaptation to split-belt treadmill walking differs between individual stroke survivors. Many discussions only address spatiotemporal parameters that are related to movement, and the changes in interlimb spatiotemporal parameters as a consequence of adaptation are poorly understood. OBJECTIVES: To investigate symmetry of the center of pressure (CoP) position relative to the center of mass (CoM), and ascertain whether this can be used to identify differences in adaptation of interlimb spatiotemporal parameters among stroke survivors during split-belt walking. METHODS: Twenty-two chronic post-stroke patients and nine elderly controls walked in tied- then split-belt (2:1 ratio of fast:slow) conditions. Spatiotemporal parameters were compared within groups to assess symmetry of the CoM-CoP angle at foot contact. RESULTS: Asymmetry of the CoM-CoP angle was associated with asymmetry of spatiotemporal parameters. Re-establishment of symmetry of CoM-CoP angle was reflected in re-established symmetry of spatiotemporal parameters in post-stroke and control participants. CONCLUSIONS: Post-stroke patients who re-establish symmetry of the COM-COP angle are able to adapt their walking for split-belt perturbation. This suggests that predictively symmetric foot placements on the fast and slow sides are necessary for adaptation in walking. Symmetrical foot placement is achieved by interlimb coordination and may contribute to dynamic stability.

Organization of functional modularity in sitting balance response and gait performance after stroke.

BACKGROUND: Recovery of postural adjustment, especially when seated, is important for performing activities of daily living after stroke. However, conventional clinical measures provide little insight into a common strategy for dynamic sitting balance and gait. We aimed to evaluate functional re-organization of posture and ambulatory performance after stroke. METHODS: The subjects of the study included 5 healthy men and 21 post-stroke patients. The spatiotemporal modular organization of ground reaction forces during a balance task in which the leg on the non-affected side was lifted off the ground while seated was quantified by using complex principal component analysis. FINDINGS: A 3% decrease in the temporal strength of the primary module in post-stroke patients was an independent predictor of gait performance in the hospital setting with high sensitivity and specificity. Tuning of the temporal strength was accompanied by the recovery of sitting and ambulation. INTERPRETATION: Our findings suggest that evaluation of the modular characteristics of ground reaction forces during a sitting balance task allows us to predict recovery and functional adaptation through daily physical rehabilitation.