Inertial-Sensor-Based Monitoring of Sample Entropy and Peak Frequency Changes in Treadmill Walking during Recovery after Total Knee Arthroplasty.

This study aimed to investigate whether sample entropy (SEn) and peak frequency values observed in treadmill walking could provide physical therapists valuable insights into gait rehabilitation following total knee arthroplasty (TKA). It was recognized that identifying movement strategies that during rehabilitation are initially adaptive but later start to hamper full recovery is critical to meet the clinical goals and minimize the risk of contralateral TKA. Eleven TKA patients were asked to perform clinical walking tests and a treadmill walking task at four different points in time (pre-TKA, 3, 6, and 12 months post-TKA). Eleven healthy peers served as the reference group. The movements of the legs were digitized with inertial sensors and SEn and peak frequency of the recorded rotational velocity-time functions were analyzed in the sagittal plane. SEn displayed a systematic increase during recovery in TKA patients (p < 0.001). Furthermore, lower peak frequency (p = 0.01) and sample entropy (p = 0.028) were found during recovery for the TKA leg. Movement strategies that initially are adaptive, and later hamper recovery, tend to diminish after 12 months post-TKA. It is concluded that inertial-sensor-based SEn and peak frequency analyses of treadmill walking enrich the assessment of movement rehabilitation after TKA.

The effectiveness of the use of a digital activity coaching system in addition to a two-week home-based exercise program in patients after total knee arthroplasty: study protocol for a randomized controlled trial.

BACKGROUND: There is consistent evidence that supervised programs are not superior to home-based programs after total knee arthroplasty (TKA), especially in patients without complications. Home-based exercise programs are effective, but we hypothesize that their effectiveness can be improved by increasing the adherence to physical therapy advice to reach an adequate exercise level during the program and thereafter. Our hypothesis is that an activity coaching system (accelerometer-based activity sensor), alongside a home-based exercise program, will increase adherence to exercises and the activity level, thereby improving physical functioning and recovery. The objective of this study is to determine the effectiveness of an activity coaching system in addition to a home-based exercise program after a TKA compared to only the home-based exercise program with physical functioning as outcome. METHODS: This study is a single-blind randomized controlled trial. Both the intervention (n = 55) and the control group (n = 55) receive a two-week home-based exercise program, and the intervention group receives an additional activity coaching system. This is a hand-held electronic device together with an app on a smartphone providing information and advice on exercise behavior during the day. The primary outcome is physical functioning, measured with the Timed Up and Go test (TUG) after two weeks, six weeks and three months. Secondary outcomes are 1) adherence to the activity level (activity diary); 2) physical functioning, measured with the 2-Minute Walk Test (2MWT) and the Knee Osteoarthritis Outcome Score; 3) quality of life (SF-36); 4) healthcare use up to one year postoperatively and 5) cost-effectiveness. Data are collected preoperatively, three days, two and six weeks, three months and one year postoperatively. DISCUSSION: The strengths of the study are the use of both performance-based tests and self-reported questionnaires and the personalized tailored program after TKA given by specialized physical therapists. Its weakness is the lack of blinding of the participants to treatment allocation. Outcomes are generalizable to uncomplicated patients as defined in the inclusion criteria. TRIAL REGISTRATION: The trial is registered in the Dutch Trial Register ( www.trialregister.nl , NTR 5109) (March 22, 2015).

Are There Prognostic Factors for One-Year Outcome After Total Knee Arthroplasty? A Systematic Review.

BACKGROUND: Preoperative factors predicting outcome for pain, physical function and quality of life after total knee arthroplasty (TKA) have not been clearly identified. METHODS: Embase and MEDLINE were searched for relevant studies. A study was considered for inclusion if the study aimed to identify preoperative prognostic factors for pain, physical function, and/or quality of life after a follow-up period of at least 1 year; included at least 200 adults suffering from osteoarthritis and undergoing TKA; and analyzed data using multivariable modeling. The quality of the evidence per prognostic factor was determined using the Grading of Recommendations, Assessment, Development and Evaluation framework for prognosis studies. RESULTS: A total of 18 studies were included. There is very low-quality evidence that preoperative more pain, presence of social support, absence of anxiety, and presence of more radiographic damage are prognostic factors for lower pain levels after TKA. There is very low-quality evidence that low preoperative physical function, less comorbidity, absence of anxiety, presence of social support, higher income, normal body mass index, and more radiographic damage are prognostic factors for better physical function. There is very low-quality evidence that female sex and less comorbidity are prognostic factors for better quality of life. CONCLUSION: Only very low-quality evidence was found for a number of prognostic factors of long-term outcome after TKA. More studies that seek to generate understanding of the underlying process for the prognosis of outcome in TKA are needed to understand and test prognostic pathways, and it might be more valuable to look at recovery curves rather than at recovery points. Systematic review registration number: CRD42015026814.

Haptic feedback helps bipedal coordination.

The present study investigated whether special haptic or visual feedback would facilitate the coordination of in-phase, cyclical feet movements of different amplitudes. Seventeen healthy participants sat with their feet on sliding panels that were moved externally over the same or different amplitudes. The participants were asked to generate simultaneous knee flexion-extension movements, or to let their feet be dragged, resulting in reference foot displacements of 150 mm and experimental foot displacements of 150, 120, or 90 mm. Four types of feedback were given: (1) special haptic feedback, involving actively following the motions of the sliders manipulated by two confederates, (2) haptic feedback resulting from passive motion, (3) veridical visual feedback, and (4) enhanced visual feedback. Both with respect to amplitude assimilation effects, correlations and standard deviation of relative phase, the results showed that enhanced visual feedback did not facilitate bipedal independence, but haptic feedback with active movement did. Implications of the findings for movement rehabilitation contexts are discussed.

Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus.

AIM: The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction. DESIGN: Clinical practice guideline underpinned by systematic review and expert consensus. DATA SOURCES: A multidisciplinary working group and steering group systematically reviewed the literature and wrote the guideline. MEDLINE and the Cochrane Library were searched for meta-analyses, systematic reviews, randomised controlled trials and prospective cohort studies published between January 1990 and June 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Included literature must have addressed 1 of 9 predetermined clinical topics: (1) preoperative predictors for postoperative outcome, (2) effectiveness of physical therapy, (3) open and closed kinetic chain quadriceps exercises, (4) strength and neuromuscular training, (5) electrostimulation and electromyographic feedback, (6) cryotherapy, (7) measurements of functional performance, (8) return to play and (9) risk for reinjury. SUMMARY: Ninety studies were included as the basis for the evidence statement. Rehabilitation after ACL injury should include a prehabilitation phase and 3 criterion-based postoperative phases: (1) impairment-based, (2) sport-specific training and (3) return to play. A battery of strength and hop tests, quality of movement and psychological tests should be used to guide progression from one rehabilitation stage to the next. Postoperative rehabilitation should continue for 9-12 months. To assess readiness to return to play and the risk for reinjury, a test battery, including strength tests, hop tests and measurement of movement quality, should be used.

Exploratory study of the lateral body sway predictability as frame of reference for gait rehabilitation following a total knee arthroplasty.

AIMS: The aim of the present study was to investigate whether the predictability of fronto-parallel trunk rotations (lateral body sway) could serve as a frame of reference to monitor recovery after total knee arthroplasty (TKA). METHODS: Before surgery, 11 TKA patients were asked to perform a treadmill walking task at three different speeds. In addition, their gait abilities were scored on three standard clinical walking tests. The treadmill walking task was repeated at three different timepoints following surgery, i.e., at 3, 6 and 12 months post-TKA. The movements of the trunk were digitized with an inertial sensor to capture the amplitude and the sample entropy (SEn) of the lateral body sway that were evaluated in separate ANOVAs. RESULTS: Before surgery the TKA group showed larger body sway (P = 0.025) with smaller SEn values (P = 0.038), which both restored to levels of healthy adults in the 12 months following surgery. Systematic correlations between the SEn values and the clinical test scores were found. CONCLUSIONS: The current findings show that movement behavior of the trunk in the fronto-parallel plane was affected by knee osteoarthritis and suggest that the predictability of the lateral body sway may serve as an index of recovery after TKA.

More Predictable and Less Automatized Movements during Walking -not during Repetitive Punching- in Knee Osteoarthritis.

Using the non-affected leg as stable frame of reference for the affected leg in gait assessment in knee osteoarthritis (KO) fails due to compensatory mechanisms. Assessing the cyclical movements of the upper extremities in a frequency-controlled repetitive punching task may provide an alternative frame of reference in gait assessment in patients with KO. Eleven participants with unilateral KO and eleven healthy controls were asked to perform treadmill walking and repetitive punching. The KO group showed more predictable (p = 0.020) and less automatized (p = 0.007) movement behavior than controls during treadmill walking. During repetitive punching, the KO group showed a similar degree of predictability (p = 0.784) but relative more automatized movement behavior (p = 0.013). Thus, the predictability of the movement behavior of the upper extremities during repetitive punching seems unaffected by KO and could provide an alternative frame of reference in gait assessment in patients with KO.

Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline.

Ankle injuries are a huge medical and socioeconomic problem. Many people have a traumatic injury of the ankle, most of which are a result of sports. Total costs of treatment and work absenteeism due to ankle injuries are high. The prevention of recurrences can result in large savings on medical costs. A multidisciplinary clinical practice guideline was developed with the aim to prevent further health impairment of patients with acute lateral ankle ligament injuries by giving recommendations with respect to improved diagnostic and therapeutic opportunities. The recommendations are based on evidence from published scientific research, which was extensively discussed by the guideline committee. This clinical guideline is helpful for healthcare providers who are involved in the management of patients with ankle injuries.

Increased Speed Elicited More Automatized but Less Predictable Control in Cyclical Arm and Leg Movements.

The present study explores variations in the degree of automaticity and predictability of cyclical arm and leg movements. Twenty healthy adults were asked to walk on a treadmill at a lower-than-preferred speed, their preferred speed, and at a higher-than-preferred speed. In a separate, repetitive punching task, the three walking frequencies were used to cue the target pace of the cyclical arm movements. Movements of the arms, legs, and trunk were digitized with inertial sensors. Whereas absolute slope values (|ß|) of the linear fit to the power spectrum of the digitized movements (p < .001, η2 = .676) were systematically smaller in treadmill walking than in repetitive punching, sample entropy measures (p < .001, η2 = .570) were larger reflecting the former task being more automated but also less predictable than the latter task. In both tasks, increased speeds enhanced automatized control (p < .001, η2 = .475) but reduced movement predictability (p = .008, η2 = .225). The latter findings are potentially relevant when evaluating effects of task demand changes in clinical contexts.

Reasons for continuing physiotherapy treatment after a high-intensity physyiotherapy program in patients after total knee arthroplasty: a mixed-methods study.

Background: Patients after total knee arthroplasty treated with a 10-day high-intensity physiotherapy program in a resort were expected to recover fast without need for a longer physiotherapy treatment period.Objective: To explore the expectations and experiences of patients with total knee arthroplasty following the high-intensity physiotherapy program, including the perceived recovery level at discharge, and reasons for (not) adhering to the given advice at discharge (being either continuing with or refraining from further physiotherapy treatment).Design: A mixed-methods approach: semi-structured interviews were held and were then used to develop items and answer categories for a survey.Methods: Fifteen patients participated in semi-structured interviews, which focused on expectations and experiences related to the total knee arthroplasty and physiotherapy program, the perceived recovery level at the moment of discharge, and the reasons for the advice at discharge (continuing with or refraining from physiotherapy treatment) being followed. A deductive thematic analysis of those interviews was used to develop a survey, which was sent to the total cohort of 60 patients. Logistic regression models were estimated to determine which factors were associated with the continuation of physiotherapy treatment and (not) following the advice. Results: Four themes were identified: (1) confidence of independent recovery; (2) experiencing residual complaints; (3) expecting further improvement of physical fitness; and (4) preferring to be supervised by a healthcare professional. These themes were covered by 14 items in the survey. In total, 55 out of 60 patients completed the survey. Out of 36 patients, 23 continued with physiotherapy treatment despite an adequate level of recovery. Five out of 19 patients, who were advised to continue with physiotherapy treatment, decided to refrain. Advice to continue with physiotherapy treatment was followed more often than advice to refrain from physiotherapy treatment (OR 0.09; 95%CI 0.01-0.85). Reasons for continuing with physiotherapy treatment were residual complaints, the expectation that their physical fitness could be improved and preferring to be supervised by a healthcare professional. In contrast, patients who refrained from physiotherapy, despite being advised to continue, were self-confident that they could do exercises by themselves.Conclusions: A substantial proportion of patients continued with physiotherapy treatment because they expected that a higher level of recovery could be reached. The level of self-confidence to recover on their own seemed to be an important factor in deciding to continue with or refrain from physiotherapy treatment. It would be helpful to focus on self-management skills during the high-intensity physiotherapy program following total knee arthroplasty.

Solution space: Monitoring the dynamics of motor rehabilitation.

This article presents and discusses a perspective on the concept of "solution space" in physiotherapy. The model is illustrated with a subjective assessment of the way movements are performed and an objective quantification of the dynamics of the recovery process for a patient with a knee injury. Based on insights from the domain of human motor control, solution space is a key concept in our recovery model that explains the emergence of a variety of adaptive changes that may occur in the movement system recovering from an injury. The three dimensions that span the solution space are: (1) information and control processes; (2) time; and (3) degrees of freedom. Each dimension is discussed within the context of feasible physiotherapeutic assessments to identify and facilitate desirable behavioral patterns or bypass emerging but undesirable behavioral patterns that could impede both short- and long-term recovery. Central to this article is our view on the relationship between the recovery process and the three dimensions of the solution space, which determines the model's usefulness as a motor-rehabilitation monitoring tool.