Real-life implementation of a G6PD deficiency screening qualitative test into routine vivax malaria diagnostic units in the Brazilian Amazon (SAFEPRIM study).

BACKGROUND: Glucose-6-phosphate dehydrogenase (G6PD) deficiency greatly hinders Plasmodium vivax malaria radical cure and further elimination due to 8-aminoquinolines-associated hemolysis. Although the deleterious health effects of primaquine in G6PD deficient individuals have been known for over 50 years, G6PD testing is not routinely performed before primaquine treatment in most P. vivax endemic areas. METHOD/PRINCIPAL FINDINGS: The qualitative CareStart G6PD screening test was implemented in 12 malaria treatment units (MTUs) in the municipality of Rio Preto da Eva, Western Brazilian Amazon, a malaria endemic area, between February 2019 and early January 2020. Training materials were developed and validated; evaluations were conducted on the effectiveness of training health care professionals (HCPs) to perform the test, the interpretation and reliability of routine testing performed by HCPs, and perceptions of HCPs and patients. Most HCPs were unaware of G6PD deficiency and primaquine-related adverse effects. Most of 110 HCPs trained (86/110, 78%) were able to correctly perform the G6PD test after a single 4-hour training session. The test performed by HCPs during implementation showed 100.0% (4/4) sensitivity and 68.1% (62/91) specificity in identifying G6PD deficient patients as compared to a point-of-care quantitative test (Standard G6PD). CONCLUSIONS/SIGNIFICANCE: G6PD screening using the qualitative CareStart G6PD test performed by HCPs in MTUs of an endemic area showed high sensitivity and concerning low specificity. The amount of false G6PD deficiency detected led to substantial loss of opportunities for radical cure.

Y-Balance Test Asymmetry and Frontal Plane Knee Projection Angle During Single-leg squat as Predictors of Patellofemoral Pain in Male Military Recruits.

OBJECTIVES: Investigate prospectively whether dynamic balance and frontal plane knee projection angle (FPKPA) are risk factors for the development of patellofemoral pain (PFP) in male military recruits. STUDY DESIGN: Prospective cohort. SETTING: Military training center. PARTICIPANTS: 135 male military recruits were followed prospectively for six weeks and the incidence of PFP was documented. MAIN OUTCOMES: Baseline measures of the Y-Balance test (YBT) and two-dimensional FPKPA during single-leg squatting were recorded. Mann-Whitney U tests and logistic regression analysis were utilized to identify possible variables associated with the development of PFP. RESULTS: A total of 14 male recruits developed PFP during the follow up period. The PFP group had significantly greater asymmetry on the YBT posterolateral direction (mean difference = 3.44 ± 0.57 cm; 95% Confidence Interval [CI] = 2.38-4.51 cm) and greater FPKPA during single-leg squat (mean difference = 5.55°±1.78°; [CI] = 1.81-9.28°) at baseline when compared to controls. Binary logistic regression models revealed that YBT posterolateral asymmetry ≥4.08 cm (Nagelkerke R2 = 0.304; X2 = 21.63; p < 0.001; OR = 5.46; [CI] = 4.47-8.06) and FPKPA ≥ 4.81° (Nagelkerke R2 = 0.249; X2 = 17.46; p < 0.001; OR = 4.65; [CI] = 3.32-9.06) were significantly associated with PFP. CONCLUSIONS: Male military recruits with greater asymmetry on the YBT posterolateral direction and FPKPA were at a greater risk of developing PFP.

Effects of three gait retraining techniques in runners with patellofemoral pain.

OBJECTIVES: Analyze the effects of 3 gait retraining: forefoot landing (FFOOT), 10% step rate increase (SR10%) and forward trunk lean (FTL) on lower limb biomechanics and clinical measurements in patellofemoral pain (PFP) runners. DESIGN: Case series report. SETTINGS: Biomechanical laboratory and treadmill running. PARTICIPANTS: Eighteen recreational PFP runners randomized in 3 groups. MAIN OUTCOME MEASURES: Lower limb kinematics and muscle activation were assessed at baseline and 2-week post-training. Pain intensity and function limitation, measured by AKPS (Anterior Knee Pain Scale) and LEFS (Lower Extremity Functional Scale) assessed at baseline, post-training and 6-month follow-up. Repeated measures analysis of variance was used to compare the effects of gait retraining. RESULTS: FFOOT and FTL increased the AKPS score at post-training(P = .001; P = .008) and 6-month follow-up(P < .001; P < .001). SR10% increased the AKPS score from baseline to 6-month follow-up(P = .006). Pain and LEFS score were improved after gait retraining regardless group. FFOOT presented greater gastrocnemius(P = .037) and rectus femoris pre-activation(P = .006) at post-retraining session. Gait retraining reduced the muscle activity during stance phase and increased during the late-swing regardless group. CONCLUSION: The three techniques presented clinical benefits, improvement of pain symptoms and functional scores, was not accompanied with significant biomechanics differences that could entirely explain this clinical improvement after the intervention.

Relationship of hip and ankle range of motion, trunk muscle endurance with knee valgus and dynamic balance in males.

OBJECTIVES: Investigate the relationship of hip internal rotation (IR) and ankle dorsiflexion (DF) range of motion (ROM), trunk flexor, extensor, and lateral flexor muscle endurance with frontal plane knee projection angle (FPKPA) and Y-balance test (YBT). STUDY DESIGN: Cross-sectional study. SETTING: Armed Force training site. PARTICIPANTS: 121 healthy male militaries with no history of musculoskeletal injury in the last 6 months. MAIN OUTCOMES: FPKPA was evaluated during single-leg squat. YBT was assessed on the anterior, posterolateral and posteromedial directions. Passive hip IR ROM and weight-bearing ankle DF ROM were measured with a digital inclinometer. Trunk muscle endurance was measured as the time the participant could hold the positions. RESULTS: FPKPA was predicted by ankle DF ROM and hip IR ROM (r2 = 0.340; P = 0.009). For YBT anterior, ankle DF ROM was the only predictor (r2 = 0.32; P < 0.001); whereas trunk extensor endurance predicted YBT posterolateral (r2 = 0.273; P < 0.001) and YBT posteromedial (r2 = 0.033; P = 0.045). CONCLUSION: The results suggest that increasing hip stiffness and ankle mobility might help to control dynamic knee alignment. In addition, the dynamic balance could be improved increasing ankle DF ROM and trunk extensor endurance.

Identification of Directed Interactions in Kinematic Data during Running.

The knowledge of motion dynamics during running activity is crucial to enhance the development of rehabilitation techniques and injury prevention programs. Recent studies investigated the interaction between joints, using several analysis techniques, as cross-correlation, sensitivity analysis, among others. However, the direction of the joints pairing is still not understood. This paper proposes a study of the influence direction pattern in healthy runners by using kinematic data together with partial directed coherence, a frequency approach of Granger causality. The analysis was divided into three anatomical planes, sagittal, frontal, and transverse, and using data from ankle, knee, hip, and trunk segments. Results indicate a predominance of proximal to distal influence during running, reflecting a centralized anatomic source of movements. These findings highlight the necessity of managing proximal joints movements, in addition to motor control and core (trunk and hip) strengthening training to lumbar spine, knee, and ankle injuries prevention and rehabilitation.

Lower limb strength and flexibility in athletes with and without patellar tendinopathy.

OBJECTIVES: To compare the hip, knee and ankle torques, as well as knee and ankle flexibility between athletes with patellar tendinopathy and asymptomatic controls. DESIGN: Cross-sectional study. SETTING: Laboratory setting. PARTICIPANTS: Fourteen male volleyball, basketball or handball athletes, divided into 2 groups, patellar tendinopathy group (TG; n = 7) and asymptomatic control group (CG; n = 7). MAIN OUTCOME MEASURES: Hip, knee and ankle isometric torques were measured with a handheld dynamometer. Weight-bearing ankle dorsiflexion, hamstring and quadriceps flexibility were measured with a gravity inclinometer. RESULTS: The TG had 27% lower hip extensor torque when compared to the CG (P = 0.031), with no group differences in knee and ankle torques (P > 0.05). Also, the TG had smaller weight-bearing ankle dorsiflexion (P = 0.038) and hamstring flexibility (P = 0.006) when compared to the CG. Regarding quadriceps flexibility, no group differences were found (P = 0.828). CONCLUSIONS: Strength and flexibility deficits might contribute to a greater overload on the knee extensor mechanism, possibly contributing to the origin/perpetuation of patellar tendinopathy. Interventions aiming at increasing hip extensors strength as well as ankle and knee flexibility might be important for the rehabilitation of athletes with patellar tendinopathy.

Rehabilitation of Patellar Tendinopathy Using Hip Extensor Strengthening and Landing-Strategy Modification: Case Report With 6-Month Follow-up.

Study Design Case report. Background Although eccentric exercises have been a cornerstone of the rehabilitation of athletes with patellar tendinopathy, the effectiveness of this intervention is sometimes less than ideal. Athletes with patellar tendinopathy have been shown to have different jump-landing patterns and lower hip extensor strength compared to asymptomatic athletes. To our knowledge, the effectiveness of an intervention addressing these impairments has not yet been investigated. Case Description The patient was a 21-year-old male volleyball athlete with a 9-month history of patellar tendon pain. Pain was measured with a visual analog scale. Disability was measured with the Victorian Institute of Sport Assessment-patella questionnaire. These assessments were conducted before and after an 8-week intervention, as well as at 6 months after the intervention. Hip and knee kinematics and kinetics during drop vertical jump and isometric strength were also measured before and after the 8-week intervention. The intervention consisted of hip extensor muscle strengthening and jump landing strategy modification training. The patient did not interrupt volleyball practice/competition during rehabilitation. Outcomes After the 8-week intervention and at 6 months postintervention, the athlete was completely asymptomatic during sports participation. This favorable clinical outcome was accompanied by a 50% increase in hip extensor moment, a 21% decrease in knee extensor moment, and a 26% decrease in patellar tendon force during jump landing measured at 8 weeks. Discussion This case report provides an example of how an 8-week intervention of hip muscle strengthening and jump-landing modification decreased pain and disability and improved jump-landing biomechanics in an athlete with patellar tendinopathy. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2015;45(11):899-909. Epub 21 Sep 2015. doi:10.2519/jospt.2015.6242.

Test-retest reliability of three-dimensional kinematics using an electromagnetic tracking system during single-leg squat and stepping maneuver.

The electromagnetic tracking system (ETS) has been used to analyze three-dimensional (3D) lower limb kinematics. The single-leg squat and stepping maneuver are useful tasks to evaluate lower extremity alignment in a clinical setting. The purpose of this study was to evaluate the test-retest reliability of trunk, pelvis, hip, and knee 3D kinematics using an ETS during single-leg squat and stepping maneuver and compare 3D kinematics between tasks. Twenty healthy volunteers (10 males and 10 females) completed two test sessions 3-5 days apart. Three-dimensional kinematics using an ETS was assessed during single-leg squat and stepping maneuver. Overall, intrarater-intrasession reliability (ICCs=0.83-1.00) and intersession reliabilities (ICCs=0.82-0.97) were high during single-leg squat and stepping maneuver. The intrasession minimal detectable change (MDC) ranged from 1.3° for the knee frontal plane range of motion for single-leg squat to 6.2° for the pelvic transverse range of motion for the stepping maneuver. Intersession MDC values ranged from 1.2° for the ipsilateral trunk lean for the single-leg squat to 8.3° for hip flexion for the stepping maneuver. Healthy participants exhibited greater anterior pelvic tilt, more hip flexion, and less contralateral pelvis forward excursion (p<0.05) during single-leg squat compared with the stepping maneuver. These findings suggest that the 3D kinematics of the trunk, pelvis, hip, and knee using an ETS is reliable during single-leg squat and the stepping maneuver. Minimal detectable change values were low during the evaluated activities. Intertask comparisons revealed differences in hip and pelvis kinematics.

Trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during a single-leg squat in males and females with and without patellofemoral pain syndrome.

STUDY DESIGN: Controlled laboratory study using a cross-sectional design. OBJECTIVES: To determine whether there are any differences between the sexes in trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during the performance of a single-leg squat in individuals with patellofemoral pain syndrome (PFPS) and control participants. BACKGROUND: Though there is a greater incidence of PFPS in females, PFPS is also quite common in males. Trunk kinematics may affect hip and knee function; however, there is a lack of studies of the influence of the trunk in individuals with PFPS. METHODS: Eighty subjects were distributed into 4 groups: females with PFPS, female controls, males with PFPS, and male controls. Trunk, pelvis, hip, and knee kinematics and gluteal muscle activation were evaluated during a single-leg squat. Hip abduction and external rotation eccentric strength was measured on an isokinetic dynamometer. Group differences were assessed using a 2-way multivariate analysis of variance (sex by PFPS status). RESULTS: Compared to controls, subjects with PFPS had greater ipsilateral trunk lean (mean ± SD, 9.3° ± 5.3° versus 6.7° ± 3.0°; P = .012), contralateral pelvic drop (10.3° ± 4.7° versus 7.4° ± 3.8°; P = .003), hip adduction (14.8° ± 7.8° versus 10.8° ± 5.6°; P<.0001), and knee abduction (9.2° ± 5.0° versus 5.8° ± 3.4°; P<.0001) when performing a single-leg squat. Subjects with PFPS also had 18% less hip abduction and 17% less hip external rotation strength. Compared to female controls, females with PFPS had more hip internal rotation (P<.05) and less muscle activation of the gluteus medius (P = .017) during the single-leg squat. CONCLUSION: Despite many similarities in findings for males and females with PFPS, there may be specific sex differences that warrant consideration in future studies and when clinically evaluating and treating females with PFPS.

Electromyographic preactivation pattern of the gluteus medius during weight-bearing functional tasks in women with and without anterior knee pain.

BACKGROUND: Proximal factors have been proposed to influence the biomechanics of the patellofemoral joint. A delayed or diminished gluteus medius (GM) activation, before the foot contact on the ground during functional activities could lead to excessive femur adduction and internal rotation and be associated with anterior knee pain (AKP). There are few studies on this topic and the results were inconclusive, therefore, it is necessary to investigate the GM preactivation pattern during functional activities. OBJECTIVE: To compare the GM electromyographic (EMG) preactivation pattern during walking, descending stairs and in single leg jump task in women with and without AKP. METHODS: Nine women clinically diagnosed with AKP and ten control subjects with no history of knee injury participated in this study. We evaluated GM EMG linear envelope before the foot contact on the ground during walking and GM onset time and EMG linear envelope during descending stairs as well as in a single leg vertical jump. Mann-Whitney U tests were used to determine the between-group differences in GM EMG preactivation pattern. RESULTS: No between-group differences were observed in GM linear envelope during walking (P=0.41), GM onset time and linear envelope during descending stairs (P=0.17 and P=0.15) and single leg jump (P=0.81 and P=0.33). CONCLUSIONS: Women with AKP did not demonstrated altered GM preactivation pattern during functional weight bearing activities. Our results did not support the hypothesis that poor GM preactivation pattern could be associated with AKP.

Electromyographic preactivation pattern of the gluteus medius during weight-bearing functional tasks in women with and without anterior knee pain / Padrão de pré-ativação eletromiográfica do glúteo médio durante atividades funcionais com descarga de peso em mulheres com e sem dor anterior do joelho

BACKGROUND: Proximal factors have been proposed to influence the biomechanics of the patellofemoral joint. A delayed or diminished gluteus medius (GM) activation, before the foot contact on the ground during functional activities could lead to excessive femur adduction and internal rotation and be associated with anterior knee pain (AKP). There are few studies on this topic and the results were inconclusive, therefore, it is necessary to investigate the GM preactivation pattern during functional activities. OBJECTIVE: To compare the GM electromyographic (EMG) preactivation pattern during walking, descending stairs and in single leg jump task in women with and without AKP. METHODS: Nine women clinically diagnosed with AKP and ten control subjects with no history of knee injury participated in this study. We evaluated GM EMG linear envelope before the foot contact on the ground during walking and GM onset time and EMG linear envelope during descending stairs as well as in a single leg vertical jump. Mann-Whitney U tests were used to determine the between-group differences in GM EMG preactivation pattern. RESULTS: No between-group differences were observed in GM linear envelope during walking (P=0.41), GM onset time and linear envelope during descending stairs (P=0.17 and P=0.15) and single leg jump (P=0.81 and P=0.33). CONCLUSIONS: Women with AKP did not demonstrated altered GM preactivation pattern during functional weight bearing activities. Our results did not support the hypothesis that poor GM preactivation pattern could be associated with AKP.

CONTEXTUALIZAÇÃO: Tem sido proposto que fatores proximais influenciam a biomecânica da articulação fêmoro-patelar. Um atraso ou diminuição da ativação do glúteo médio (GM) antes do contato do pé no solo, durante atividades funcionais, poderia levar a adução e rotação interna excessiva do fêmur e provocar a dor anterior do joelho (DAJ). Existem poucos estudos sobre o assunto, e os resultados não foram conclusivos; assim, há necessidade de estudar a pré-ativação do GM durante atividades funcionais. OBJETIVO: Comparar o padrão de pré-ativação eletromiográfica (EMG) do GM durante a caminhada, descida de degraus e salto unipodal entre mulheres com e sem DAJ. MÉTODOS: Nove mulheres com diagnóstico clínico de DAJ e dez mulheres sem história de lesão no joelho participaram do estudo. Avaliou-se a envoltória linear do sinal EMG do GM antes do contato do pé no solo, durante caminhada; o tempo de ativação do GM e a envoltória linear do sinal EMG durante descida de degraus e salto unipodal. Utilizou-se o teste Mann-Whitney para determinar a diferença intergrupos no padrão de pré-ativação EMG do GM. RESULTADOS: Não se encontrou nenhuma diferença intergrupos na envoltória linear do GM durante caminhada (P=0.41), no tempo de ativação e na envoltória linear, durante descida de degraus (P=0.17 e P=0.15) e salto unipodal (P=0.81 e P=0.33). CONCLUSÕES: Mulheres com DAJ não apresentaram alterações significativas no padrão de pré-ativação do GM durante atividades funcionais. Os presentes resultados não sustentam a hipótese de que o pobre padrão de pré-ativação do GM esteja envolvido na DAJ.