Construction of the Mobility to Participation Assessment Scale for Stroke (MPASS) and Testing Its Validity and Reliability in Persons With Stroke in Thailand.

OBJECTIVES: This study was conducted to develop the Mobility to Participation Assessment Scale for Stroke (MPASS) and assess its content validity, internal consistency, inter-rater and intra-rater reliability, and convergent validity in people with stroke living in the community. METHODS: The MPASS was developed using published data on mobility-related activity and participation timing in elderly individuals, and then reviewed by community physical therapists. Content validity was established by reaching a consensus of experienced physical therapists in a focus group. The MPASS was scored for 32 participants with stroke (mean age 61.75±4.92 years) by 3 individual testers. Reliability was examined using the intraclass correlation coefficient (ICC), internal consistency using the Cronbach alpha coefficient (α), and convergent validity using the Pearson correlation coefficient (r) to compare the MPASS to the Modified Rivermead Mobility Index as a referent test of mobility. RESULTS: The MPASS consists of 8 items, and its scoring system provides information on the ability of people with stroke to reach a movement level enabling them to live in society, including interactions with other people and safe living in the community. The inter-rater and intra-rater reliability were excellent (ICC, 0.948; 95% confidence interval [CI], 0.893 to 0.982 and ICC, 0.967; 95% CI, 0.933 to 0.989, respectively). Internal consistency was good (α=0.877). The convergent validity was moderate (r=0.646; p<0.001). CONCLUSIONS: The newly developed MPASS showed acceptable construct validity and high reliability. The MPASS is suitable for use in people with stroke, especially those who have been discharged and live in the community with the ability to initiate sitting.

Construction of the Short-Form Thai-Home Fall Hazard Assessment Tool (Thai-HFHAT-SF) and Testing Its Validity and Reliability in the Elderly.

The Thai-Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to identify the fall risk among the elderly arising from their home environment. However, it is more time consuming for large items. Therefore, this study developed a short-form of Thai-HFHAT (Thai-HFHAT-SF). In phase I, we developed the Thai-HFHAT-SF by performing a confirmatory factor analysis (CFA) of 450 rural elderly people. In phase II, a total of 105 participants; 50 elderly people, 50 caregivers, and 5 village health volunteers (VHV) were recruited to examine the reliability of the Thai-HFHAT-SF. Intra-class correlation coefficient (ICC) was used to analyze the inter-rater and test-retest reliability. Factor analysis selected 28 out of the 69 original Thai-HFHAT items in 4 components: indoor area, garage, outdoor areas, and risky spots/areas including pets. The factor loading was 0.67, 0.60, 0.32, and 0.31 in each component. The fitness index indicated that this model was fit (χ2/df = 1.38, goodness-of-fit Index (GFI) = 0.988, adjusted goodness-of-fit index (AGFI) = 0.970, standardized root mean square residual (SRMR) = 0.030, and root mean square error of approximation (RMSEA) = 0.029). The inter-rater reliability of the Thai-HFHAT-SF was 0.82 (95% CI: 0.71-0.89). The test-retest reliability was 0.77 (95% CI: 0.60-0.87) for the older person group, 0.85 (95% CI: 0.73-0.91) for the caregiver group, and 0.60 (95% CI: 0.29-0.77) for the VHV group. The new 28-item scale focused on home fall hazards and can be conducted in 10-15 min. Thai-HFHAT-SF is suitable for home hazards assessment among elderly in Thailand.

Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA): a systematic review update and individual participant data meta-analysis protocol.

INTRODUCTION: Knee and hip osteoarthritis (OA) is a leading cause of disability worldwide. Therapeutic exercise is a recommended core treatment for people with knee and hip OA, however, the observed effect sizes for reducing pain and improving physical function are small to moderate. This may be due to insufficient targeting of exercise to subgroups of people who are most likely to respond and/or suboptimal content of exercise programmes. This study aims to identify: (1) subgroups of people with knee and hip OA that do/do not respond to therapeutic exercise and to different types of exercise and (2) mediators of the effect of therapeutic exercise for reducing pain and improving physical function. This will enable optimal targeting and refining the content of future exercise interventions. METHODS AND ANALYSIS: Systematic review and individual participant data meta-analyses. A previous comprehensive systematic review will be updated to identify randomised controlled trials that compare the effects of therapeutic exercise for people with knee and hip OA on pain and physical function to a non-exercise control. Lead authors of eligible trials will be invited to share individual participant data. Trial-level and participant-level characteristics (for baseline variables and outcomes) of included studies will be summarised. Meta-analyses will use a two-stage approach, where effect estimates are obtained for each trial and then synthesised using a random effects model (to account for heterogeneity). All analyses will be on an intention-to-treat principle and all summary meta-analysis estimates will be reported as standardised mean differences with 95% CI. ETHICS AND DISSEMINATION: Research ethical or governance approval is exempt as no new data are being collected and no identifiable participant information will be shared. Findings will be disseminated via national and international conferences, publication in peer-reviewed journals and summaries posted on websites accessed by the public and clinicians. PROSPERO REGISTRATION NUMBER: CRD42017054049.

Autologous Fibrin-Base Scaffold for Chondrocytes and Bone Marrow Mesenchymal Stem Cells Implantation: The Development and Comparison to Conventional Fibrin Glue.

Objective: The authors developed the autologous fibrin-base scaffold for chondrocytes and bone marrow mesenchymal stem cells (BM-MSCs) implantation and evaluated cells viability in autologous fibrin-base scaffold comparing to commercial fibrin glue. Material and Method: The chondrocytes and BM-MSCs were seeded into autologous fibrin-base scaffold and commercial fibrin glue. The cell viability and proliferation were evaluated at 1 and 7 days. The histology were evaluated with hematoxylineosin (H&E) staining and cartilaginous matrices formation with Alcian blue, Saffanin-0, Toluidine blue, and Collagen type II staining at 6 weeks. The fixation of the scaffolds was observed. Results: The chondrocytes and BM-MSCs could not survive in commercial fibrin glue. The chondrocytes and BM-MSCs in autologous fibrin-base scaffold could proliferate and synthesize the cartilaginous matrices on Alcian blue, Saffanin-0, Toluidine blue, and Collagen type II staining at 6 weeks. The fixation strength is excellent. Conclusion: The developed autologous fibrin-base scaffold can be used as the scaffold for chondrocytes and BM-MSCs implantation with potential to implant chondrocytes and BM-MSCs arthroscopically.

Autologous bone marrow mesenchymal stem cells implantation for cartilage defects: two cases report.

OBJECTIVE: The authors reported the results of autologous bone marrow mesenchymal stem cells (BM-MSCs) implantation in two patients with large traumatic cartilage defects of the knee. MATERIAL AND METHOD: Two patients with grade 3-4 according to the International Cartilage Repair Society Classification System were performed autologous bone marrow mesenchymal stem cells (BM-MSCs) implantation on December 2007 and January 2008. The bone marrow aspiration was performed in the outpatient visit under local anesthesia and sent to the laboratory for BM-MSCs isolation and expansion. The BM-MSCs were re-implanted into the defects with the three-dimensional collagen scaffold. The patients were clinical evaluated preoperatively and postoperatively with Knee and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee Score (IKDC Score) and arthroscopic examination. The duration of follow-up was 30-31 months. RESULTS: There was no postoperative complication. The clinical evaluation with Knee and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee Score (IKDC Score) showed significant improvement. The arthroscopic assessment showed the good defect fill, stiffness and incorporation to the adjacent cartilage. CONCLUSION: The autologous bone marrow mesenchymal stem cells implantation showed the potential for the treatment of large cartilage defects. The one-stage procedure is the advantage over the conventional autologous chondrocytes implantation. The long-term follow-up with long last hyaline-like cartilage is required.

Autologous chondrocytes implantation with three-dimensional collagen scaffold.

OBJECTIVE: The authors report a patient with large traumatic knee cartilage defects treated with autologous chondrocytes implantation (ACI) in three-dimensional collagen scaffold. MATERIAL AND METHOD: A patient with grade 3-4 according to ICRS (International Cartilage Repair Society) Classification System was performed ACI with three-dimensional collagen scaffold. The two-stage procedure was performed First, the cartilage was arthroscopic harvested. The chondrocytes were isolated in the laboratory. Second, the chondrocytes were re-implanted into the defects using three-dimensional collagen scaffold. The patients were clinically evaluated pre-operatively and post operatively and magnetic resonance imaging. The duration of follow-up was 12 months. RESULTS: There was no post operative complication. The clinical evaluations were excellent. The MRI showed the hyaline-like cartilage tissue formation at the defects. CONCLUSION: The autologous chondrocytes implantation with three-dimensional collagen scaffold showed the excellent outcome. Long-term follow-up is required.

Autologous chondrocytes implantation for traumatic cartilage defects of the knee.

OBJECTIVE: To evaluate the results of autologous chondrocytes implantation in the patients with large traumatic cartilage defects of the knee. MATERIAL AND METHOD: Five patients (six knees) with grade 3-4 according to International Cartilage Repair Society Classification System were performed ACI between May 2006 and April 2007. The two-stage procedure was performed. First, the cartilage was arthroscopic harvested. The chondrocytes were isolated in the laboratory. Second, the chondrocytes were re-implanted into the defects. The patients were clinically evaluated preoperatively and postoperatively with Knee and Osteoarthritis Outcome Score (KOOS), magnetic resonance imaging, and arthroscopic assessment. The mean duration of follow-up was 19.8 +/- 4.6 months. RESULTS: There was no postoperative complication. The clinical evaluation with Knee and Osteoarthritis Outcome Score (KOOS) showed significant improvement. The MRI showed the filling of regenerative cartilage tissue formation at the defects. The arthroscopic assessment showed the good defect fill, stiffness, and incorporation to the adjacent cartilage. CONCLUSION: The autologous chondrocytes implantation showed the potential for the treatment of large cartilage defects. The excellent results allowed patients to return to normal activity level.

No difference between home-based strength training and home-based balance training on pain in patients with knee osteoarthritis: a randomised trial.

QUESTION: Is four weeks of home-based balance training more effective than four weeks of home-based strength training at decreasing pain in patients with knee osteoarthritis? DESIGN: Randomised trial with concealed allocation and assessor blinding. PARTICIPANTS: 48 community volunteers with knee osteoarthritis. INTERVENTION: Two groups undertook home-based exercise programs: one group performed balance training and the other performed strength training. Participants performed 30 repetitions/leg/day, 5 days/week for four weeks. OUTCOME MEASURES: The Knee injury and Osteoarthritis Outcome Score was used to evaluate pain, which was the primary outcome. Secondary outcomes were the other subscales of the Knee injury and Osteoarthritis Outcome Score (other symptoms, function in daily living, function in sport and recreation, knee-related quality of life), strength, and mobility. RESULTS: There was no significant difference between groups for pain (mean difference -3 points out of 100, 95% CI -10 to 5). The only between-group difference in the Knee injury and Osteoarthritis Outcome Score was in knee-related quality of life, where the strength group improved 17 points out of 100 (95% CI 5 to 28) more than the balance group. There was no significant difference between groups for strength. The only between-group difference in mobility was in the time taken to walk downstairs, where the strength group improved by 2 s (95% CI 0 to 3) more than the balance group. CONCLUSION: There was no difference in pain between home-based strength training and home-based balance training in patients with knee osteoarthritis. TRIAL REGISTRATION: NCT 00687726.

The use of debrided human articular cartilage for autologous chondrocyte implantation: maintenance of chondrocyte differentiation and proliferation in type I collagen gels.

UNLABELLED: Autologous chondrocyte implantation (ACI) is the most promising surgical treatment for large full thickness knee joint articular cartilage (AC) defects where cells from healthy non-weight bearing area AC are multiplied in vitro and implanted into such defects. In the routine surgical procedure for symptomatic knee full thickness AC defects, damaged AC surrounding the edge and the base of such defects is usually debrided and discarded. The purpose of this study was to examine if chondrocytes from this 'debrided' AC can proliferate, synthesize a cartilage specific matrix and thus can be used for ACI. METHODS: Biopsies were retrieved from 12 patients (debrided articular cartilage: DAC, aged 35-61) and from two autopsies (normal articular cartilage: NAC, aged 21 and 25). Chondrocytes were isolated, seeded at low density in type I collagen gels and as monolayer cultures for 4 weeks without passage. RESULTS: After 4 weeks cultures in type I collagen gels, cell proliferation from DAC (18.34 +/- 1.95 fold) was similar to cells from NAC (11.24 +/- 1.02 fold). Syntheses of proteoglycan and collagen in DAC were also similar to NAC. Newly synthesized matrices in gel cultures consisted predominantly of type II collagen as shown by immuno-labelling and SDS-PAGE followed by fluorography. Chondrocytes from 'debrided human AC' cultured at low density in type I collagen gels may be used for the ACI procedure as they provide sufficient viable cell numbers for ACI and maintain their chondrocyte phenotype as they synthesize a cartilage-like matrix.

Effects of growth factors on cell proliferation and matrix synthesis of low-density, primary bovine chondrocytes cultured in collagen I gels.

Low cell density cell numbers and dedifferentiation are two major problems of human chondrocyte culture associated with articular cartilage repair. Bovine chondrocytes seeded at low density (3.5 x 10(4) cells/ml of gels) in three-dimensional collagen type I gels do proliferate and maintain their phenotype as shown by cell counts, morphology and matrix synthesis. The combination of three growth factors (3GFs; 10 ng/ml TGF-beta1 + 100 ng/ml IGF-I + 10 ng/ml b-FGF) added to serum-free culture medium in this culture system enhances the mitotic activity of bovine chondrocytes similar to 20% foetal calf serum (FCS). At day 21, cells proliferated by 41 fold in gels-FCS and 37 fold in gels-3GFs. Protein synthesis by gels-3GFs cultures was similar to 20% FCS when cultured for 3 weeks but much less proteoglycan was synthesized. The matrix deposition as observed by light and electron microscopy was quite different. More small diameter branching collagen fibrils and a denser matrix were presented in gels-FCS culture whilst loosely arranged larger diameter collagen fibrils were observed in gels-3GFs.