Intrarater and interrater reliability of digital calipers in assessing Achilles tendon thickness in patients with knee osteoarthritis.

OBJECTIVE: This study aimed to evaluate the intrarater and interrater reliability of measuring Achilles tendon (AT) thickness using a digital caliper in patients with knee osteoarthritis. METHODS: A cross-sectional survey was conducted at the Physiotherapy Department of Rabia Moon Hospital, involving the recruitment of 61 patients with knee osteoarthritis. Measurements were taken in millimeters at a 90-degree angle, approximately 5 cm from the attachment to the calcaneus, precisely where the ankle joint joins the medial malleolus. Two physical therapists conducted two testing sessions, separated by 7 days, to assess both the intrarater and interrater reliability of the digital caliper. During the second session, two raters simultaneously assessed the patients' responses on the digital caliper. The study analyzed reliability indices, including the Intraclass Correlation Coefficient (ICC) and Bland-Altman plot. RESULTS: The study found high intrarater reliability for the digital caliper, with an ICC of 0.96 (95% confidence interval: 0.22, 0.99). For interrater reliability, the ICC was 0.98 (95% CI: 0.96, 0.98) in patients with knee OA. Additionally, both interrater and intrarater agreement for measuring AT thickness with the digital caliper fell within acceptable limits on 95% of occasions, as indicated by the Limits of Agreement values: 0.32 to -0.53 mm for interrater agreement and -0.35 to -0.04 mm for intrarater agreement. CONCLUSIONS: Digital Calipers have been found to provide excellent intrarater and interrater reliability when used to measure AT thickness in patients with knee osteoarthritis (OA).

Determinants of Achilles tendon thickness and their influence on knee function and foot alignment in knee osteoarthritis.

Knee osteoarthritis (OA) significantly impacts the quality of life of individuals globally. However, the interconnections between Achilles tendon thickness, knee symptoms/functions, and foot alignment remain understudied in knee OA patients. This study determines the relationships between Achilles tendon thickness (ATT), knee symptoms/functions, and foot alignment in knee OA patients, considering their interconnected biomechanical nature. In a cross-sectional analysis involving 122 knee OA patients, Knee injury and Osteoarthritis Outcome Score (KOOS) assessed knee function and symptoms. Forefoot, midfoot, and rearfoot alignment were measured using hallux valgus angle, navicular/foot ratio, and rearfoot angle. The navicular/foot ratio represented the ratio of navicular height to total foot length. ATT was measured using a digital calliper. Pearson correlations and stepwise multiple linear regression models were employed to explore relationships and determinants. Out of 122 participants, 88 (72.1%) were females. ATT correlated significantly with ankle range of motion, forefoot alignment, and midfoot alignment. In stepwise multivariable regression, ankle range of motion, navicular/foot ratio, and age were significantly associated with ATT (adjusted R2 = 0.44). Similarly, KOOS-Symptoms scores were linked to the OA severity, navicular/foot ratio, ankle range of motion, gastrocnemius strength, and age (adjusted R2 = 0.22). KOOS-Function scores were significantly associated with knee OA severity, gastrocnemius strength, ankle range of motion, and age (adjusted R2 = 0.19). Midfoot alignment was significantly associated with ATT and knee symptoms in patients with Knee OA. This suggests potential benefits of interventions targeting both Achilles tendon properties and foot alignment for improved knee OA outcomes.

Efficacy of Mulligan joint mobilizations and trunk stabilization exercises versus isometric knee strengthening in the management of knee osteoarthritis: a randomized controlled trial.

BACKGROUND: Knee osteoarthritis (KOA) progression is often influenced by biomechanical factors. Biomechanical interventions, such as Trunk stabilization exercise (TSE) and Mulligan joint mobilization (MWM), may offer relief from KOA symptoms and potentially slow disease progression. However, the comparative efficacy of these therapies remains uncertain. This study aimed to compare the efficacy of TSE, Mulligan joint mobilization, and isometric knee strengthening (KSE) on disability, pain severity, and aerobic exercise capacity in patients with KOA. METHODOLOGY: A randomized controlled trial (RCT) with three intervention groups was conducted between September 2020 to February 2021. The study enrolled adults aged between 40 and 60 years with a confirmed KOA diagnosis recruited from the physical therapy clinic of the Sindh Institute of Physical Medicine and Rehabilitation, Pakistan. Participants were randomly assigned to receive 24 sessions of either TSE, MWM, or KSE. The knee's functionality was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), pain on a visual analogue scale (VAS), and two objective functional tests-the 6-minute walk test (6MWT) and the 11-stair climb test (SCT). These assessments were conducted at baseline, the third week, and the sixth week. Changes in outcome measures were analyzed using a mixed-design ANOVA with Bonferroni post-hoc analysis, with statistical significance set at a p-value < 0.05. RESULT: Of the 60 participants, 22 (36.7%) were females, and 38 (63.3%) were males. Within-group analysis revealed a significant improvement in all outcome measures at the third week (p < 0.05) and sixth week (p < 0.05). Notably, the TSE group exhibited a greater reduction in mean difference (M.D) in VAS scores than the MWM and KSE groups across various measures in the third week. At rest, during stair ascent, and descent, the TSE group showed significant improvements in VAS scores: MWM (-2.05; -1.94; -1.94), TSE (-2.38; -2.5; -2.5), KSE (-1.05; -0.63; -0.63). Additionally, during sub-maximal exercise capacity assessment, the TSE group showed greater improvement (MWM 12.89; TSE 22.68; KSE 7.89), as well as in Knee Injury and Osteoarthritis Outcome Score for activities of daily living (KOOS-ADL) (MWM 20.84; TSE 28.84; KSE 12.68), and KOOS-pain (MWM 24.84; TSE 27.77; KSE 5.77) at the third-week assessment (p < 0.05). The TSE group demonstrated significant improvements (p < 0.05) across various measures in the sixth week. Specifically, improvements were observed in VAS scores at rest (MWM - 4.15; TSE - 4.42; KSE - 3.78), during stair ascent (MWM - 3.89; TSE - 4.88; KSE - 3.56) and descent (MWM - 3.78; TSE - 4.05; KSE - 2.94). Furthermore, significant improvements were noted in the stair climb test (MWM - 7.05; TSE - 7.16; KSE - 4.21), 6-minute walk test (6MWT) (MWM 22.42; TSE 37.6; KSE 13.84), KOOS-pain (MWM 41.47; TSE 49.11; KSE 28.73), and KOOS-ADL (MWM 40.31; TSE 50.57; KSE 26.05). CONCLUSION: In this study in patients with KOA, TSE had greater efficacy compared to MWM and KSE in enhancing functional levels, reducing pain, improving sub-maximal exercise capacity, and performance on the stair climb test. Importantly, mean scores between the groups, particularly in the TSE group, reached the minimally important level, particularly in key areas such as pain, functional levels, sub-maximal exercise capacity, and stair climb performance. Clinicians should consider the significant pain reduction, improved functionality, and enhanced exercise capacity demonstrated by TSE, indicating its potential as a valuable therapeutic choice for individuals with KOA. TRIAL NO: ClinicalTrials.gov = NCT04099017 23/9/2019.

Are antiepileptic drugs effective for the primary and secondary prevention of Seizures after stroke? A Cochrane Review summary with commentary.

BACKGROUND: In post stroke patients, seizures can complicate the recovery process and lead to poor outcomes. It is unclear whether antiepileptic drugs (AEDs) can prevent seizures after a stroke. OBJECTIVE: To summarize the evidence on the effects of AEDs on the primary and secondary prevention of post stroke seizures. METHODS: The authors searched the Cochrane Register of Studies and MEDLINE (last search on 9 March 2021), checked the reference lists of articles retrieved and contacted the corresponding authors of the study where needed. Only randomized controlled trials were included (RCT). There were no language and time limits. RESULTS: Two RCTs with 856 adult participants with a clinical diagnosis of stroke were included. There was moderate-certainty evidence that the AEDs were not effective for primary prevention of post stroke seizures (Relative effect, 95% CI = RR 0.65, 95% CI 0.34 to 1.26). They also did not affect the mortality rate (RR 1.03, 95% CI 0.78 to 1.36). Both studies were at low risk of bias and certainty of the evidence was low to moderate. CONCLUSION: The evidence for routine use of AED for the primary and secondary prophylaxis of post stroke seizures is unclear. There is a need for high-quality trials to address this question using a larger sample size.

The Relationship Between Fear-Avoidance Beliefs, Disability, and Physical Capacity in Patients with Chronic Low Back Pain.

Objective: The objective of this study was to document the multi-dimensional profile of patients referring with chronic low back pain (CLBP) and determine the relationship among fear-avoidance belief and disability and physical capacity in the Pakistani population. Methods: A cross-sectional survey was conducted at the Physiotherapy Department of the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences. Consecutive sampling was used among the population of CLBP, and objective measures were fear-avoidance beliefs (FABQ-total) and Roland Morris questionnaire (RMDQ) and pain. Each participant performed a physical capacity test, which included a 6-minute walk test (6MWT), abdominal muscular endurance (AME), hand grip strength (HGS), and Functional reach test (FRT). Result: Of the 136 participants, 70(51.5%) were males. The mean and SD of the tests performed were: 6MWT (487.97±51.46), AME (9.31±4.68), FRT (35.14±2.79), HGS (33.31±14.55), VAS (5.51±1.27), RMDQ (18.25±2.17), FABQ-total (48.18±5.31). Multivariate regression revealed that symptom duration, FRT, AME, HGS, VAS, RMDQ were all found to be associated with fear-avoidance belief, accounting for 60% (adjusted R2 = 0.60) of variability. Likewise, only 6-MWT, FRT, FABQ-total were the significant predictors of disability (adjusted R2=0.282). Conclusion: It has been demonstrated that sub-maximal exercise capacity, strength, endurance, pain and flexibility are the contributing factors for the change in disability and fear-avoidance beliefs among the individuals with CLBP. The findings of this study could have inference for increasing productivity both at individual and organizational levels by formulating effective strategies to manage CLBP.

Wii Fit for Balance Training in Elderly: A Systematic Review.

Falls due to poor balance are common in elderly people and can cause fractures, head injury, soft tissue trauma; and may even result in death from these complications. Balance training is one of the strategies used to prevent falls among the elderly population. Wii Fit is a new technological approach of balance training in the community dwelling elderly. The primary aim of this systematic review is to study the effectiveness of Wii Fit as a balance-training tool in older adults using various balance and fall risk assessment scales as outcome measures. Using selected keywords in English only, online literature search was conducted from 2009 to 2019. The initial search resulted in 312 articles. After screening, 14 full text articles were included for the final review and qualitative analysis. There is evidence that Wii Fit plus is a useful, cost-effective, user-friendly, less time consuming, home-based approach for reducing the risk of fall and improving the balance and physical performance in older adults. There are few or no adverse events of using Wii Fit. The commonly used outcome measures were 8 foot up and go test, activities-specific balance confidence scale, Berg balance scale, falls efficacy scale, postural sway, times up and go test and static and dynamic balance assessment tool. Key Words: Postural balance, Rehabilitation, Video games, Virtual reality, Evidence-based medicine, Technology.