Axial Spondyloarthritis: Overcoming the Barriers to Early Diagnosis-an Early Inflammatory Back Pain Service.

PURPOSE OF REVIEW: To discuss the challenges to early diagnosis of axial spondyloarthritis (axSpA) and present the impact an early inflammatory back pain service (EIBPS) had on diagnostic delay in the UK. RECENT FINDINGS: Diagnostic delay in axSpA varies greatly worldwide, and has continued in the UK at an average of 8.5 years. Education, public awareness, and accessibility to inflammatory back pain (IBP) pathways are some of the key barriers to achieving a prompt diagnosis. A recent national inquiry has highlighted insufficiencies in the availability of specialist axSpA services and limited provision of education and training to first contact practitioners and allied healthcare providers. We demonstrate diagnostic delay in axSpA can be successfully reduced to 3 years when an early inflammatory back pain service is embedded within a rheumatology department alongside a local educational and awareness campaign. Sharing these experiences and outcomes will enable other departments to engage in best practice and achieve similar results, facilitating a timely and accurate diagnosis.

Knee extensors kinetic chain training in anterior cruciate ligament deficiency.

Open kinetic chain (OKC) knee extensor resistance training has lost favour in rehabilitation of patients with knee ACLD due to concerns that this exercise is harmful to the remaining portion of the ACL and its secondary stabilizers, and will be less effective in improving function. In this randomized, single-blind clinical trial, closed and OKC knee extensor training were compared for their effects on knee laxity and function in patients with ACLD knees. Sixty-four patients with a diagnosis of knee ACLD (49 M, 15 F; mean age=30 years) were measured for knee laxity, using a ligament arthrometer, and function with the Hughston Clinic knee self-assessment questionnaire and maximal effort single leg jump testing. Between the above tests and identical tests carried out 6 weeks later, subjects trained using either open or closed kinetic chain resistance of their knee and hip extensors as part of formal physical therapy sessions three times per week for 6 weeks. The groups exhibited no statistically significant differences (p<0.083) in outcome. These results indicate that knee extensor OKC training, as used in this study, can be safely applied to patients with knee ACL deficiency, and shows no superiority to CKC training.

Effects of distally fixated versus nondistally fixated leg extensor resistance training on knee pain in the early period after anterior cruciate ligament reconstruction.

BACKGROUND AND PURPOSE: Nondistally fixated (ie, what is often referred to as "open kinetic chain" [OKC]) knee extensor resistance training appears to have lost favor for some forms of rehabilitation due partly to concerns that this exercise will irritate the extensor mechanism. In this randomized, single-blind clinical trial, nondistally fixated versus distally fixated (ie, often called "closed kinetic chain" [CKC]) leg extensor training were compared for their effects on knee pain. SUBJECTS: Forty-three patients recovering from anterior cruciate ligament (ACL) reconstruction surgery (34 male, 9 female; mean age=29 years, SD=7.9, range=16-54). METHODS: Knee pain was measured at 2 and 6 weeks after ACL reconstruction surgery using visual analog scales in a self-assessment questionnaire and during maximal isometric contractions of the knee extensors. Between test sessions, subjects trained 3 times per week using either OKC or CKC resistance of their knee and hip extensors as part of their physical therapy. RESULTS: No differences in knee pain were found between the treatment groups. DISCUSSION AND CONCLUSION: Open kinetic chain and CKC leg extensor training in the early period after ACL reconstruction surgery do not differ in their immediate effects on anterior knee pain. Based on these findings, further studies are needed using different exercise dosages and patient groups.