Effects of small community walking intervention on physical activity, well-being, and social capital among older patients with cardiovascular disease in the maintenance phase: a randomized controlled trial.

[Purpose] Older patients with cardiovascular disease should increase their physical activity and prioritize positive psychological and social approaches in the maintenance phase of their cardiac rehabilitation. This study aimed to clarify the effect of small community walking on physical activity, well-being, and social capital in older patients with cardiovascular disease in the maintenance phase. [Participants and Methods] We conducted a multicenter study in Kumamoto, Japan. We randomly divided 55 patients with cardiovascular disease into two groups: small community walking and walking alone. For three months, a registered cardiac rehabilitation instructor provided walking guidance to both groups using a wearable device. We measured physical activity, social capital, and subjective happiness before and after the intervention. [Results] Results revealed a statistically significant main effect of time on physical activity and social participation. In the subjective happiness scale, there was an association between group and time. [Conclusion] Our results suggest that walking guidance using a wearable device was beneficial in improving overall physical activity, regardless of whether the individual did small community walking or walking alone. Furthermore, small community walking intervention may effectively enhance well-being. The relationship between physical activity and social participation needs to be further investigated.

Derivation of a screening tool for predicting the risk of falls in community-dwelling older adults with knee osteoarthritis.

The aim of this study was to derive a screening tool for predicting the risk of falls in community-dwelling older adults with knee osteoarthritis. This prospective cohort study was conducted in four orthopedic clinics. The main outcome measure was falls or nonfalls for 5 months, and the predictors were sex, age, BMI, Kellgren-Lawrence grade, laterality, number of comorbidities, pharmacotherapy, physical therapy period, use of a cane, household, previous history of falls, visual analog scale for pain, one-leg standing test (OLST), five times sit-to-stand test (FTSST), and Frenchay activities index. Ninety outpatients (74 females and 16 males) with a mean (SD) age of 73.1 (9.3) years completed a 5-month follow-up. According to the binomial logistic regression analysis, previous history of falls [odds ratio (OR), 6.85; P = 0.019], OLST (OR, 5.97; P = 0.048), and FTSST (OR, 12.93; P = 0.034) were identified as risk factors for falls, and the clinical prediction rule was derived from these variables. The pretest probability of fallers in this study was 21.1% (19 of 90 participants). When the total screening tool score was three points (the participant scored one point for each item: previous history of falls, yes; OLST, ≤6.84 s; FTSST, ≥8.77 s), the positive likelihood ratio was 16:19, and the posttest probability increased to 81.3%. Therefore, this simple screening tool possesses potential clinical utility for identifying patients with knee osteoarthritis at high risk of falls in the future because it demonstrated sufficient diagnostic test accuracy.

Self-reported physical activity is related to knee muscle strength on the unaffected side and walking ability in patients with knee osteoarthritis awaiting total knee arthroplasty: a cross-sectional study.

Background: Additional evidence regarding the effectiveness of self-management programs for patients awaiting total knee arthroplasty is required.Objective: The study aimed to determine if self-reported physical activity was related to muscle strength and walking ability in patients with knee osteoarthritis awaiting total knee arthroplasty.Methods: The study included subjects with knee osteoarthritis awaiting total knee arthroplasty (n = 767). Walking ability and bilateral knee muscle strength were measured as dependent variables. Self-report physical activity was assessed based on the guidelines from the Japanese Ministry of Health, Labor and Welfare. Multiple regression models determined if self-reported physical activity was significantly related to dependent variables, after accounting for other related factors.Results: Physical activity was associated with both higher knee flexion (ß = -0.09, p = .013) and higher extension (ß = -0.09, p = .007) muscle strength on the unaffected side only. In addition, physical inactivity was associated with a lower walking ability level (TUG: ß = 0.08, p = .015; 5mWT: ß = 0.10, p = .005).Conclusions: These results can help health-services providers develop educational and/or self-management programs to maintain muscle strength on the unaffected side and walking ability in patients awaiting total knee arthroplasty.

Factors characterizing gait performance of patients before and soon after knee arthroplasty.

[Purpose] For monitoring patients with knee osteoarthritis undergoing knee arthroplasty, the Timed Up and Go and maximum walking speed tests are commonly used. To provide appropriate peri-surgical rehabilitation, we evaluated the factors associated with postsurgical changes in Timed Up and Go and maximum walking speed results. [Participants and Methods] We enrolled 545 knee osteoarthritis patients undergoing either of the following knee arthroplasties: conventional total knee arthroplasty, minimally invasive total knee arthroplasty, and unicompartmental knee arthroplasty. Comfortable Timed Up and Go, maximum Timed Up and Go, and maximum walking speed were measured 2 weeks before and soon after surgery. Factors (gender, age, and surgical mode) that might influence changes in test results were evaluated by multiple regression analysis and a two-factor stratification diagram. [Results] Multiple regression analysis revealed that postsurgical changes in comfortable/maximum Timed Up and Go and maximum walking speed results were associated with age and surgical mode after adjustment for preoperative values. Two-factor diagrams showed that the older the patient, the greater was the slowdown in the Timed Up and Go test performed postoperatively. The levels of slowdown in the postoperative Timed Up and Go and maximum walking speed tests were the smallest in those who underwent conventional total knee arthroplasty, followed by those who underwent minimally invasive and unicompartmental knee arthroplasty. Among patients whose preoperative Timed Up and Go and maximum walking speed were slow, slowdown in Timed Up and Go was pronounced with age, and slowdown in maximum walking speed was higher in conventional total knee arthroplasty. [Conclusion] The changes in Timed Up and Go and maximum walking speed results 2 weeks after knee arthroplasty depended on age and surgical modes. These findings are relevant for the implementation of appropriate peri-surgical rehabilitation.

Determination of reference intervals for knee motor functions specific to patients undergoing knee arthroplasty.

BACKGROUND: In patients with knee osteoarthritis (KOA) undergoing knee arthroplasty (KA), lower-limb motor function tests are commonly measured during peri-surgical rehabilitation. To clarify their sources of variation and determine reference intervals (RIs), a multicenter study was performed in Japan. METHODS: We enrolled 545 KOA patients (127 men; 418 women; mean age 74.2 years) who underwent KA and followed a normal recovery course. The surgical modes included total KA (TKA), minimally invasive TKA (MIS-TKA), and unicompartmental KA (UKA). Motor functions measured twice before and two weeks after surgery included timed up-and-go (TUG), maximum walking speed (MWS), extensor and flexor muscle strength (MS), and knee range of motion (ROM). Multiple regression analysis was performed to evaluate their sources of variation including sex, age, BMI, and surgical mode. Magnitude of between-subgroup differences was expressed as SD ratio (SDR) based on 3-level nested ANOVA. SDR≥0.4 was set as the threshold for requiring RIs specific for each subgroup. RESULTS: Before surgery, age-related changes exceeding the threshold were observed for TUG and MWS. Between-sex difference was noted for extensor and flexor MS, but extension and flexion ROMs were not influenced by sex or age. After surgery, in addition to similar influences of sex and age on test results, surgical modes of UKA and MIS-TKA generally had a favorable influence on MWS, extensor MS, and flexion ROM. All motor function test results showed a variable degree of skewness in distribution, and thus RIs were basically derived by the parametric method after Gaussian transformation of test results. CONCLUSIONS: This is the first study to determine RIs for knee motor functions specific to KOA patients after careful consideration of their sources of variation and distribution shapes. These RIs facilitate objective implementation of peri-surgical rehabilitation and allow detection of patients who deviate from the normal course of recovery.

Cross-Validation of a Screening Tool to Distinguish Between Fallers and Nonfallers in Community-Dwelling Older Adults With Knee Osteoarthritis.

OBJECTIVES: This study aimed to cross-validate a previously developed knee osteoarthritis falls (KOAF) screening tool to distinguish between fallers and nonfallers among community-dwelling older adults with knee osteoarthritis (OA). DESIGN: Cross-sectional survey study. SETTING: Three independent orthopedic clinics. PARTICIPANTS: Older outpatients with knee OA (N=86; 71 women, 15 men; mean age, 75.2±6.2y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The primary outcome was to identify fallers and nonfallers among outpatients with OA based on their history of falls within the past year. We investigated factors including sex, age, body mass index, Kellgren-Lawrence grade, affected side (bilateral or unilateral knee OA), number of comorbidities, pharmacotherapy, physical therapy, pain, and activity as individual predictors of falls. Participants performed the one-leg standing test and the 5 times sit-to-stand test to determine motor function. Sensitivity, specificity, likelihood ratio, and post-test probability of the KOAF screening tool were calculated using receiver operating characteristic (ROC) curve analysis. RESULTS: The results of the one-leg standing test and 5 times sit-to-stand test differed significantly between the 2 groups (P<.05). ROC curve analysis showed that the area under the curve was 0.88 (95% confidence interval, 0.80-0.96; P<.001). The post-test probability of falls was 83.3% (positive likelihood ratio, 11.54) when the total score of KOAF screening tool was 2 points and 2.6% (negative likelihood ratio, 0.06) when the total score of KOAF screening tool was less than 1 point. CONCLUSIONS: Cross-validation results for the KOAF screening tool were better, confirming that the screening tool could distinguish between fallers and nonfallers with high accuracy. Our findings suggest that this simple screening tool could be readily used in clinical practice and could aid in clinical decision-making through providing choices for physical therapy evaluation and recommendations for physical therapy programs.

Do Sociodemographic Factors Relate to Walking Ability in Individuals Who Underwent Total Knee Arthroplasty?

BACKGROUND AND PURPOSE: Knee osteoarthritis is one of the most common health problems in older adults and total knee arthroplasty (TKA) is able to improve walking ability in these individuals. There have been few studies investigating whether sociodemographic factors influence walking ability after TKA. The aim of this study was to examine which sociodemographic factors relate to walking ability in Japanese older adults following TKA during the acute stage of recovery. METHODS: This prospective cohort study included 388 participants, from a multicenter database, who underwent TKA. The Timed Up and Go test 2 weeks after TKA was the dependent variable. Sociodemographic factors including age, sex, body mass index, marital status, and academic qualification were independent variables. In addition, type of surgery and severity of osteoarthritis were measured as confounding variables. A hierarchical multiple regression analysis was used to predict the factors that have the greatest influence on walking ability. Models were examined with and without confounding factors. RESULTS AND DISCUSSION: In the final regression model, older age, conventional TKA approaches, increased severity of Kellgren-Lawrence grade, and women were associated with longer Timed Up and Go time. Academic qualification and marital status were not related to walking ability. CONCLUSIONS: Our results suggest that age, type of surgery, severity of osteoarthritis, and sex are related to Timed Up and Go time during the acute stage following TKA and need to be assessed.

Factors for Assessing the Effectiveness of Early Rehabilitation after Minimally Invasive Total Knee Arthroplasty: A Prospective Cohort Study.

The effectiveness of current rehabilitation programs is supported by high-level evidence from the results of randomized controlled trials, but an increasing number of patients are not discharged from the hospital because of the schedule of the critical path (CP). The present study aimed to determine which factors can be used to assess the effectiveness of early rehabilitation. We enrolled 123 patients with medial knee osteoarthritis (OA) who had undergone unilateral minimally invasive total knee arthroplasty for the first time. The following factors were assessed preoperatively: the maximum isometric muscle strength of the knee extensors and flexors, maximum knee and hip joint angle, pain, 5-m maximum walking speed, sex, age, body mass index, exercise habits, Kellgren-Lawrence grade, femorotibial angle, failure side (bilateral or unilateral knee OA), and functional independence measure. We re-evaluated physical function (i.e., muscle strength, joint angle, and pain) and motor function (5-m maximum walking speed) 14 days postoperatively. Changes in physical function, motor function (5-m maximum walking speed), and number of days to independent walking were used as explanatory variables. The postoperative duration of hospitalization (in days) was used as the dependent variable in multivariate analyses. These analyses were adjusted for sex, age, body mass index, exercise habits, Kellgren-Lawrence grade, femorotibial angle, failure side, and functional independence measure. The duration of hospitalization was significantly affected by the number of days to independent walking (p < 0.001, ß = 0.507) and a change in the 5-m maximum walking speed (p = 0.016, ß = -0.262). Multiple regression analysis showed that the radiographic knee grade (p = 0.029, ß = 0.239) was a significant confounding factor. Independent walking and walking speed recovery were considered to reduce the duration of hospitalization. Therefore, these indices can be used to assess the effectiveness of early rehabilitation.

Factors related to low back pain in patients with hip osteoarthritis.

BACKGROUND: The incidence of low back pain (LBP) is high in patients with hip osteoarthritis (OA). Evidence from previous studies suggests that lumbar alignments and hip range of motion (ROM) are important etiological factors for LBP. However, no studies have investigated which factors that have the greatest influence on LBP. OBJECTIVE: This investigation aimed to collectively examine factors related to LBP in patients with hip OA, including lumbar lordosis angle (LLA), leg length discrepancy (LLD), and hip ROM. METHODS: Thirty-five patients participated in this study. LBP was treated as a dependent variable, whereas hip ROMs were treated as independent variables. Patients' age and body mass index (BMI) were recorded as confounding factors, as were LLA and LLD. A logistic regression model was performed to determine the most accurate set of variables to predict LBP. RESULTS: BMI and ROM of hip flexion on the affected side were identified as significant variables. CONCLUSIONS: Our results suggest that BMI and ROM of hip flexion on the affected side are related to LBP in patients with hip OA and need to be assessed.

Health education programs may be as effective as exercise intervention on improving health-related quality of life among Japanese people over 65 years.

AIM: The current study was aimed to examine the short-term effects of a 3-month health education program on health-related quality of life using the Short-Form 36. METHODS: Twenty-five Japanese older people aged 65 and older in the health education program were compared with two historical control groups (n = 25 each) undertaking group and resistance exercise interventions and matched by age, sex and body mass index. A series of split-design two-way analyses of variance were conducted for data analysis. RESULTS: Significant improvements were observed in general health and vitality subscales of the Short-Form 36 in the educational program group. Multivariate analyses, adjusted for several confounding factors, revealed that the effects of the three programs were comparable. CONCLUSIONS: The findings suggest that a structured 3-month educational program may be as effective as exercise interventions in improving general health and vitality in a community-dwelling Japanese older population.

Self-reported home exercise and younger age predict improved health-related quality of life among community-dwelling elderly participants in a three-month group exercise class.

This study investigated predictors of outcome for a three-month group-exercise program among a community-dwelling Japanese population aged over 65 (n=42). The primary outcome variable was health-related quality of life (HRQOL) using the Short Form 36 (SF-36). Candidate predictors included demographic variables, medical history of chronic diseases, and lifestyle-related factors, including self-reported home exercise at baseline examination. At follow-up, only the vitality domain of the SF-36 was significantly improved. Self-reported home exercise and younger age at baseline were significant predictors of a good outcome in the mental and physical components, respectively, of the SF-36. These results indicate that group exercise may be effective to improve the vitality component of HRQOL for Japanese seniors. However, the effects on the physical components of HRQOL are limited. Home exercise and younger age may influence the effects of group exercise on HRQOL for this population.

Baseline comorbidity associated with the short-term effects of exercise intervention on quality of life in the Japanese older population: an observational study.

UNLABELLED: Tamari K. Baseline comorbidity associated with the short-term effects of exercise intervention on quality of life in the Japanese older population: an observational study. OBJECTIVE: To investigate predictors of responses to a class-based exercise program in terms of health-related quality of life (HRQOL). DESIGN: A 3-month prospective cohort study. SETTING: General community. PARTICIPANTS: A sample of community-dwelling Japanese volunteers (N=137; aged > or =65y) initially was included in the study. More than three fourths (76.6%) completed the follow-up examination. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Eight domains of the Medical Outcomes Study 36-Item Short-Form Health Survey, version 2, were used as main outcome measures. Candidate predictors included demographic variables, medical history of chronic diseases, and results of a set of physical performance tests at the baseline examination. Logistic regression models were used to detect predictors. RESULTS: Bodily pain, vitality, social functioning, and mental health domains improved after the intervention (P<.01 vs baseline). The absence of diabetes mellitus showed an association with a good response in the identified domains, with an adjusted odds ratio (OR) of 2.88 (confidence interval [CI], .90-9.25). More than 20% of participants had negative changes in the physical functioning, physical role, general health, and emotional role domains at follow-up. The presence of osteoarthritis significantly predicted a poor response in these domains, with an adjusted OR of 6.75 (CI, 1.58-28.83). CONCLUSIONS: Three months of class-based exercise is effective in alleviating bodily pain and the mental components of HRQOL; however, the effect of exercise on the physical domains of HRQOL may be limited. The presence of osteoarthritis may moderate the effects of exercise on HRQOL physical components.

Diabetes predicts decreased quality of life among community-dwelling seniors undertaking progressive resistance exercise: an observational study.

QUESTION: What baseline characteristics predict good or poor quality of life among community-dwelling seniors undertaking a three-month progressive resistance exercise program? DESIGN: A prospective cohort observational study. PARTICIPANTS: 63 Japanese men and women over 65 years with mild disability. OUTCOME MEASURES: Health-related quality of life was measured using the Short Form 36. Predictors included age, sex, body mass index, presence of chronic diseases, frequency of exercise, number of falls, and activity limitations measured before undertaking the exercise program. RESULTS: The presence of diabetes negatively predicted a good outcome (OR 0.20, 95% CI 0.05 to 0.88) and positively predicted a poor outcome (OR 4.40, 95% CI 1.21 to 18.86) when adjusted for age, sex and body mass index. The accuracy of the prediction of a good outcome was 1.25 (LR+) and 0.44 (LR-). The accuracy of the prediction of a poor outcome was 7.15 (LR+) and 0.87 (LR-). CONCLUSION: The quality of life improved in a community-dwelling elderly population with mild disability who undertook a three-month group-based progressive resistance exercise program. However, those with diabetes mellitus were more likely to experience decreased quality of life. Therefore, health care providers need to monitor carefully participants with this disease who are undertaking progressive resistance exercise.

Variations in torsion of the lower limb in Japanese and Caucasians with and without knee osteoarthritis.

OBJECTIVE: Associations between torsion of the lower limb and knee osteoarthritis (OA) appear to be inconsistent across populations. We examined whether femoral and tibiofibular torsion differed between people with and without knee OA (main effect), and whether the differences were consistent across Japanese and Australian Caucasian persons, and between women and men (interaction effect). METHODS: Data collection was conducted in Japan and Australia. Subjects with knee OA included 100 Japanese and 102 Australian Caucasians, and healthy subjects included 52 Japanese and 34 Australian Caucasians. Femoral and tibiofibular torsion were measured using reliable clinical techniques. Three-way analysis of variance was conducted to examine the main and interaction effects. RESULTS: While there were no significant differences in femoral and tibiofibular torsion between the subjects with and without knee OA as a whole (main effect), there were significant interactions (p < 0.05). Femoral antetorsion was lower only in the female subjects with knee OA compared with their healthy counterparts (p < 0.05). Tibiofibular torsion was lower only in the Japanese subjects with knee OA compared with their healthy counterparts (p < 0.01). CONCLUSION: There may be ethnic and sex variations in the relationship between torsion of the lower limb and knee OA; and lower tibiofibular torsion can be a characteristic in a Japanese population with the disease. Longitudinal study is warranted to examine relationships between these variables and knee OA in a population-specific manner to determine whether the observed relationships express cause or effect.

Ethnic-, gender-, and age-related differences in femorotibial angle, femoral antetorsion, and tibiofibular torsion: cross-sectional study among healthy Japanese and Australian Caucasians.

The current study was conducted to examine ethnic, gender, and age-related differences in femorotibial angle (FTA), femoral antetorsion and tibiofibular torsion. Healthy Japanese (n = 120) and Australian Caucasian (n = 82) subjects were examined using a series of clinically reliable methods for measuring FTA and torsion of the lower limb. Subjects between 18-29 years of age were categorized as younger, 30-59 years as middle age, and 60 or more as older age. Three-way analysis of variance was utilized for data analysis. The Japanese subjects had significantly greater FTA (more varus) than the Australian subjects (P < 0.001). Femoral antetorsion in the Japanese subjects was significantly smaller in middle and older age groups than younger group (P < 0.05), but did not differ between the age groups in the Australian subjects. Further, tibiofibular torsion in female subjects was significantly greater in younger and middle age groups than the older age group (P < 0.01), but was not different between different age groups in males. The results suggest that healthy Japanese may have more genu varus alignment compared to the corresponding Australian population. Age-related ethnic and gender differences in femoral and tibiofibular torsion are worthy of further study.

A new concept of indexing tibiofibular torsion: a pilot study using dry bones.

A newly developed clinical method of indexing tibial torsion uses the medial surface of the tibia as the proximal reference; however, the selection of a specific landmark on the medial surface has not been justified. Three different surfaces relating to the tibial tuberosity were tested using 24 dry tibial bones to determine which provides the most accurate and reliable landmark for use as the proximal reference. The medial surface of the tibia at the inferior point of the tibial tuberosity was the most reliable proximal reference that yielded the highest level of association between the newly developed clinical method and true tibial torsion (r = 0.77). The new method has the potential to describe the anatomy of the leg and to improve the clinical measurement of tibiofibular torsion.

Validity and reliability of existing and modified clinical methods of measuring femoral and tibiofibular torsion in healthy subjects: use of different reference axes may improve reliability.

Previous studies have evaluated reliability and validity of clinical measurements of femoral and tibiofibular torsion, however, the results are conflicting, warranting an alternative method. The authors developed modified methods of measuring femoral and tibiofibular torsion using different reference axes, and validity and reliability of the modified and existing methods were examined in healthy subjects. Reference values were established using magnetic resonance imaging (MRI) for the validity study. There were significant differences between all clinical methods and corresponding MRI outcomes (P <0.05), whereas Pearson's correlation coefficients between the clinical methods and MRI ranged from 0.67-0.92. For modified methods, intraclass correlation coefficients were 0.89-0.97, whereas those of existing methods were 0.75-0.81. Modified methods were more precise, with standard error of measurements (SEM) of 1.5-2.9 degrees , compared to existing methods (SEM=4.0-5.1 degrees). These results indicate that clinical methods available currently do not accurately measure true torsion of the femur and tibia. Nevertheless, the clinical methods may be useful for screening and descriptive purposes as indices of true torsion, and use of different reference axes could improve their reliability.

Gender and age-related differences in axial alignment of the lower limb among healthy Japanese volunteers: comparative and correlation study.

A cross-sectional study was designed for this investigation using a healthy Japanese population. The objectives of this study were to confirm gender and age-related differences in axial alignment of the lower limb, and to investigate the correlation between femorotibial angle and axial alignment of the lower limb among a healthy Japanese population. Although axial alignment of the lower limb has been defined as one of the associating factors for osteoarthritis of the knee along with varus and valgus deformity, the results in the literature are inconsistent. Since there is gender difference in femorotibial angle, axial alignment of the lower limb should show the difference if it is an associating factor for osteoarthritis of the knee. Few studies have been conducted to investigate gender difference in axial alignment of the lower limb. One hundred and forty four healthy Japanese subjects took part in the study. Reliable clinical methods of measuring femoral torsion, tibiofibular torsion, rotational range of motion of the hip and knee joints, and femorotibial angle were employed utilizing a digital inclinometer. Two way ANOVA and Pearson product-moment correlation analysis were used for statistical analyses. Axial alignment of the lower limb was different between genders (p<0.05). An age-related difference was also shown in hip rotation (p<0.05). Further, the femorotibial angle was significantly correlated with hip and knee joint rotation (p<0.05) in older males and younger females. This study implied that axial alignment of the lower limb may be related to deformity of the knee joint.