In vivo measurements of spinal stiffness according to a stepwise increase of axial load.

BACKGROUND: The spine has a complex motor control. Its different stabilization mechanisms through passive, active, and neurological subsystems may result in spinal stiffness. To better understand lumbar spinal motor control, this study aimed to measure the effects of increasing the axial load on spinal stiffness. METHODS: A total of 19 healthy young participants (mean age, 24 ± 2.1 years; 8 males and 11 females) were assessed in an upright standing position. Under different axial loads, the posterior-to-anterior spinal stiffness of the thoracic and lumbar spine was measured. Loads were 0%, 10%, 45%, and 80% of the participant's body weight. RESULTS: Data were normally distributed and showed excellent reliability. A repeated-measures analysis of variance with a Greenhouse-Geisser correction showed an effect of the loading condition on the mean spinal stiffness [F (2.6, 744) = 3.456, p < 0.001]. Vertebrae and loading had no interaction [F (2.6, 741) = 0.656, p = 0.559]. Post hoc tests using Bonferroni correction revealed no changes with 10% loading (p = 1.000), and with every additional step of loading, spinal stiffness decreased: 0% or 10-45% loading (p < 0.001), 0% or 10-80% loading (p < 0.001), and 45-80% (p < 0.001). CONCLUSION: We conclude that a load of ≥ 45% of the participant's body weight can lead to changes in the spinal motor control. An axial load of 10% showed no significant changes. Rehabilitation should include high-axial-load exercise if needed in everyday living.

Influence of body position and axial load on spinal stiffness in healthy young adults.

PURPOSE: This study aimed at investigating the effects of different body positions and axial loads on spinal stiffness to better understand spinal stabilisation mechanisms. METHODS: The posterior-to-anterior lumbar and thoracic spinal stiffness of 100 young healthy adults (mean age 23 years; 50 females) were measured in three test situations: prone, standing and standing while carrying a load equal to 50% of the subject's body weight. Each test situation comprised three trials. RESULTS: Spinal stiffness in all test situations showed good reliability. Repeated measures analysis of covariance showed significantly higher spinal stiffness in standing than in the prone position [F(1/1694) = 433.630, p < 0.001]. However, spinal stiffness was significantly lower when standing while carrying a load of 50% of the body weight than when standing without additional load [F(1/1494) = 754.358, p < 0.001]. CONCLUSION: This study showed that spinal lumbar and thoracic stiffness increases when body position is changed from prone to standing. Additional axial load of 50% of the subject's body weight results in reduced spinal stiffness during standing. These slides can be retrieved under Electronic Supplementary Material.

Effects of three home-based exercise programmes regarding falls, quality of life and exercise-adherence in older adults at risk of falling: protocol for a randomized controlled trial.

BACKGROUND: Fall prevention interventions with home-based exercise programmes are effective to reduce the number and the rate of falls, by reducing risk factors. They improve balance, strength, function, physical activity, but it is known that older adults' exercise adherence declines over time. However, it is unclear which delivery-modalities of the home-based exercise programmes show the best adherence and the largest effect. We created a new home-based exercise programme, the Test-and-Exercise (T&E) programme, based on the concepts of self-efficacy and empowerment. Patients learn to build their own exercise programme with a mobile application, a brochure and cards, as well as with eight coaching sessions by physiotherapists. The main objective of this study is to compare the T&E programme with the Otago Exercise Programme and the recommendation-booklet and exercise-cards of Helsana regarding incidence of falls. Other outcomes are severity of falls, functional capacities, quality of life and exercise-adherence. METHODS: The design of this study is a Swiss multicentre assessor blind randomized controlled trial. A block-randomization, stratified in groups for age and risk of fall categories, will be used to allocate the participants to three groups. The targeted study sample consists of 405 older adults, ≥ 65 years of age, living in the community and evaluated as at "risk of falling". Experimental group will receive the T&E programme (N = 162). Second group will receive the Otago programme (N = 162) and the third group will receive the Helsana programme (N = 81). All interventions last six months. Blinded assessors will assess participants three times: at baseline before the start of the intervention, after six months of intervention and a final assessment after twelve months (six months of follow up). DISCUSSION: Although home-based exercises programmes show positive effects in fall prevention in elderly persons, existing programmes do often not include patients in the decision-making process about exercise selection. In our programme the physiotherapist and the older adult work together to select the exercises; this collaboration helps to increase health literacy, pleasure of exercising, and empowers patients to be more autonomy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02926105 , First Posted: October 6, 2016, Last Update: November 11, 2016: Enrolment of the first participant.

Dynamic Postural Stability and Hearing Preservation after Cochlear Implantation.

OBJECTIVES: (1) To assess dynamic postural stability before and after cochlear implantation using a functional gait assessment (FGA). (2) To evaluate the correlation between loss of residual hearing and changes in dynamic postural stability after cochlear implantation. METHODS: Candidates for first-sided cochlear implantation were prospectively included. The FGAs and pure-tone audiograms were performed before and 4-6 weeks after cochlear implantation. RESULTS: Twenty-three subjects were included. Forty-eight percent (n = 11) showed FGA performance below the age-referenced norm before surgery. One subject had a clinically relevant decrease of the FGA score after cochlear implantation. No significant difference between the mean pre- and postoperative FGA scores was detectable (p = 0.4). Postoperative hearing loss showed no correlation with a change in FGA score after surgery (r = 0.3, p = 0.3, n = 16). CONCLUSION: Single-sided cochlear implantation does not adversely affect dynamic postural stability 5 weeks after surgery. Loss of functional residual hearing is not correlated with a decrease in dynamic postural stability.

Instrumented Measurement of Spinal Stiffness: A Systematic Literature Review of Reliability.

OBJECTIVE: The purpose of this review was to critically appraise the quality of studies evaluating the reliability of spinal stiffness assessment devices. METHODS: An electronic search of the MEDLINE, PubMed, CINAHL, PsycINFO, PEDro, and Embase databases up to September 2016 was performed. Information on participants, measurement protocols, reliability, and accuracy were extracted. Two reviewers independently applied the COnsensus-based Standards for the selection of health Measurement INstruments checklist to assess the methodological quality of the measurement properties reliability and measurement error, which were rated as excellent, good, fair, or poor. The overall score was determined using the worst score counts method. RESULTS: In total, 1,728 studies were identified and 9 studies were included in this review. All included studies showed high reliability, with intraclass correlation coefficient values ranging from 0.65 to 0.99. In the quality assessment, 2 studies were rated as fair and 7 studies as poor, mainly because of sample sizes. CONCLUSION: The studies demonstrated favorable high-reliability values but low methodological quality. In the future, high-quality studies with larger sample sizes are needed.

Step-Down Test Assessment of Postural Stability in Patients With Chronic Ankle Instability.

CONTEXT: The underlying mechanism in 27% of ankle sprains is a fall while navigating stairs. Therefore, the step-down test (SDT) may be useful to investigate dynamic postural stability deficits in individuals with chronic ankle instability (CAI). OBJECTIVE: To investigate the test-retest reliability and validity of the forward and lateral SDT protocol between individuals with CAI and uninjured controls. DESIGN: Test-retest study. SETTING: University hospital. PARTICIPANTS: A total of 46  individuals, 23 with CAI and 23 uninjured controls. MAIN OUTCOME MEASURES: Time to stabilization of the forward and lateral SDT. RESULTS: The absolute reliability (SEM = 0.04-0.12 s; SDD = 0.11-0.33 s) of the SDT protocol was acceptable, whereas the relative reliability (ICC3, k = 0.12-0.63) and discriminant validity (P = .42-.99; AUC = 0.50-0.57) were not. CONCLUSIONS: The SDT appears to not be challenging enough to detect dynamic postural stability differences between individuals with and without CAI. However, the SDT may be capable of measuring change over time based on its good absolute reliability.

Discriminant validity and test re-test reproducibility of a gait assessment in patients with vestibular dysfunction.

BACKGROUND: Gait function may be impaired in patients with vestibular disorders, making gait assessment in the clinical setting relevant for this patient population. The purpose of this study was to evaluate the discriminant validity of a gait assessment protocol between patients with vestibular disorders and healthy participants. Furthermore, test re-test reproducibility and the measurement error of gait performance measures in patients with vestibular lesions was performed under different walking conditions. METHODS: Gait parameters of thirty-five patients with vestibular disorders and twenty-seven healthy controls were assessed twice with the GAITRite® system. Discriminant validity, reproducibility (intra class correlation [ICC]) and the measurement error (standard error of measurement [SEM], smallest detectable change [SDC]) were determined for gait speed, cadence and step length. Bland-Altman plots were made to assess systematic bias between tests. RESULTS: A significant effect of grouping on gait performance indicates discriminant validity of gait assessment. All tests revealed differences between patients and healthy controls (p < 0.01). The ICCs for test re-test reproducibility were excellent (0.70-0.96) and measurement error showed acceptable SDC values for gait parameters derived from three walking conditions (9-19 %). Bland-Altman plots indicated no systematic bias. CONCLUSIONS: Good validity and reproducibility of GAITRite® system measurements suggest that this system could facilitate the study of gait in patients with vestibular disorders in clinical settings. The SDC values for gait are generally small enough to detect changes after a rehabilitation program for patients with vestibular disorders.

Identifying fallers and nonfallers with the maximal base of support width (BSW): a one-year prospective study.

The purpose of this prospective cohort study was to determine whether the maximal width of the base of support (BSW) measure is able to predict the risk of multiple falls in community-dwelling women. Thirty-eight community-dwelling women (mean age of 72 ± 8 years old) participated. Falls were prospectively recorded during the following year. Overall, 29 falls were recorded; six (16%) women were multiple fallers and 32 (84%) were nonfallers. There was a significant difference in the BSW between the fallers and nonfallers (F[1, 37] = 5.134 [p = .030]). A logistic regression analysis indicated a significant contribution of the BSW test to the model (odds ratio = 0.637; 95% CI [0.407, 0.993]; p = .046 per 1 cm).The cut-off score was determined to be 27.8 cm (67% sensitivity and 84% specificity). These results indicate that women with a smaller BSW at baseline had a significantly higher risk of sustaining a fall.

Prognostic factors for recurrences in neck pain patients up to 1 year after chiropractic care.

OBJECTIVE: Information about recurrence and prognostic factors is important for patients and practitioners to set realistic expectations about the chances of full recovery and to reduce patient anxiety and uncertainty. Therefore, the purpose of this study was to assess recurrence and prognostic factors for neck pain in a chiropractic patient population at 1 year from the start of the current episode. METHODS: Within a prospective cohort study, 642 neck pain patients were recruited by chiropractors in Switzerland. After a course of chiropractic therapy, patients were followed up for 1 year regarding recurrence of neck pain. A logistic regression analysis was used to assess prognostic factors for recurrent neck pain. The independent variables age, pain medication usage, sex, work status, duration of complaint, previous episodes of neck pain and trauma onset, numerical rating scale, and Bournemouth questionnaire for neck pain were analyzed. Prognostic factors that have been identified in previous studies to influence recovery of neck pain are psychologic distress, poor general health at baseline, and a previous history of pain elsewhere. RESULTS: Five hundred forty five patients (341 females), with a mean age of 42.1 years (SD, 13.1) completed the 1-year follow-up period. Fifty-four participants (11%) were identified as "recurrent." Prognostic factors associated with recurrent neck pain were previous episodes of neck pain and increasing age. CONCLUSION: The results of this study suggest that recurrence of neck pain within 1 year after chiropractic intervention in Swiss chiropractic patients presenting from varied onsets is low. This study found preliminary findings that older age and a previous episode of neck may be useful predictors of neck pain recurrence within 1 year.

Exercise- and education-based prehabilitation before total knee arthroplasty: a pilot study.

OBJECTIVE: To determine the feasibility and estimates of effects of a supervised exercise- and education-based prehabilitation programme aiming to improve knee functioning compared with usual care in patients awaiting total knee arthroplasty. DESIGN: A randomized controlled pilot study. SUBJECTS: Patients receiving primary, unilateral total knee arthroplasty. METHODS: Patients randomized to the intervention group participated in a personalized 4-8-week prehabilitation programme before surgery. Feasibility of the intervention and self-reported knee functioning, pain, physical performance and hospital stay were assessed at baseline, immediately preoperatively, 6 and 12 weeks after surgery. RESULTS: Twenty patients (mean age 72.7±5.95 years) were enrolled in this study. The personalized prehabilitation programme was found to be feasible and safe, with an exercise adherence of 90%. Significant medium interaction effects between groups and over time favouring prehabilitation were reported for the sport subscale of the Knee Osteoarthritis Outcome Score (F(3/54) = 2.895, p = 0.043, η² = 0.139) and Tegner Activity Scale (F(2.2/39.1) = 3.20, p = 0.048, η² = 0.151). CONCLUSION: The absence of adverse events and high adherence to the programme, coupled with beneficial changes shown in the intervention group, support the conduct of a full-scale trial investigating the effectiveness of prehabilitation.

Interrater reliability of clinical tests to evaluate scapulothoracic motion.

BACKGROUND: Decreased scapulothoracic motion has been associated with various pathologies of the shoulder. Reliable and simple assessment methods of scapular mobility are, however lacking. The aim of this study was to evaluate the interrater reliability of four clinical tests to assess scapulothoracic motion in patients with a slightly restricted shoulder flexion. METHODS: A total of nineteen patients with a symptomatic slight restriction of shoulder flexion and twenty asymptomatic subjects were evaluated. The investigation consisted of four palpatory tests to assess scapulothoracic motion. A two-level rating scale (positive, negative) was utilised. Interrater reliability was evaluated using kappa coefficients. RESULTS: We found substantial to almost perfect (Kappa = 0.63-0.4) interrater reliability for the four tests. CONCLUSION: Our study demonstrates that the four mobility tests of the shoulder are a reliable and simple instrument to assess patients with a slightly restricted shoulder flexion. Future studies should be conducted to evaluate the validity of these tests and to establish their clinical usefulness.

Typical Cockpit Ergonomics Influence on Cervical Motor Control in Healthy Young Male Adults.

INTRODUCTION: Neck pain and injury are common problems in military high-performance aircraft and helicopter aircrews. A contributing factor may be the reclined sitting position in cockpits. This study aimed to determine the effect of typical cockpit ergonomics on cervical proprioception, assessed by using the cervical joint position error (cJPE).METHODS: A total of 49 healthy male military employees (mean age 19.9 ± 2.2 yr) were examined. Measurements of the cJPE were obtained in the flexion, extension, and rotation directions in an upright and in a 30°-reclined sitting position. Each condition comprised three trials, with an additional 3-kg head load to mimic real world working conditions.RESULTS: A smaller cJPE was noted in the 30°-reclined sitting position (mean cJPE = 3.9 cm) than in the upright sitting position (mean cJPE = 4.6 cm) in the flexion direction. The cJPE decreased significantly in all movement directions across the three trials; for example, in the flexion direction in the 30°-reclined sitting position: Trial 1/2/3 mean cJPE = 5.0/3.8/3.1 cm.CONCLUSION: It seems that a reclined seating position has a positive influence on cJPE. However, the result is weak. In both sitting positions and all three directions, the first tests of the cJPE showed the highest values. Already after one or two further measurement runs, a significantly reduced cJPE was observed. This rapid improvement might indicate that an exercise similar to the cJPE test may improve the pilots' cervical proprioception and possibly reduce the risk of injury or pain.Heggli U, Swanenburg J, Hofstetter L, Häusler M, Schweinhardt P, Bron D. Typical cockpit ergonomics influence on cervical motor control in healthy young male adults. Aerosp Med Hum Perform. 2023; 94(3):107-112.

Lunar and mars gravity induce similar changes in spinal motor control as microgravity.

Introduction: Once more, plans are underway to send humans to the Moon or possibly even to Mars. It is therefore, important to know potential physiological effects of a prolonged stay in space and to minimize possible health risks to astronauts. It has been shown that spinal motor control strategies change during microgravity induced by parabolic flight. The way in which spinal motor control strategies change during partial microgravity, such as that encountered on the Moon and on Mars, is not known. Methods: Spinal motor control measurements were performed during Earth, lunar, Mars, and micro-gravity conditions and two hypergravity conditions of a parabola. Three proxy measures of spinal motor control were recorded: spinal stiffness of lumbar L3 vertebra using the impulse response, muscle activity of lumbar flexors and extensors using surface electromyography, and lumbar curvature using two curvature distance sensors placed at the upper and lower lumbar spine. The participants were six females and six males, with a mean age of 33 years (standard deviation: 7 years). Results: Gravity condition had a statistically significant (Friedmann tests) effect spinal stiffness (p < 0.001); on EMG measures (multifidus (p = 0.047), transversus abdominis (p < 0.001), and psoas (p < 0.001) muscles) and on upper lumbar curvature sensor (p < 0.001). No effect was found on the erector spinae muscle (p = 0.063) or lower curvature sensor (p = 0.170). Post hoc tests revealed a significant increase in stiffness under micro-, lunar-, and Martian gravity conditions (all p's < 0.034). Spinal stiffness decreased under both hypergravity conditions (all p's ≤ 0.012) and decreased during the second hypergravity compared to the first hypergravity condition (p = 0.012). Discussion: Micro-, lunar-, and Martian gravity conditions resulted in similar increases in spinal stiffness, a decrease in transversus abdominis muscle activity, with no change in psoas muscle activity and thus modulation of spinal motor stabilization strategy compared to those observed under Earth's gravity. These findings suggest that the spine is highly sensitive to gravity transitions but that Lunar and Martian gravity are below that required for normal modulation of spinal motor stabilization strategy and thus may be associated with LBP and/or IVD risk without the definition of countermeasures.

Earth-vertical motion perception assessment using an elevator: a feasibility study.

A feasible, inexpensive, rapid, and easy-to-use method to measure vestibular vertical movement perception is needed to assess the sacculus-mediated low-frequency otolith function of dizzy patients. To evaluate the feasibility of reaction time assessment in response to vertical motion induced by an elevator in healthy young individuals. We recorded linear acceleration/deceleration reaction times (LA-RT/LD-RT) of 20 healthy (13 female) subjects (mean age: 22 years ± 1 SD) as a measure of vertical vestibular motion perception. LA-RT/LD-RT were defined as the time elapsed from the start of elevator acceleration or deceleration to the time at which subjects in a sitting position indicated perceiving a change in velocity by pushing a button with their thumb. The light reaction time was measured as a reference. All 20 subjects tolerated the assessment with repeated elevator rides and reported no adverse events. Over all experiments, one upward and four downward rides had to be excluded for technical reasons (2.5%). The fraction of premature button presses varied among the four conditions, possibly related to elevator vibration (upward rides: LA-RT-up 66%, LD-RT-up 0%; downward rides: LA-RT-down 12%, LD-RT-down 4%). Thus LD-RT-up yielded the most robust results. The reaction time to earth-vertical deceleration elicited by an elevator provides a consistent indicator of linear vestibular motion perception in healthy humans. The testing procedure is inexpensive and easy to use. Deceleration on upward rides yielded the most robust measurements.

Feedback on Trunk Movements From an Electronic Game to Improve Postural Balance in People With Nonspecific Low Back Pain: Pilot Randomized Controlled Trial.

BACKGROUND: Postural balance is compromised in people with low back pain, possibly by changes in motor control of the trunk. Augmenting exercising interventions with sensor-based feedback on trunk posture and movements might improve postural balance in people with low back pain. OBJECTIVE: We hypothesized that exercising with feedback on trunk movements reduces sway in anterior-posterior direction during quiet standing in people with low back pain. Secondary outcomes were lumbar spine and hip movement assessed during box lift and waiter bow tasks, as well as participant-reported outcomes. Adherence to the exercising intervention was also examined. METHODS: A randomized controlled trial was conducted with the intervention group receiving unsupervised home exercises with visual feedback using the Valedo Home, an exergame based on 2 inertial measurement units. The control group received no intervention. Outcomes were recorded by blinded staff during 4 visits (T1-T4) at University Hospital Zurich. The intervention group performed 9 sessions of 20 minutes in the 3 weeks between T2 and T3 and were instructed to exercise at their own convenience between T3 and T4. Postural balance was assessed on a force platform. Lumbar spine and hip angles were obtained from 3 inertial measurement units. The assessments included pain intensity, disability, quality of life, and fear of movement questionnaires. RESULTS: A total of 32 participants with nonspecific low back pain completed the first assessment T1, and 27 (84%) participants were randomized at T2 (n=14, 52% control and n=13, 48% intervention). Intention-to-treat analysis revealed no significant difference in change in anterior-posterior sway direction during the intervention period with a specified schedule (T2-T3) between the groups (W=99; P=.36; r=0.07). None of the outcomes showed significant change in accordance with our hypotheses. The intervention group completed a median of 61% (55/90; range 2%-99%) of the exercises in the predefined training program. Adherence was higher in the first intervention period with a specified schedule. CONCLUSIONS: The intervention had no significant effect on postural balance or other outcomes, but the wide range of adherence and a limited sample size challenged the robustness of these conclusions. Future work should increase focus on improving adherence to digital interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT04364243; https://clinicaltrials.gov/ct2/show/NCT04364243. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/26982.

The association of fear of movement and postural sway in people with low back pain.

Background: Fear of movement is thought to interfere with the recovery from low back pain (LBP). To date, the relationship between fear of movement and postural balance has not been adequately elucidated. Recent findings suggest that more specific fears need to be assessed and put in relation to a specific movement task. We propose that the fear to bend the trunk in a certain direction is distinctly related to the amount of postural sway in different directions. Therefore, our aim was to investigate whether fear of movement in general and fear of bending the trunk in a certain plane is related to postural sway. Methods: Data was collected from participants with LBP during two assessments ~3 weeks apart. Postural sway was measured with a force-platform during quiet standing with the eyes closed. Fear of movement was assessed with an abbreviated version of the Tampa Scale of Kinesiophobia (TSK-11) and custom items referring to fear of bending the trunk in the sagittal and the frontal plane. Results: Based on data from 25 participants, fear of bending the trunk in the frontal plane was positively related to displacement in the sagittal and frontal plane and to velocity in the frontal plane (χ 2 = 4.35, p = 0.04; χ 2 = 8.15, p = 0.004; χ 2 = 9.79, p = 0.002). Fear of bending the trunk in the sagittal plane was not associated with any direction specific measure of sway. A positive relation of the TSK-11 with velocity of the frontal plane (χ 2 = 7.14, p = 0.008) was found, but no association with undirected measures of sway. Discussion: Fear of bending the trunk in the frontal plane may be especially relevant to postural sway under the investigated stance conditions. It is possible that fear of bending the trunk in the frontal plane could interfere with balance control at the hip, shifting the weight from side to side to control balance. Conclusion: For the first time the directional relationship of fear of movement and postural sway was studied. Fear of bending the trunk in the frontal plane was positively associated with several measures of postural sway.

Responsiveness of the German version of the Neck Disability Index in chronic neck pain patients: a prospective cohort study with a seven-week follow-up.

BACKGROUND: The need for an efficient and feasible strategy to deal with neck pain has a high priority for many countries. Validated assessment tools like the Neck Disability Index (NDI) to evaluate the functional status of a neck pain patient are urgently needed to treat and to follow-up patients purposefully. A German version (NDI-G) was shown to be valid and reliable, but has so far not been tested for responsiveness. The aim of this study was to evaluate the NDI-G`s responsiveness. METHODS: This was a prospective cohort study with a seven-week follow-up. Fifty chronic neck pain patients filled out NDI-G twice. Additionally, the Patients' Global Impression of Change score (PGIC) was assessed at follow-up. Wilcoxon and Spearman tests were used to assess direction and strength of the association between the change in NDI-G and PGIC. The receiver operating characteristics method and the area under the curve (AUC) were calculated to assess sensitivity and specificity of the NDI-G change over time. RESULTS: The Wilcoxon test showed statistically significant differences for NDI-G at baseline and follow-up in the total sample, the "clinically improved" and "clinically not improved" subgroups as indicated in the PGIC. Spearman test resulted in a moderate correlation between the NDI-G and the PGIC (rS = -0.53, p = 0.01) at follow-up. AUC showed an acceptable discrimination [AUC = 0.78 (95% confidence interval 0.64 - 0.91)] of the NDI-G, with a cutoff score of 1.5, between clinically improved and clinically not improved patients, based on the PGIC. CONCLUSIONS: The NDI-G is responsive to change in chronic neck pain. Together with the results of a previous study on its validity and reliability, the NDI-G can be recommended for research and clinical settings in patients with neck pain in German speaking countries. TRIAL REGISTRATION: NCT02676141. February 8, 2016.

Prehabilitation Improves Knee Functioning Before and Within the First Year After Total Knee Arthroplasty: A Systematic Review With Meta-analysis.

OBJECTIVE: To assess whether prehabilitation influenced knee functioning before and within the first year after total knee arthroplasty (TKA) surgery. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: The authors searched the MEDLINE/PubMED, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, Web of Science, and Scopus databases from their inception until March 2022. STUDY SELECTION CITERIA: The authors included peer-reviewed articles comparing preoperative, short-, mid- or long-term effects of exercise-based physical therapy before primary unilateral TKA with TKA without prehabilitation. DATA SYNTHESIS: We assessed bias using the Cochrane Risk-of-Bias tool (ROB 2.0) and therapeutic validity using the i-CONTENT tool. Standardized mean differences (Hedges' g) and 95% confidence intervals (CIs) were calculated for knee functioning. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Sixteen trials (968 participants) were included; 14 qualified for meta-analysis. Low to very low certainty of evidence favored prehabilitation over no intervention for improving knee functioning before (g = 1.23; 95% CI: 0.49, 1.97) and up to 3 months after TKA (short-term: 1 day to 1 month, g = 0.90; 95% CI: 0.18, 1.61; mid-term: 6 weeks to 3 months, g = 0.45; 95% CI: 0.06, 0.84). There were no significant between-group differences at long-term follow-up (6-12 months, g = 0.07; 95% CI: -0.17, 0.30). CONCLUSION: There was low to very low certainty of evidence that prehabilitation promotes superior knee functioning before and up to 3 months after TKA, compared to TKA alone. The long-term postoperative effects were inconclusive. J Orthop Sports Phys Ther 2022;52(11):709-725 Epub: 20 September 2022. doi:10.2519/jospt.2022.11160.

Exergaming Using Postural Feedback From Wearable Sensors and Exercise Therapy to Improve Postural Balance in People With Nonspecific Low Back Pain: Protocol for a Factorial Pilot Randomized Controlled Trial.

BACKGROUND: Physical exercise is a common treatment for people with low back pain (LBP). Wearable sensors that provide feedback on body movements and posture during exercise may enhance postural balance and motor control in people with LBP. OBJECTIVE: This study aims to investigate whether physical exercising with postural feedback (EPF) improves postural balance, motor control, and patient-reported outcomes in people with LBP. METHODS: The study was an assessor-blinded 2×2 factorial trial. We planned to recruit 80 participants with nonspecific LBP who did not receive treatment for LBP. In addition, we aimed to recruit 40 patients with chronic, nonspecific LBP who were receiving exercise therapy (ET) at the University Hospital Zurich. Both ET patients and participants without treatment were randomized to receive either an additional EPF intervention or no additional intervention. This resulted in four different combinations of interventions: ET+EPF, ET, EPF, and no intervention. The participants underwent outcome assessments at inclusion (T1); 3 weeks later, at randomization (T2); after an intervention period of 3 weeks with a predefined exercise schedule for participants receiving EPF (T3); and after an additional 6 weeks, during which participants assigned to the EPF groups could exercise as much as they wished (T4). Patients receiving ET completed their regularly prescribed therapies during the study period. Balance was assessed during quiet standing on a force platform, and motor control was assessed during a lifting task and a waiter's bow task. Physical activity was recorded using an activity tracker and the participants' mobile phones during the study. The predefined EPF schedule consisted of nine sessions of 20 minutes of exercise with a tablet and inertial measurement unit sensors at home. Participants performed a series of trunk and hip movements and received feedback on their movements in a gamified environment displayed on the tablet. RESULTS: The first participant was recruited in May 2019. Data collection was completed in October 2020, with 3 patients and 32 eligible people without therapy who passed the eligibility check. CONCLUSIONS: Although it will not be possible to investigate differences in patients and people without other therapies, we expect this pilot study to provide insights into the potential of EPF to improve balance in people with LBP and adherence to such interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26982.