Construct Validity and Responsiveness of Performance-based Tests in Individuals With Knee Osteoarthritis.

OBJECTIVES: To assess the construct validity and responsiveness of 3 performance-based tests in individuals with knee osteoarthritis (KOA). DESIGN: This study has a prospective cohort design. SETTING: Assessments were administered at the Federal University of São Carlos (Brazil) by 3 different raters. PARTICIPANTS: A total of 107 participants with KOA were aged ≥40 years (N=107). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: This study assessed the construct validity and responsiveness of 3 performance-based tests: 40-meter fast-paced walk test (40-m FPWT), 11-step stair climb test (11-step SCT), and 30-second chair stand test (30-s CST). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), sedentary behavior (activPAL), and numeric pain rating scale (NPRS) were used as comparator instruments. Measurements were obtained at baseline and after 6 months. The construct validity and responsiveness were calculated using Spearman correlation coefficient within predefined hypotheses based on a panel comprising 5 experts in the field of outcome measurement in KOA. RESULTS: The three performance-based tests showed excellent (ICC>0.9) reliability (intra and inter); however, only the 40-m FPWT and 11-step SCT were considered valid and responsive because both confirmed >75% of the priori hypotheses. The 30-s CST was not considered valid or responsive because it has not confirmed ≥75% of the priori hypotheses. CONCLUSION: The 3 performance-based tests are reliable for intra and inter assessments. The 40-m FPWT and 11-step SCT are both valid and responsive for measuring physical function in patients with KOA. The 30-s CST was not considered valid or responsive. Therefore, 40-m FPWT and 11-step SCT can detect changes over time and are indicated for functional assessment in clinical practice.

Concurrent Validity and Reliability of Video-Based Approach to Assess Physical Function in Adults With Knee Osteoarthritis.

OBJECTIVES: The aim of this study was to determine the concurrent validity and reliability of the Osteoarthritis Research Society International recommended performance-based tests delivered by video-based in adults with knee osteoarthritis. METHODS: Thirty-two participants (aged 40-70 years; 15 men) undertook assessments of 4 performance-based tests via both video-based (real-time and recorded) and face-to-face approaches, on the same day. Outcome measures were performance-based test and the number of technical issues encountered. The performance-based tests included the 40-Meter Fast-Paced Walk Test (velocity, m/s), the 30-Second Chair Stand Test (number of repetitions), the Stair Climb Test (time, seconds), and the Timed "Up & Go" Test (time, seconds). The Bland-Altman limit of agreement measures, standard error of measurement (SEM), coefficient of variation (CV), minimal detectable changes, and bias (mean difference) were employed to analyze the concurrent validity between video-based and face-to-face approaches of the performance-based tests. Reliability was measured using intraclass correlation coefficients, CV, and SEM. RESULTS: A high degree of concurrent validity for the Timed "Up & Go" Test (bias = -0.22), the 30-Second Chair Stand Test (bias = -0.22), the Stair Climb Test (bias = -0.31), and the 40-Meter Fast-Paced Walk Test (bias = -0.06) was found. SEM and CV values were within the acceptable level for concurrent validity. There was a high degree of reliability demonstrated for all tests analyzed. Intraclass correlation coefficient measures ranged from 0.95 to 1.00 for intrarater reliability, and from 0.95 to 0.99 for interrater reliability. CONCLUSIONS: Video-based assessment of physical performance tests is a valid and reliable tool for measuring physical function among adults with knee osteoarthritis via Microsoft Teams (Microsoft Corp, Redmond, WA, USA). IMPACT: Video-based assessment is a promising public health tool to measure physical function in adults with knee osteoarthritis.

Oxygen uptake efficiency slope in community-dwelling ambulant stroke survivors during walking and stair climbing: a cross-sectional study.

BACKGROUND: Oxygen uptake efficiency slope during submaximal tests has been proposed as a more appropriate measure of aerobic capacity after suffering a stroke, since some individuals cannot tolerate maximal exercise testing. However, it has not yet been investigated whether the oxygen uptake efficiency slope is able to differentiate between healthy individuals and those who have suffered a stroke. OBJECTIVES: To compare the oxygen uptake efficiency slope during walking and stair climbing between stroke survivors and age- and sex-matched healthy controls. METHODS: This is a cross-sectional study in which 18 individuals who had suffered a stroke (stroke survivors) and 18 healthy controls matched for sex and age were included. Oxygen consumption and minute ventilation were collected breath-by-breath during walking (6-min Walk Test) and stair climbing. The oxygen uptake efficiency slope was estimated by the slope of the line obtained through linear regression. RESULTS: The stroke survivors had a lower oxygen uptake efficiency slope during the 6-min Walk Test than the healthy controls (MD 498, 95% CI 122 to 873, p = .01). The between-group difference for the Stair Test was smaller and not statistically significant (MD 349, 95%CI -73 to 772, p = .10). CONCLUSIONS: Stroke survivors had lower oxygen uptake efficiency slope during the performance of the 6-min Walk Test when compared to sex- and age-matched healthy controls. This suggests that stroke survivors have worse cardiopulmonary capacity.

SARC-CalF-assessed risk of sarcopenia and associated factors in cancer patients.

INTRODUCTION: Introduction: sarcopenia is considered a risk factor for cancer patients, as it increases mortality and post-surgical complications, and reduces response to treatment and quality of life. Objective: to identify the risk of sarcopenia by SARC-CalF, as well as the factors associated with this outcome in patients with cancer of the gastrointestinal tract (GIT) and adnexal glands. Methods: this cross-sectional study included patients with cancer of the GIT and adnexal glands, without edema or ascites, of both sexes and aged ≥ 20 years. Conventional anthropometric variables and handgrip strength (HGS) were measured. The risk of sarcopenia was assessed through the SARC-CalF questionnaire, and nutritional status by the Patient-Generated Subjective Global Assessment (PG-SGA). The data analysis was performed using the SPSS® software, 22.0, with a significance of 5 %. Results: seventy patients took part in the study. Of these, 55.7 % were female, 52.9 % were aged over 60 years, and 64.3 % were non-white. PG-SGA identified 50.0 % of patients as well-nourished and 50.0 % as having some degree of malnutrition. The prevalence of risk of sarcopenia was 28.6 %. There were different correlations between the SARC-CalF score and anthropometric variables (p < 0.05) according to life stage (adults and elderly). After a linear regression analysis the measures that most influenced the SARC-CalF score were arm circumference (AC) and adductor pollicis muscle thickness in the dominant hand (DAPMT) for adults, while for the elderly current weight and DAPTM (p < 0.05) were more relevant. Conclusion: SARC-CalF identified 28.6 % of patients at risk for sarcopenia and was associated with body weight and anthropometric variables indicative of muscle reserve in adults and the elderly.

INTRODUCCIÓN: Introducción: se considera la sarcopenia un factor de riesgo, especialmente para los pacientes con cáncer, ya que aumenta la mortalidad y las complicaciones posquirúrgicas, reduciendo la respuesta al tratamiento y la calidad de vida. Objetivo: identificar el riesgo de sarcopenia por el SARC-CalF y los factores asociados en pacientes con cáncer del tracto gastrointestinal (TGI) y las glándulas anexas. Métodos: estudio transversal descriptivo. Se incluyeron pacientes con cáncer del TGI y glándulas anexas, sin edema o ascitis, de ambos sexos y de edad ≥ 20 años. Se midieron las variables antropométricas convencionales y la fuerza de presión manual (FPM). El riesgo de sarcopenia se obtuvo mediante el cuestionario SARC-CalF y el estado nutricional mediante la valoración global subjetiva generada por el propio paciente (VGS-GP). El análisis de los datos se realizó con el software SPSS®, versión 22.0, con una significancia del 5 %. Resultados: Participaron 70 pacientes. De estos, el 55,7 % eran mujeres, el 52,9 % eran mayores de 60 años y el 64,3 % eran de etnia no caucásica (64,3 %). La VGS-GP identificó un 50,0 % de pacientes bien alimentados y un 50,0 % con algún grado de desnutrición. El riesgo de sarcopenia fue del 28,6 %. Hubo diferentes correlaciones entre el puntaje SARC-CalF y las variables antropométricas (p < 0,05) según la etapa de la vida (adultos y ancianos). Después del análisis de regresión lineal, las medidas que más influyeron en el puntaje SARC-CalF fueron la circunferencia muscular del brazo (CMB) y el espesor del músculo aductor del pulgar de la mano dominante (EMAPD) en los adultos, mientras que en los ancianos fueron el peso actual y elEMAPD (p < 0,05). Conclusión: el SARC-CalF identificó al 28,6 % de los pacientes con riesgo de sarcopenia y se asoció con el peso corporal y las variables antropométricas indicativas de reserva muscular en adultos y ancianos.

Gait Activity Classification on Unbalanced Data from Inertial Sensors Using Shallow and Deep Learning.

Activity recognition is one of the most active areas of research in ubiquitous computing. In particular, gait activity recognition is useful to identify various risk factors in people's health that are directly related to their physical activity. One of the issues in activity recognition, and gait in particular, is that often datasets are unbalanced (i.e., the distribution of classes is not uniform), and due to this disparity, the models tend to categorize into the class with more instances. In the present study, two methods for classifying gait activities using accelerometer and gyroscope data from a large-scale public dataset were evaluated and compared. The gait activities in this dataset are: (i) going down an incline, (ii) going up an incline, (iii) walking on level ground, (iv) going down stairs, and (v) going up stairs. The proposed methods are based on conventional (shallow) and deep learning techniques. In addition, data were evaluated from three data treatments: original unbalanced data, sampled data, and augmented data. The latter was based on the generation of synthetic data according to segmented gait data. The best results were obtained with classifiers built with augmented data, with F-measure results of 0.812 (σ = 0.078) for the shallow learning approach, and of 0.927 (σ = 0.033) for the deep learning approach. In addition, the data augmentation strategy proposed to deal with the unbalanced problem resulted in increased classification performance using both techniques.

Immediate effects of a distal gait modification during stair descent in individuals with patellofemoral pain.

Background: Knee pain during stair managing is a common complaint among individuals with PFP and can negatively affect their activities of daily living. Gait modification programs can be used to decrease patellofemoral pain. Immediate effects of a stair descent distal gait modification session that intended to emphasize forefoot landing during stair descent are described in this study. Objectives: To analyze the immediate effects of a distal gait modification session on lower extremity movements and intensity of pain in women with patellofemoral pain during stair descent. Method: Nonrandomized controlled trial. Sixteen women with patellofemoral pain were allocated into two groups: (1) Gait Modification Group (n = 8); and 2) Control Group (n = 8). The intensity of pain (visual analog scale) and kinematics of knee, ankle, and forefoot (multi-segmental foot model) during stair descent were assessed before and after the intervention. Results: After the gait modification session, there was an increase of forefoot eversion and ankle plantarflexion as well as a decrease of knee flexion. An immediate decrease in patellofemoral pain intensity during stair descent was also observed. Conclusion: The distal gait modification session changed the lower extremity kinetic chain strategy of movement, increasing foot and ankle movement contribution and decreasing knee contribution to the task. An immediate decrease in patellofemoral pain intensity during stair descent was also observed. To emphasize forefoot landing may be a useful intervention to immediately relieve pain in patients with patellofemoral pain during stair descent. Clinical studies are needed to verify the gait modification session effects in medium and long terms.

Influence and benefits of foot orthoses on kinematics, kinetics and muscle activation during step descent task.

BACKGROUND: Medial wedged foot orthoses are frequently prescribed to reduce retropatellar stress in patients with patellofemoral pain (PFP) by controlling calcaneal eversion and internal rotation of the tibia. During activities of daily living, the highest patella loads occur during stair descent, but the effect of foot orthoses during stair descent remains unclear. RESEARCH QUESTION: The purpose of this study was to compare the kinematics, kinetics and muscle activation during a step descent task in healthy volunteers using three designs of foot orthoses (insoles). METHODS: Sixteen healthy subjects with a mean age of 25.7 years, BMI of 23.3, and +5 Foot Posture Index were recruited. Subjects performed a step down task from 20 cm using a 5o rearfoot medial wedge (R), a 5o rearfoot and forefoot medial wedge (R/F), and a control flat insole (C). RESULTS: Significant improvements in control were seen in the R and R/F insoles over the C insole in the foot and at the ankle and hip kinematics. The R and R/F insoles increased the knee adduction moments, but reduced knee internal rotation moment compared to the C insole. Abductor hallucis (AH) activity was reduced with both insoles, whereas tibialis anterior (TA) activity was reduced with the R insole only. SIGNIFICANCE: Foot orthoses can change joint mechanics in the foot and lower limbs providing greater stability and less work done by AH and TA muscles. This data supports the use of foot orthoses to provide functional benefits during step descent, which may benefit patients with PFP.

Quadriceps neuromuscular function in women with patellofemoral pain: Influences of the type of the task and the level of pain.

The present study aimed at investigating whether the neuromuscular system behaves differently (in terms of force and muscle activity generation) as a function of the task being performed (i.e. maximal voluntary efforts vs stair negotiation) and the presence of patellofemoral pain (PFP) and possible influences of pain intensity. Thirty-eight women with (n = 19) and without PFP (n = 19) had their knee strength (extension joint torque) measured during maximal voluntary isometric contractions (MVIC) and electromyography (EMG) data recorded during both MVIC and stair ascent tasks, which were performed before and after a loading protocol designed to exacerbate pain symptoms. Women with PFP displayed lower levels of vastus medialis (p = 0.002) and vastus lateralis (p = 0.032) EMG activation during MVIC assessments. Conversely, the PFP group showed higher levels of vastus medialis muscle activity during stair climbing (p = 0.007), which happened exclusively after the loading protocol. Similarly, women with PFP displayed lower knee extensor torque only during the MVIC tests performed after the loading protocol, which was moderately correlated with the increase in self-reported pain (p = 0.041, r = 0.37), whereas the changes in EMG activity during stair ascent were not correlated with changes in pain intensity (p = 0.215, r = 0.12). These results suggest that, in comparison to pain-free controls, women with PFP display lower levels of quadriceps EMG activation during maximal contractions, but higher activation during dynamic tasks (stair ascent). In addition, the moderate association between the decrease in knee extensor torque and increase in self-reported pain indicates that care should be taken by clinicians during quadriceps strength evaluation in women with PFP, as misleading outcomes may emerge if the intensity of knee pain is not considered during screening. Additionally, rehabilitation strategies should focus on both restoring neuromuscular control and increasing muscle strength.

Relationship between knee abduction moment with patellofemoral joint reaction force, stress and self-reported pain during stair descent in women with patellofemoral pain.

BACKGROUND: Increased external knee abduction moment has been proposed as a risk factor for patellofemoral pain. This alteration is thought to be associated with elevated patellofemoral joint reaction force and stress, however these relationships remain poorly explored. Therefore, this study aimed at comparing knee abduction moment parameters (peak, rate of moment development and impulse), patellofemoral joint reaction force and stress of women with patellofemoral pain and pain-free controls during stair descent; and investigating the relationship among these variables with self-reported pain. METHODS: Kinetic data was obtained by inverse-dynamics equations and a previously reported algorithmic model was used to determine patellofemoral joint reaction force and stress. Participants' worst pain in the last month and pain level during stair descent were evaluated using a visual analogue scale. FINDINGS: Women with patellofemoral pain presented higher peak, rate of moment development and impulse of the external knee abduction moment, patellofemoral joint reaction force and stress (p = 0.005 to 0.04, effect size = 0.52 to 0.96) during stair descent than pain-free controls. Only knee abduction moment impulse presented positive moderate correlations with worst pain level in the last month (r = 0.53, p < 000.1), pain level during stair descent (r = 0.33, p = 0.042), patellofemoral joint reaction force (r = 0.65, p < 000.1) and stress (r = 0.58, p < 000.1). INTERPRETATION: These findings indicate that strategies aimed at decreasing external knee abduction moment impulse could reduce the load over the patellofemoral joint and improve pain of women with patellofemoral pain.

The Glittre-ADL Test Cut-Off Point to Discriminate Abnormal Functional Capacity in Patients with COPD.

The study objective was to determine a cut-off point for the Glittre activities of daily living (ADL)test (TGlittre) to discriminate patients with normal and abnormal functional capacity. Fifty-nine patients with moderate to very severe COPD (45 males; 65 ± 8.84 years; BMI: 26 ± 4.78 kg/m2; FEV1: 35.3 ± 13.4% pred) were evaluated for spirometry, TGlittre, 6-minute walk test (6 MWT), physical ADL, modified Medical Research Council scale (mMRC), BODE index, Saint George's Respiratory Questionnaire (SGRQ), and COPD Assessment Test (CAT). The receiver operating characteristic (ROC) curve was used to determine the cut-off point for TGlittre in order to discriminate patients with 6 MWT < 82% pred. The ROC curve indicated a cut-off point of 3.5 minutes for the TGlittre (sensitivity = 92%, specificity = 83%, and area under the ROC curve = 0.95 [95% CI: 0.89-0.99]). Patients with abnormal functional capacity had higher mMRC (median difference 1 point), CAT (mean difference: 4.5 points), SGRQ (mean difference: 12.1 points), and BODE (1.37 points) scores, longer time of physical activity <1.5 metabolic equivalent of task (mean difference: 47.9 minutes) and in sitting position (mean difference: 59.4 minutes) and smaller number of steps (mean difference: 1,549 minutes); p < 0.05 for all. In conclusion, the cut-off point of 3.5 minutes in the TGlittre is sensitive and specific to distinguish COPD patients with abnormal and normal functional capacity.

Should we consider steps with variable height for a safer stair negotiation in older adults?

BACKGROUND: Effects of exercise on foot clearances are important. In older adults variations in foot clearances during walking may lead to a fall, but there is a lack of information concerning stair negotiation in older adults. Whether a condition of post exercise changes foot clearances between steps of a staircase in older adults still unknown. OBJECTIVE: To determine differences in clearances when older adults negotiate different steps of a staircase before and after a session of aerobic exercise. METHODS: Kinematics data from 30 older adults were acquired and the toe and heel clearances were determined for each step. Clearances were compared between the steps. RESULTS: Smaller clearances were found at the highest step during ascending and descending, which was not changed by exercise. Smaller clearances suggest higher risk of tripping at the top of the staircase, regardless of exercise. CONCLUSION: A smaller step at the top of a short flight of stairs could reduce chances of tripping in older adults. It suggests that steps with variable height could make stair negotiation safer in older adults. This hypothesis should be tested in further studies.

Acciones motivacionales para promover actividad física en la comunidad que asiste a un Hospital Universitario / Taking action for promoting physical activity in the community attending a university hospital

Introducción: el sedentarismo ha llegado para quedarse. Cualquier tipo de acción para combatirlo será de gran utilidad; solo bastará con conocer su eficacia y con que la gente se adhiera. Métodos: se ha realizado un estudio cuasi experimental antes-después no controlado, con 3 intervenciones aditivas sobre la población que concurre al Hospital Italiano de Buenos Aires (Hospital Universitario). Se comparó la proporción de personas que usaban la escalera mecánica con aquellas que subían por la escalera convencional, antes y después de las siguientes intervenciones: con autoadhesivos que anunciaban las calorías perdidas al subir cada escalón, luego se agregaron carteles acerca del beneficio de hacer actividad física y, por último, se entregaron folletos sobre los beneficios de hacer actividad física. Resultados: se realizaron 39 967 observaciones. Cada intervención significó un aumento de personas que subían por la escalera convencional (P < 0,001). Con la intervención de los autoadhesivos se produjo un incremento del 2,39% frente al basal (11,07% - 8,68%, p=0,001) de personas que subieron por la escalera convencional. La intervención autoadhesivos + cartel aumentó 2,33% (13,4% -11,07%, p=0,001) y la intervención autoadhesivos + cartel + folletos produjo un aumento del 1,09% (14,49%-13,4%, p=0,03). Interpretación: en este estudio se midió cuál era el beneficio de las intervenciones para promover que más gente utilizara la escalera convencional; cada una de ellas proveyó una mayor cantidad de personas que, adoptando una actitud más activa, subieron por la escalera convencional. Medidas sencillas y económicas muestran un gran cambio en promover la actividad física. (AU)

Background: The sedentary lifestyle has become predominant in our society. Any measures taken to fight it are useful, it's just necessary to know their effectiveness and get people to stick with them. Methods: we performed a quasi-experimental pre-post study testing three persistent interventions on the population that attends a university hospital. Its main entrance allows the access to different areas through stairs, escalators or an elevator. We took baseline data on the number of people who took the escalator or the stairs. Then we performed progressive interventions designed to promote the use of the stairs. First, we used stickers placed on in each step that announced the amount of calories burned per step climbed. Then, we placed banners which informed the benefits of physical activity. Lastly, brochures were handed out with a list of benefits of doing physical activity. We quantified the number of people taking the stairs or the escalator with each intervention. Results: in eight weeks 39·967 observations were performed. Each intervention found an increase in the number of people that decided to take the stairs. At baseline, 880 people used the escalator and 9264 people took the stairs. With the first intervention, i.e. the use of stickers on the steps, there was an increase of 2·39% in the number of people that took the stairs compared to baseline data (from 8·68% to 11·07%, p=0.001). With the second intervention, i.e. stickers plus physical activity promotion banners, there was an additional increase of 2·33% (from 11·07% to 13·40%, p=0.001) in the proportion of people taking the stairs. Finally, the intervention of stickers in addition to the banners and brochures about benefits of physical activity, was associated with an increase of 1·09% (from 13·40% to 14·49%, p=0.03). Discussion: in this study we aimed to measure the benefits of multiple interventions to promote physical activity in a university hospital setting. Each intervention was associated with a larger number of people that decided to take the stairs instead of taking the escalator or the elevator. The interventions were simple, cheap and very effective to promote change independently from gender, age or health conditions. (AU)

Assessment of Knee Kinematics in Older Adults Using High-Speed Stereo Radiography.

PURPOSE: Quantification of knee motion is essential for assessment of pathologic joint function, such as tracking osteoarthritis progression and evaluating outcomes after conservative or surgical treatment, including total knee arthroplasty. Our purpose was to establish a useful baseline for the kinematic envelope of knee motion in healthy older adults performing movements of daily living. METHODS: A high-speed stereo radiography system was used to measure the three-dimensional tibiofemoral kinematics of eight healthy people over 55 yr of age (4 women/4 men; age, 61.7 ± 5.4 yr; body mass, 74.6 ± 7.7 kg; body mass index, 26.7 ± 4.4 kg·m; height, 168.2 ± 13.7 cm) during seated knee extension, level walking, pivoting, and step descent. RESULTS: Internal-external and varus-valgus rotation and anterior-posterior range of motion through stance in normal walking averaged 3.6° ± 1.1°, 2.3° ± 0.6°, and 3.4 ± 1.57 mm, respectively. Average range of motion across subjects was greater during the step-down in both internal-external rotation (average, 6.5° ± 3.1°) and anterior-posterior translation (average, 4.5 ± 1.1). Average internal-external range of motion increased to 13.5° ± 3.6° during pivoting. Range of motion of the knee in varus-valgus rotation was nearly the same for each subject across activities, rarely exceeding 6°. CONCLUSIONS: Pivoting and step descending during walking had greater internal-external rotation and anterior-posterior translation than normal gait. Internal-external rotation and anterior-posterior translation were shown to have greater activity dependence, whereas varus-valgus rotation was consistent across activities. These results were similar to prior measurements in younger cohorts, though a trend toward reduced range of motion in the older adults was observed.

Energy expenditure and cost of walking and stair climbing in individuals with chronic stroke.

BACKGROUND: Subjects with stroke show higher energy cost (EC) during walking, when compared to healthy individuals, but the mechanisms are not fully understood. Additionally, the behavior of physiological variables during other activities has not been investigated. OBJECTIVES: To investigate energy expenditure (EE) and EC during the six-minute walking test (6MWT) and stair climb test (SCT) in chronic stroke subjects compared to healthy controls. METHODS: Cross-sectional study in which stroke subjects (n=18) (community-walking speed ≥0.8m/s) or limited-community <0.8m/s walkers and matched healthy controls (n=18) had their EE and EC assessed during the 6MWT and SCT with a portable monitoring system. RESULTS: Significant differences in EE were observed for both the 6MWT (MD 7.29; 95%CI 4.08-10.50) and SCT (MD 8.53; 95%CI 5.07-12.00) between the stroke and control groups, but not between the stroke subgroups. Significant between-group differences in EC were found for both the 6MWT and SCT. For the 6MWT, differences were significant between the limited-community and the community walkers (MD 0.19; 95%CI 0.05-0.33) and controls (MD 0.17; 95%CI 0.04-0.29). No significant differences were found between the community walkers and controls (MD 0.02; 95%CI -0.09 to 0.13). For the SCT, the limited-community walkers showed highest EC, followed by the community walkers, and controls. CONCLUSIONS: Both stroke subgroups demonstrated lower EE compared to healthy controls. During the 6MWT, the limited-community walkers demonstrated higher EC compared to the community walkers and controls. During the SCT, the limited-community walkers demonstrated higher EC, followed by the community walkers, and controls.

Proximal mechanics during stair ascent are more discriminate of females with patellofemoral pain than distal mechanics.

BACKGROUND: Several hypotheses have been proposed to explain the pathomechanisms underlying patellofemoral pain (PFP). Concurrent evaluation of lower limb mechanics in the same PFP population is needed to determine which may be more important to target during rehabilitation. This study aimed to investigate possible differences in rearfoot eversion, hip adduction, and knee flexion during stair ascent; the relationship between these variables; and the discriminatory capability of each in identifying females with PFP. METHOD: Thirty-six females with PFP and 31 asymptomatic controls underwent three-dimensional kinematic analyses during stair ascent. Between-group comparisons were made for peak rearfoot eversion, hip adduction, and knee flexion. Pearson's correlation coefficients were calculated to evaluate relationships among these parameters. Receiver operating characteristic curves were applied to identify the discriminatory capability of each. FINDINGS: Females with PFP ascended stairs with reduced peak knee flexion, greater peak hip adduction and peak rearfoot eversion. Peak hip adduction (>10.6°; sensitivity=67%, specificity=77%) discriminated females with PFP more effectively than rearfoot eversion (>5.0°; sensitivity=58%, specificity=67%). Reduced peak hip adduction was found to be associated with reduced peak knee flexion (r=0.54, p=0.002) in females with PFP. INTERPRETATION: These findings indicate that proximal, local, and distal kinematics should be considered in PFP management, but proximally targeted interventions may be most important. The relationship of reduced knee flexion with reduced hip adduction also indicates a possible compensatory strategy to reduce patellofemoral joint stress, and this may need to be addressed during rehabilitation.

Assessing the physical activity environment in Mexican healthcare settings.

OBJECTIVE: To assess the informational, educational and instrumental environments among Mexican healthcare settings for their potential to promote physical activity (PA). MATERIALS AND METHODS: The Environmental Physical Activity Assessment Tool for Healthcare Settings (EPATHS) was developed to assess the PA environments of 40 clinics/hospitals representing the three Mexican healthcare systems in Guadalajara. The EPATHS assessed the presence and quality of PA enhancing features in the informational (e.g. signage), educational (e.g. pamphlets), and instrumental (e.g. stairs) environments of included clinics/hospitals. RESULTS: 28 (70%) clinics/hospitals had more than one floor with stairs; 60% of these had elevators. Nearly 90% of stairs were visible, accessible and clean compared to fewer than 30% of elevators. Outdoor spaces were observed in just over half (55%) of clinics/hospitals, and most (70%) were of good quality. Only 25% clinics/hospitals had educational PA materials. CONCLUSIONS: The PA instrumental environment of Mexican healthcare settings is encouraging. The informational and educational environments could improve.

Assessing the physical activity environment in Mexican healthcare settings / Evaluación del entorno de actividad física en el sector salud

Objective. To assess the informational, educational and instrumental environments among Mexican healthcare settings for their potential to promote physical activity (PA). Materials and methods. The Environmental Physical Activity Assessment Tool for Healthcare Settings (EPATHS) was developed to assess the PA environments of 40 clinics/hospitals representing the three Mexican healthcare systems in Guadalajara. The EPATHS assessed the presence and quality of PA enhancing features in the informational (e.g. signage), educational (e.g. pamphlets), and instrumental (e.g. stairs) environments of included clinics/hospitals. Results. 28 (70%) clinics/hospitals had more than one floor with stairs; 60% of these had elevators. Nearly 90% of stairs were visible, accessible and clean compared to fewer than 30% of elevators. Outdoor spaces were observed in just over half (55%) of clinics/hospitals, and most (70%) were of good quality. Only 25% clinics/hospitals had educational PA materials. Conclusions. The PA instrumental environment of Mexican healthcare settings is encouraging. The informational and educational environments could improve.

Objetivo. Evaluar el entorno informacional, educacional e instrumental de clínicas/hospitales en México y determinar su potencial para promover la actividad física (AF). Material y métodos. Se desarrolló una herramienta (Environmental physical activity assessment tool for healthcare settings [EPATHS]) para evaluar los entornos de AF en 40 clínicas/hospitales de Guadalajara afiliados a los tres sistemas de salud de México. Con el EPATHS se evaluó la presencia y calidad del entorno informacional (pe.: letreros), educacional (ep.: panfletos) e instrumental (pe.: escaleras). Resultados. Del total de clínicas/hospitales incluidos, 28 (70%) tuvieron más de un piso y escaleras; de éstos, 60% tuvo elevadores. Cerca de 90% de las escaleras eran visibles, accesibles y limpias, lo que contrasta con menos de 30% para los elevadores. En 55% de las clínicas/hospitales se observaron áreas verdes, la mayoría de éstas (80%) de buena calidad. En sólo 25% de las clínicas/hospitales se observaron materiales educativos sobre AF. Conclusiones. El entorno instrumental en clínicas/hospitales mexicanos es alentador. Los entornos informativos y educativos podrían mejorar.