Effects of blood flow restriction therapy in patients with knee osteoarthritis: protocol for an overview of systematic reviews.

Background: Osteoarthritis (OA) is the most common and prevalent musculoskeletal disease associated with population aging, negatively impacting function and quality of life. A consequence of knee OA is quadriceps muscle weakness. Musculoskeletal rehabilitation using low load exercises, associated with Blood Flow Restriction (BFR) may be a useful alternative to high load exercises when those cannot be tolerated. Several systematic reviews have reported inconclusive results due to discrepancies in study findings, heterogeneity of results, evaluated time points, and research questions explored. Objective: To perform an overview of systematic reviews with meta-analyses, synthesizing the most recent evidence on the effects of muscle strength training with BFR for knee OA. Methodology: Systematic reviews that include primary controlled and randomized clinical trials will be considered for inclusion. Articles will be considered only if they present a clear and reproducible methodological structure, and when they clearly demonstrate that a critical analysis of the evidence was carried out using instrumented analysis. Narrative reviews, other types of review, overviews of systematic reviews, and diagnostic, prognostic and economic evaluation studies will be excluded. Studies must include adults aged 40 years and older with a diagnosis of knee OA. Two authors will perform an electronic search with guidance from an experienced librarian. The following databases will be searched: PubMed via MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), PEDro, Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO host, Web of Science, and the gray literature. The search strategy used in the databases will follow the acronym PICOS (population, intervention, comparison, outcome, and study design). Screening (i.e., titles and abstracts) of studies identified by the search strategy will be selected using Rayyan (http://rayyan.qcri.org). The quality assessment will be performed using the "Assessment of Multiple Systematic Reviews" (AMSTAR-2) tool. Systematic Review Registration: PROSPERO, CRD42022367209.

The Corbett Targeted Coin Test: Reliability, criterion related validity, and normative data.

STUDY DESIGN: Clinical measurement. BACKGROUND: Many daily living tasks require in-hand manipulation (IHM). There is a gap in standardized assessment tools for measuring IHM. The Corbett Targeted Coin Test (CTCT) was designed to allow measurement of that fine motor skill. PURPOSE: 1) To evaluate the interrater, test-retest reliability, and validity of the CTCT, and 2) to establish adult norms for the CTCT. METHODS: Reliability and Validity - 30 participants (25 females, age range 21-45) were assessed with the Nine-Hole Peg test and CTCT consecutively by three researchers, then re-evaluated one week later on the CTCT; Reliability was determined using intraclass correlation (ICC2,k) between tests and across testers; Criterion-related validity was determined by comparing scores from nine-hole test and CTCT across testers using ICC2,k. Normative - 190 participants (147 females, age range 20-80) were assessed with the CTCT; mean and standard deviation for participants' scores were calculated by age groups and gender. RESULTS: Test-retest reliability: poor for the right hand (ICCs = -0.29 to 0.45), and poor-moderate for the left hand (ICCs = 0.17-0.56). Inter-rater reliability ranged from moderate to excellent (ICCs = 0.60-0.80). The agreement between CTCT scores and Nine-Hole Peg test was poor for the right (ICC = 0.02; 95% CI: [-0.06, 0.14]) and left hands (ICC = 0.06; 95% CI: [-0.08, 0.28]). CTCT normative data: 41-50 age group demonstrated the highest performance while the 71-80 age group demonstrated the lowest performance. Scores between genders were similar. DISCUSSION: The poor test-retest reliability of CTCT was probably due to practice effect, while interrater reliability indicated that the test can be administered by different testers without compromising the results. The poor validity between tools proves their different constructs. CONCLUSIONS: Use of the CTCT may add another dimension to assessment of dexterity and fine motor skills, specifically, in-hand manipulation, but needs further research on test-retest reliability.

Dosage of resistance exercises in fibromyalgia: evidence synthesis for a systematic literature review up-date and meta-analysis.

Several studies have examined the effect of different types of exercise on people with fibromyalgia. The aim of this study was to identify which dosage of resistance training is effective to reduce pain in women with fibromyalgia. Two authors independently selected studies included in a Cochrane Systematic Review and from an updated search up to May 2021 using the following databases: Embase, Central, Lilacs, PEDro, Current Controlled Trials, and WHO International Clinical Trials Registry Platform, Scopus and ISI Web of Science. Inclusion criteria were randomized clinical trials (RCTs) with female patients (18 years of age or older) diagnosed with fibromyalgia according to the American College of Rheumatology (ACR) criteria and the intervention, resistance exercises for pain reduction. The pain outcome value was extracted from studies for meta-analysis. Nine RCTs were included. Compared to the control groups, resistance exercise groups demonstrated a clinically and statistically significant effect on pain reduction when each exercise was performed in 1-2 sets or 3-5 sets of 4-12 or 5-20 repetitions twice a week, for 8-12 weeks, at intensities of 40-80% with one repetition maximum or perceived exertion. Resistance training exercises are effective to reduce pain in women with fibromyalgia when performed at moderate-to-high intensity in 1-2 sets of 4-20 repetitions twice a week, for 8-12 weeks. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) platform, CRD42018095205.

An Analysis of Traumatic Ankle Fracture Patients: Does Income Status Influence Access to Acute Orthopaedic Surgical Care?

PURPOSE: To evaluate if income status affects the timing of presentation to orthopaedic care, surgical treatment, or continuity of care following a closed ankle fracture. METHODS: Th is retrospective study identified 434 patients with closed ankle fractures treated with operative fixation from 2014 to 2016. Median income data were extracted using the patients' ZIP codes and data from the U.S. Census Bureau. RESULTS: Lower-income patients presented to the hospital and received surgical treatment significantly later than others. They were also more often uninsured and nonadherent with postoperative weightbearing precautions. Additionally, these patients less frequently sought care on the day of their injury, and they had both shorter inpatient stays and duration of overall follow-up in comparison with others. CONCLUSION: Socioeconomic status is a vital consideration for improving patient access to acute orthopaedic surgical care. Lower-income patients are more susceptible to multiple time-sensitive delays in their care, and these patients frequently encounter difficulties maintaining appropriate follow-up carex.

Effect of prehabilitation in older adults undergoing total joint replacement: An Overview of Systematic Reviews.

PURPOSE OF REVIEW: To review and discuss the findings of systematic reviews that synthesized the evidence on the effect of preoperative exercises (prehabilitation) on postoperative functional recovery in older adults undergoing total knee or hip joint replacement. RECENT FINDINGS: Ten systematic reviews (8 meta-analyses) were included in this review. Findings from the systematic reviews indicated that prehabilitation decreases length of hospital stay but does not improve postoperative functional recovery in older adults undergoing joint replacement. Individual studies in the systematic reviews varied considerably in prehabilitation protocol, assessment timepoints, and outcome measures. Most importantly, systematic reviews did not assess the outcomes pre-post prehabilitation as this timepoint was not addressed in most individual studies. Therefore, it is not known whether the prehabilitation programs improved outcomes preoperatively. SUMMARY: There is a need to develop comprehensive prehabilitation protocols and systematically assess the preoperative and postoperative effectiveness of prehabilitation protocols on functional outcomes (i.e., self-reported and performance-based) in older adults undergoing total joint replacement.

Recommendation Rates for Physical Therapy, Lifestyle Counseling, and Pain Medications for Managing Knee Osteoarthritis in Ambulatory Care Settings: A Cross-Sectional Analysis of the National Ambulatory Care Survey (2007-2015).

OBJECTIVE: To describe and compare triennial rates of physicians' recommendations for physical therapy (PT), lifestyle counseling, and pain medication for knee osteoarthritis (OA) and to identify patient, physician, and practice factors associated with each treatment recommendation. METHODS: We conducted a cross-sectional analysis examining data between 2007 and 2015 from the National Ambulatory Medical Care Survey. Visits to orthopedists and primary care physicians for knee OA were identified and assessed for the following: PT referral, lifestyle counseling, nonsteroidal antiinflammatory drug (NSAID) prescriptions, and narcotics prescriptions. Triennial rates for each treatment were calculated. We examined associations between patient (e.g., race, insurance), physician, and practice factors (e.g., ownership, location) and treatments prescribed using multivariate logistic regression that accounted for complex sampling design. RESULTS: A total of 2,297 physician visits related to knee OA (~67 [±4] million weighted visits) were identified. For visits to orthopedists, PT and lifestyle recommendation rates declined (158 to 88 of 1,000 visits and 184 to 86 of 1,000 visits, respectively), while NSAID and narcotics prescriptions increased (132 to 278 of 1,000 visits and 77 to 236 of 1,000 visits, respectively) over time (P < 0.05). For visits to primary care physicians, there were no significant changes in rates of PT, lifestyle counseling, and narcotics prescriptions over time, while NSAIDs prescriptions increased (221 to 498 of 1,000 visits; P < 0.05). Treatment recommendations were associated with nonclinical factors, including practice type, location, and type of provider. CONCLUSION: In patients with knee OA, PT and lifestyle counseling seem underutilized, while pain medication prescriptions increased during the investigated timeframe. Variation in treatment choices were associated with nonclinical factors. Future research is necessary to examine ways to improve PT and lifestyle utilization and reduce variation in care for knee OA.

Dose-Response Relationship Between Neuromuscular Electrical Stimulation and Muscle Function in People With Rheumatoid Arthritis.

BACKGROUND: Neuromuscular electrical stimulation (NMES) is a viable intervention for improving impaired muscle function in individuals with rheumatoid arthritis (RA). However, there is limited evidence about the dose-response relationship between NMES and muscle function in these individuals. OBJECTIVE: The objectives of this study were to investigate the dose-response relationship between NMES and muscle function in individuals with RA and to establish the minimal NMES training intensity for promoting improvements. DESIGN: This study was a secondary analysis of data obtained before and after an NMES intervention in a randomized study. METHODS: The study took place at a research clinic. Only adults diagnosed with RA were included. The intervention consisted of 36 NMES treatment sessions for the quadriceps muscles over 16 weeks. Muscle function was measured before and after the intervention; quadriceps cross-sectional area and muscle quality were assessed using computed tomography, and strength was measured with an isokinetic dynamometer. NMES training intensity was calculated as a percentage by dividing NMES-elicited quadriceps muscle torque by the maximum voluntary isometric contraction. Improvements in muscle function were calculated using paired-sample t tests. The dose-response relationship was determined using curve estimation regression statistics. The minimum NMES training intensity was defined as that sufficient to significantly improve all muscle function measures. RESULTS: Twenty-four people (48 legs) participated (75% women; mean [SD] age = 58 [8] years; mean body mass index = 32 [7] kg/m2). Quadriceps cross-sectional area, muscle quality, and strength improved after the intervention. Associations between NMES training intensity and muscle quality (r2 = 0.20) and strength (r2 = 0.23) were statistically significant, but that between NMES training intensity and muscle cross-sectional area was not (r2 = 0.02). The minimum NMES training intensity necessary to improve all measures of muscle function ranged from 11% to 20% of the maximum voluntary isometric contraction. LIMITATIONS: The relatively small sample size was a limitation. CONCLUSIONS: The minimum NMES training intensity for significant gains in muscle function was ∼15%. Higher NMES intensities may promote better muscle quality and strength in individuals with RA.

The Role of the Environment on Sedentary Behavior in Community-Dwelling Older Adults.

OBJECTIVES: To compare amounts of sedentary behavior and physical activity in adults residing in planned group residential settings to those residing in private homes. METHODS: Thirty-one older adults who resided in planned group residential settings (n=13) and in private homes (n=18) participated. Daily activities were measured using the Sensewear Armband for 7 days. Estimates of the duration of daily activities performed across sedentary, light, and moderate-to-vigorous intensities were captured. RESULTS: Participants in planned group residential settings were older (age 85.9±3.5 vs 78.3±7.2; p=0.001) and spent more time in sedentary behaviors (12.7±1.5 vs 11.3±1.6; p=0.02) than participants in private homes. The difference was attenuated slightly after controlling for age and wear time (adjusted difference 1.2±0.6 hours, p=0.06). DISCUSSION: Adults residing in planned group residential settings, which provide supportive services, were more sedentary than adults residing in private homes. The environment in which older adults live may contribute to sedentary behavior.

Effectiveness of Later-Stage Exercise Programs vs Usual Medical Care on Physical Function and Activity After Total Knee Replacement: A Randomized Clinical Trial.

Importance: Several functional limitations persist after total knee replacement (TKR). Intensive exercise programs could resolve these limitations but are not well tolerated by many patients until a later stage (>2 months) after surgery. Evidence for exercise at a later stage after TKR is limited. Objectives: To compare the effectiveness of later-stage exercise programs after TKR and to explore heterogeneity of treatment effects. Design, Setting, and Participants: Three-arm single-blind randomized clinical trial (January 7, 2015, to November 9, 2017) using an intent-to-treat approach with follow-ups at 3 months and 6 months. The setting was Allegheny County, Pennsylvania (an outpatient physical therapy clinic and 4 community centers). Participants had primary TKR performed more than 2 months previously, were 60 years or older, experienced moderate functional limitations, and were medically cleared to exercise. Interventions: Clinic-based physical therapy exercise (physical therapy arm), community-based group exercise (community arm), and usual care (control arm). The control arm continued their usual care, whereas the exercise arms participated in supervised exercise programs lasting 12 weeks. Main Outcomes and Measures: The primary outcome was arm differences in the Western Ontario and McMaster Universities Osteoarthritis Index-Physical Function (WOMAC-PF) at 3 months. The secondary outcomes included performance-based tests germane to knee replacement and additional surveys of physical function. Data were analyzed by linear mixed models and responder analysis. Results: A total of 240 participants (mean [SD] age, 70 [7] years; 61.7% female) were allocated to physical therapy (n = 96), community exercise (n = 96), or control (n = 48). All 3 arms demonstrated clinically important improvement. At 3 months, between-arm analyses for the WOMAC-PF demonstrated no differences between physical therapy and community (-2.2; 98.3% CI, -4.5 to 0.1), physical therapy and control (-2.1; 98.3% CI, -4.9 to 0.7), and community and control (0.1; 98.3% CI, -2.7 to 2.9). Performance-based tests demonstrated greater improvement in the physical therapy arm compared with both the community (0.1 z score units; 98.3% CI, 0.0-0.2) and control (0.3 z score units; 98.3% CI, 0.1-0.4) arms and the community arm compared with the control arm (0.2 z score units; 98.3% CI, 0.0-0.3). The physical therapy arm had more than 17.7% responders than the community arm and more than 19.0% responders than the control arm. There was no difference in responder rates between the community and control arms. Conclusions and Relevance: Based on the primary outcome, participation in late-stage exercise programs after TKR offered no benefit over usual care. The benefits of physical therapy identified by the secondary outcomes and responder analysis require confirmation. Trial Registration: ClinicalTrials.gov Identifier: NCT02237911.

Physical activity after total joint arthroplasty: a narrative review.

BACKGROUND: Total joint arthroplasty (TJA) is a common procedure to treat individuals with hip and knee osteoarthritis. While TJAs are successful in decreasing pain and improving quality of life, it is unclear whether individuals who undergo TJA become more physically active after surgery. It is possible that TJA, by itself, is not sufficient to affect the behavior of patients toward physical activity (PA) participation. To increase PA participation, individuals with TJA may need to be exposed to exercise/behavioral interventions specifically aimed to promote PA (ie, in addition to the surgery). OBJECTIVES: This narrative review aimed to assess the evidence on 1) whether TJAs change PA participation from pre- to postsurgery and 2) whether exercise/behavioral interventions delivered before or after TJA help to promote PA in these patients. RESULTS: For aim 1, the studies that assessed PA from pre- to post-TJA reported that PA does not change in the first 3 months postsurgery. The results of follow-ups longer than 3 months but shorter than 12 months are contradictory, and the results of follow-ups longer than 12 months provide weak evidence of increased PA. Assessment of changes in PA due to TJA is challenged by the wide variability in demographics, methods used to assess PA, and different pathways of care used across studies. The results for aim 2 were limited by a scarcity of studies that used exercise/behavioral interventions to promote PA. CONCLUSION: TJA relieves joint pain and offers a unique opportunity for patients to become more physically active. However, the current evidence is limited and unable to offer definitive results of whether TJA is effective to change PA from pre- to postsurgery. Future large studies in representative samples of patients with TJA are needed to adequately answer this question.

Effect of Comprehensive Behavioral and Exercise Intervention on Physical Function and Activity Participation After Total Knee Replacement: A Pilot Randomized Study.

OBJECTIVE: To test the feasibility of a comprehensive behavioral intervention (CBI) program that combines intense exercises with an education program, to be implemented at a later stage (3 months) following total knee replacement (TKR), and to get a first impression of the effects of the CBI as compared to a standard of care exercise (SCE) program on the outcomes of physical function and physical activity. METHODS: A total of 44 subjects participated in a 3-month program of either CBI or SCE, followed by 3 months of a home exercise program. Outcomes of physical function and physical activity were measured at baseline and at 6-month followup. Analysis of variance was used to compare statistical differences between groups, whereas responder analyses were used for clinically important differences. RESULTS: The CBI was found to be safe and well tolerated. As compared to the SCE group, the CBI group had less pain (P = 0.035) and better physical function based on the Short Form 36 health survey (P = 0.017) and the single-leg stance test (P = 0.037). The other outcome measures did not demonstrate statistically significant differences between the 2 groups. Results from the responder analysis demonstrated that the CBI group had a 36% higher rate of responders in physical function as compared to the SCE group. Also, the CBI group had 23% more responders in the combined domains of physical function and physical activity. CONCLUSION: The CBI program is feasible and improves physical function and physical activity in patients several months after TKR. Larger pragmatic randomized trials are needed to confirm the results of this study.

Responsiveness of Physical Activity Measures Following Exercise Programs after Total Knee Arthroplasty.

BACKGROUND: Few instruments that measure physical activity (pa) can accurately quantify pa performed at light and moderate intensities, which is particularly relevant to older adults. Evidence for responsiveness of these instruments after an intervention is limited. OBJECTIVES: o estimate and compare the responsiveness of two activity monitors and one questionnaire in assessing PA after an intervention following total knee Arthroplasty. METHODS: This one-group pretest-posttest, repeated-measures study analyzed changes in duration of daily PA and the standardized response mean (SRM) to assess internal responsiveness that were compared across instruments. Correlations between changes in PA measured by the proposed instruments and the global rating of change were used to test external responsiveness. Agreement between PA instruments on identifying individuals who changed their PA based on measurement error was assessed using weighted-Kappa (K). RESULTS: Thirty subjects, mean age 67(6) and 73% female, were analyzed. Changes in PA measured by each instrument were small (p>0.05), resulting in a small degree of responsiveness (SRM<0.30). Global rating of change scores did not correlate with changes in PA (rho=0.13-0.28, p>0.05). The activity monitors agreed on identifying changes in moderate-intensity PA (K=0.60) and number of steps (K=0.63), but did not agree with scores from questionnaire(K≤0.22). CONCLUSION: Analyzing group-based changes in PA is challenging due to high-variability in the outcome. Investigating changes in PA at the individual-level may be a more viable alternative.

Reliability of Physical Activity Measures During Free-Living Activities in People After Total Knee Arthroplasty.

BACKGROUND: Few instruments that measure physical activity (PA) can accurately quantify PA performed at light and moderate intensities, which is particularly relevant in older adults. The evidence of their reliability in free-living conditions is limited. OBJECTIVE: The study objectives were: (1) to determine the test-retest reliability of the Actigraph (ACT), SenseWear Armband (SWA), and Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire in assessing free-living PA at light and moderate intensities in people after total knee arthroplasty; (2) to compare the reliability of the 3 instruments relative to each other; and (3) to determine the reliability of commonly used monitoring time frames (24 hours, waking hours, and 10 hours from awakening). DESIGN: A one-group, repeated-measures design was used. METHODS: Participants wore the activity monitors for 2 weeks, and the CHAMPS questionnaire was completed at the end of each week. Test-retest reliability was determined by using the intraclass correlation coefficient (ICC [2,k]) to compare PA measures from one week with those from the other week. RESULTS: Data from 28 participants who reported similar PA during the 2 weeks were included in the analysis. The mean age of these participants was 69 years (SD=8), and 75% of them were women. Reliability ranged from moderate to excellent for the ACT (ICC=.75-.86) and was excellent for the SWA (ICC=.93-.95) and the CHAMPS questionnaire (ICC=.86-.92). The 95% confidence intervals (95% CI) of the ICCs from the SWA were the only ones within the excellent reliability range (.85-.98). The CHAMPS questionnaire showed systematic bias, with less PA being reported in week 2. The reliability of PA measures in the waking-hour time frame was comparable to that in the 24-hour time frame and reflected most PA performed during this period. LIMITATIONS: Reliability may be lower for time intervals longer than 1 week. CONCLUSIONS: All PA measures showed good reliability. The reliability of the ACT was lower than those of the SWA and the CHAMPS questionnaire. The SWA provided more precise reliability estimates. Wearing PA monitors during waking hours provided sufficiently reliable measures and can reduce the burden on people wearing them.

Association of Light-Intensity Physical Activity With Lower Cardiovascular Disease Risk Burden in Rheumatoid Arthritis.

OBJECTIVE: To characterize physical activity (PA) in individuals with rheumatoid arthritis (RA) and to determine the associations between PA participation at light to moderate intensities and cardiovascular disease risk factors, disability, and disease activity. METHODS: The cross-sectional study used data from 2 RA cohorts. PA was measured using an accelerometry-based activity monitor, recording minutes/day spent in sedentary (≤1 metabolic equivalent [MET]), very light (1.1-1.9 METs), light (2-2.9 METs), and moderate activities (≥3 METs). Cardiovascular markers included body mass index, blood pressure, insulin resistance, and lipid profile. Disability and disease activity were measured using the Health Assessment Questionnaire (HAQ) and the Disease Activity Score in 28 joints (DAS28), respectively. Associations between PA at each intensity level and health markers were assessed by multiple linear regression models, adjusted for age, sex, and cohort. RESULTS: Ninety-eight subjects (mean ± SD age 58 ± 9 years, 85% female) were included. Subjects spent 9.8 hours/day being sedentary, 3.5 hours/day engaged in very light PA, 2.1 hours/day engaged in light PA, and 35 minutes/day engaged in moderate PA. Only 17% were physically active (≥150 minutes/week of moderate PA in 10-minute bouts). Regression models showed that very light, light, and moderate PA were inversely associated with most cardiovascular disease risk factors and HAQ and DAS28 scores (R(2) Δ range 0.04-0.52, P < 0.05). The associations between PA and cardiovascular disease markers were either equivalent or stronger at very light and light intensities, as compared to moderate intensity. CONCLUSION: Individuals with RA are mostly active at very light and light intensities. PA at these intensity levels associates favorably with cardiovascular markers and lower disability and disease activity in RA.

A randomized trial to compare exercise treatment methods for patients after total knee replacement: protocol paper.

BACKGROUND: Although the outcome of total knee replacement (TKR) is favorable, surgery alone fails to resolve the functional limitations and physical inactivity that existed prior to surgery. Exercise is likely the only intervention capable of improving these persistent limitations, but exercises have to be performed with intensity sufficient to promote significant changes, at levels that cannot be tolerated until later stages post TKR. The current evidence is limited regarding the effectiveness of exercise at a later stage post TKR. To that end, this study aims to compare the outcomes of physical function and physical activity between 3 treatment groups: clinic-based individual outpatient rehabilitative exercise during 12 weeks, community-based group exercise classes during 12 weeks, and usual medical care (wait-listed control group). The secondary aim is to identify baseline predictors of functional recovery for the exercise groups. METHODS/DESIGN: This protocol paper describes a comparative effectiveness study, designed as a 3-group single-blind randomized clinical trial. Two hundred and forty older adults who underwent TKR at least 2 months prior will be randomized into one of the three treatment approaches. Data will be collected at baseline, 3 months, and 6 months. The wait-listed control group will be randomized to one of the 2 exercise groups after 6 months of study participation, and will complete a 9-month follow-up. Primary outcome is physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index Physical Function Subscale (WOMAC-PF). Physical function is also measured by performance-based tests. Secondary outcomes include performance-based tests and physical activity assessed by a patient-reported survey and accelerometry-based physical activity monitors. Exploratory outcomes include adherence, co-interventions, attrition, and adverse events including number of falls. Linear mixed models will be fitted to compare the changes in outcome across groups. Logistic regression will identify patient characteristics that predict functional recovery in the exercise groups. Instrumental variable methods will be used to estimate the efficacy of the interventions in the presence of non-compliance. DISCUSSION: Results will inform recommendations on exercise programs to improve physical function and activity for patients at the later stage post TKR and help tailor interventions according with patients' characteristics. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT02237911.

Validity of physical activity measures in individuals after total knee arthroplasty.

OBJECTIVE: To determine the concurrent criterion-related validity of 2 activity monitors in comparison with the criterion method of indirect calorimetry in older adults after total knee arthroplasty (TKA). DESIGN: Validation study. SETTING: Subjects completed 9 increasingly demanding daily activities in a research laboratory; each activity was performed for 7 minutes, for a total of 80 minutes, while the activity monitors and criterion method were used concurrently. PARTICIPANTS: Subjects (N=21, 67% women) had a mean age ± SD of 68±7 years and a body mass index of 29±4. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Energy expenditure (in kcal/min) measured by accelerometer-based and multisensor-based monitors and by a criterion method. Validity was assessed by the paired t test, intraclass correlation coefficient (ICC), and Bland-Altman plots comparing the measurements from the activity monitors with those of the criterion method. RESULTS: Measurements from the accelerometer-based monitor were significantly lower than those of the criterion method across all walking and nonwalking activities. The underestimations ranged from 40% to 100%. The accelerometer-based monitor demonstrated small to moderate agreement compared with the criterion method (ICCs from 0 to .38). Measurements from the multisensor-based monitor were significantly lower than those of the criterion method during several nonwalking activities; yet, the differences were minor (2%-19%). Measurements from the multisensor-based monitor during walking activities were not different compared with the criterion method. The multisensor-based monitor demonstrated moderate to excellent agreement with the criterion method (ICCs from .48 to .81). CONCLUSIONS: The multisensor-based monitor showed better criterion-related validity than the accelerometer-based monitor and should be considered as a tool to measure physical activity in individuals after TKA.

Cemented, cementless or hybrid fixation options in total knee arthroplasty for osteoarthritis and other non-traumatic diseases.

BACKGROUND: It is not clear which fixation of total knee arthroplasty obtains the best clinical, functional and radiographic results in people with osteoarthritis and other non-traumatic diseases, such as rheumatoid arthritis. OBJECTIVES: To assess the benefits and harms of cemented, cementless and hybrid knee prostheses fixation techniques in participants with primary osteoarthritis (osteoarthritis following trauma was not included) and other non-traumatic diseases, such as rheumatoid arthritis. SEARCH METHODS: We searched CENTRAL (2011, issue 10), MEDLINE via PubMed, EMBASE, Current Controlled Trials, LILACS, The Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Health Technology Assessment Database and the Database of Abstracts of Reviews of Effectiveness, all from implementation to October 2011, along with handsearches of high-yield journals and reference lists of articles. No language restrictions were applied. SELECTION CRITERIA: Randomized controlled trials (RCTs) evaluating cemented, cementless and hybrid fixation. Participants included patients that were 18 years or older with osteoarthritis and other non-traumatic diseases who were undergoing primary total knee arthroplasty. DATA COLLECTION AND ANALYSIS: Three authors independently selected the eligible trials, assessed the trial quality, risk of bias and extracted data. Researchers were contacted to obtain missing information. MAIN RESULTS: Five RCTs and 297 participants were included in this review. Using meta-analysis on roentgen stereophotogrammetric analysis (RSA) we observed that cemented fixation of the tibial components demonstrated smaller displacement in relation to cementless fixation (with and without hydroxyapatite) after a follow-up of two years (maximum total point-motion, N = 167, two RCTs, mean difference (MD) = 0.52 mm, 95% confidence interval (CI) 0.31 to 0.74). However, the risk of future aseptic loosening with uncemented fixation was approximately half that of cemented fixation according to the arthroplasty instability classification (moderate quality as assessed by GRADE) inferred from RSA (N = 216, three RCTs, risk ratio (RR) = 0.47, 95% CI 0.24 to 0.92) with a 16% absolute risk difference between groups. The number needed to treat for an additional beneficial outcome (NNTB) to prevent future aseptic loosening was 7 (95% CI 5 to 44). There was a low risk of bias for RSA among the studies included. It was not possible to perform meta-analysis on patient-important outcomes, such as the survival rate of the implant (any change of a component), patient global assessments, functional measures, pain, health-related quality of life measures and adverse events. Almost all included studies recorded functional measures of Knee Society and Hospital for Special Surgery knee scores, but the authors of each study found no significant difference between the groups. AUTHORS' CONCLUSIONS: There was a smaller displacement of the cemented tibial component in relation to the cementless fixation in studies with osteoarthritis and rheumatoid arthritis participants who underwent primary total knee prosthesis with a follow-up of two years; however, the cemented fixation presented a greater risk of future aseptic loosening than cementless fixation.

Multi-label classification for the analysis of human motion quality.

Knowing how well an activity is performed is important for home rehabilitation. We would like to not only know if a motion is being performed correctly, but also in what way the motion is incorrect so that we may provide feedback to the user. This paper describes methods for assessing human motion quality using body-worn tri-axial accelerometers and gyroscopes. We use multi-label classifiers to detect subtle errors in exercise performances of eight individuals with knee osteoarthritis, a degenerative disease of the cartilage. We present results obtained using various machine learning methods with decision tree base classifiers. The classifier can detect classes in multi-label data with 75% sensitivity, 90% specificity and 80% accuracy. The methods presented here form the basis for an at-home rehabilitation device that will recognize errors in patient exercise performance, provide appropriate feedback on the performance, and motivate the patient to continue the prescribed regimen.

Physical activity measured by the SenseWear Armband in women with rheumatoid arthritis.

BACKGROUND: Individuals with rheumatoid arthritis (RA) often are sedentary and have an increased risk of developing comorbid conditions. Women with RA are more likely to experience challenges in maintaining an active lifestyle over their life span than men with RA or people who are healthy. As the benefits of physical activity (PA) are well known, measuring PA accurately in this population is important. OBJECTIVES: The purposes of this study were: (1) to characterize PA as measured with the SenseWear Armband (SWA) in women with RA and (2) to determine the measurement time frame to obtain consistent estimates of PA and daily energy expenditure (EE) in women with RA. DESIGN: This was a cross-sectional study. METHODS: Participants wore the SWA for 7 days. Measurements of daily total energy expenditure (TEE), physical activity energy expenditure (PAEE) during activities at or above 1 metabolic equivalent (MET) level (PAEE≥1MET), PAEE during activities at or above 2 METs (PAEE≥2METs), PAEE during activities at or above 3 METs (PAEE≥3METs), and number of steps were obtained. RESULTS: Fifty-three women participated. Complete data were obtained for 47 participants (89%). Daily usage of the SWA was 98% of the time (23:31 hours/24 hours). Means (SD) were 2,099 (340) kcal/d for TEE, 1,050 (331) kcal/d for PAEE≥1MET, 642 (309) kcal/d for PAEE≥2METs, 239 (178) kcal/d for PAEE≥3METs, and 7,260 (2,710) for number of steps. Results of intraclass correlation coefficient analyses and multiple linear regressions indicated that 2 days were needed to reliably estimate TEE; 3 days for PAEE≥1MET, PAEE≥2METs, and number of steps; and 4 days for PAEE≥3METs. LIMITATIONS: The sample was composed of well-educated women with RA who had mild to moderate difficulty performing daily activities. CONCLUSION: The SWA may be useful to quantify PA in women with RA and to monitor effectiveness of interventions aiming to increase PA levels. Minimizing the number of days necessary for data collection will reduce the individual's burden and may improve adherence in studies of PA behaviors.

Contribution of hip abductor strength to physical function in patients with total knee arthroplasty.

BACKGROUND: Investigating modifiable factors that contribute to functional limitations in patients with total knee arthroplasty (TKA) may guide changes in rehabilitation protocols and improve functional outcomes. Whereas quadriceps muscle weakness has been demonstrated to contribute to functional limitations in TKA, the role of hip abductor weakness has not received attention. OBJECTIVE: The purpose of this study was to determine whether hip abductor strength (force-generating capacity) contributes to physical function beyond what can be explained by quadriceps muscle strength in patients after a TKA. DESIGN: A cross-sectional design was used in the study. SETTING: The study was conducted in a clinical laboratory at an academic center. PATIENTS: Thirty-one people with TKA (74% female; mean age=68 years, SD=8; mean body mass index=31 kg/m(2), SD=5) participated in the study. MEASUREMENTS: Strength of quadriceps muscles and hip abductors was measured using an isokinetic dynamometer. Performance-based physical function was assessed with 4 measures: self-selected walking speed, the Figure-of-8 Walk Test, the Stair Ascend/Descend Test, and the 5-Chair Rise Test. Self-reported physical function was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index Physical Function Subscale. RESULTS: In hierarchical regression models, after accounting for demographic and anthropometric factors, quadriceps muscle strength was associated with performance on the Stair Ascend/Descend Test. After accounting for demographic, anthropometric, and quadriceps strength, hip abductor strength was associated with performance on the Stair Ascend/Descend Test, the Figure-of-8 Walk Test, and the 5-Chair Rise Test. LIMITATIONS: The study design precluded ascertainment of causal relationships. CONCLUSIONS: After TKA, hip abductor strength influenced physical function in participants more than did demographic or anthropometric measures or quadriceps strength. Longitudinal studies with larger samples are warranted. If findings are replicated, they will justify targeting the hip abductors during rehabilitation after TKA.