Hormone replacement therapy (conjugated oestrogens plus bazedoxifene) for post-menopausal women with symptomatic hand osteoarthritis: primary report from the HOPE-e randomised, placebo-controlled, feasibility study.

Background: Symptomatic hand osteoarthritis is more common in women than in men, and its incidence increases around the age of menopause, implicating oestrogen deficiency. No randomised controlled trials of hormone replacement therapy (HRT) have been done in people with hand osteoarthritis. We aimed to determine the feasibility and acceptability of a form of HRT (conjugated oestrogens plus bazedoxifene) in post-menopausal women with painful hand osteoarthritis. Methods: The HOPE-e feasibility study was a randomised, double-blind, placebo-controlled trial, for which we recruited women aged 40-65 years, for whom 1-10 years had passed after their final menstrual period, with definite hand osteoarthritis and at least two painful hand joints. Participants were recruited across three primary or secondary care sites and from the community and were randomly assigned (1:1) to receive conjugated oestrogens plus bazedoxifene or placebo, orally once every day for 24 weeks, before weaning for 4 weeks until the end of the study. The primary feasibility outcomes were rates of identification, recruitment, randomisation, retention, and compliance of eligible participants, and the likelihood of unmasking. The secondary objective was to generate proof-of-concept quantitative and qualitative data on the acceptability of proposed clinical outcomes for a full trial and adverse events. We used an intention-to-treat analysis, and criteria for progression to a full trial were pre-defined as recruitment of at least 30 participants across all sites in 18 months; a dropout rate of less than or equal to 30% of randomised individuals; and acceptability to the majority of participants, including acceptable rates of adverse events. Due to the COVID-19 pandemic, the recruitment window was reduced to 12-15 months. A proportionately reduced minimum sample size of 22 was judged to be sufficient to test feasibility. This trial was registered at ISRCTN, ISRCTN12196200. Findings: From May 9, 2019 to Dec 31, 2020, 434 enquiries or referrals were received. We did 96 telephone pre-screens; of the 35 eligible participants, seven were excluded as ineligible at the telephone or face-to-face screening and 28 (80% [95% CI 63-92]) were randomly assigned. Of the 406 who were not randomly assigned, 250 (62%) were ineligible (with contraindicated medications accounting for 50 [20%] of these), 101 (25%) did not respond to further enquiries, and 55 (14%) chose not to proceed (with the most common reason being not wanting to take a hormone-based drug). All 28 randomised participants completed all follow-up assessments with high compliance and outcome measure completeness. All three adverse event-related treatment withdrawals were in the placebo group. No serious adverse events were reported. Participants and investigators were successfully masked (participant Bang's blinding index placebo group 0·50 [95% CI 0·25-0·75]). The trial met the prespecified criteria for progression to a full trial. Interpretation: This first-ever feasibility study of a randomised controlled trial of HRT for post-menopausal women with painful hand osteoarthritis met its progression criteria, although it was not powered to detect a clinical effect. This outcome indicates that a full trial of an HRT in this population is feasible and acceptable and identifies potential refinements with regard to the design of such a trial. Funding: Research for Patient Benefit programme, National Institute for Health Research.

Effect of Visual Information on Postural Control in Children with Autism Spectrum Disorder.

Visual information is crucial for postural control. Visual processing in children with autism spectrum disorder (ASD) was hypothesized to be less efficient and thus they would display a less stable standing posture than typically developing children. The present study compared the static standing responses and attentional demands of 15 children with ASD and 18 control participants in conditions of eyes open and eyes closed. The results showed that postural responses and attention invested in standing were similar between the participant groups in the two visual conditions. Both groups displayed a more stable posture when their eyes were open in comparison to eyes closed. The finding suggests that normal postural control development could occur in children with ASD.

Postural control adaptation to optic flow in children and adults with autism spectrum disorder.

BACKGROUND: Sensory reweighting is important for humans to flexibly up-weigh and down-weigh sensory information in dynamic environments. There is an element of time involved in the sensory reweighting process. A longer time spent on sensory reweighting may increase the destabilizing effect of postural control. Individuals with autism spectrum disorder (ASD) are reported to have poor postural control. It is uncertain if a different sensory reweighting process underlies the postural control deficit in children and adults with ASD. RESEARCH QUESTION: To explore the sensory reweighting capability in ASD, the present study examined whether the temporal domains of postural control differed in children and adults, with and without ASD under various optic flow conditions. METHODS: Thirty-three children (8-12 years old) and 33 adults (18-50 years old) with and without ASD underwent quiet standing in six radial optic flow conditions. Each condition lasted for 60 s and was shown twice to all participants. For each optic flow condition, changes in postural response within-trial and between-trials were measured. RESULTS: Under various optic flow illusions, both children with and without ASD took a longer time to restore their posture compared with adults with and without ASD. Nonetheless, all groups demonstrated comparable abilities to adjust their posture to one that is close to the baseline position after one exposure to the optic flow stimulation. SIGNIFICANCE: The present study showed that the temporal domains of postural control under different optic flow conditions were similar between individuals with and without ASD from the same age group. The ability to down-weigh visual information efficiently comes with the developmental progression of the sensory reweighting system. These findings suggest that the sensory reweighting process does not elucidate the postural control deficits in individuals with ASD and thus alternative explanations to determine the underlying mechanism for postural instability are needed.

Effect of Visual Information on Postural Control in Adults with Autism Spectrum Disorder.

Sensory processing difficulties affect the development of sensorimotor skills in individuals with autism spectrum disorder (ASD). However, the effect of sensory information on postural control is unclear in the ASD adult population. The present study examined the effect of visual information on postural control as well as the attentional demands associated with postural control in fourteen adults with ASD and seventeen typically developed adults. The results showed that postural sway and attention demands of postural control were larger in adults with ASD than in typically developed adults. These findings indicate that visual processing used for postural control may be different in adults with ASD. Further research in visual field processing and visual motion processing may elucidate these sensorimotor differences.

Effect of Optic Flow on Postural Control in Children and Adults with Autism Spectrum Disorder.

Individuals with autism spectrum disorder (ASD) have been associated with sensorimotor difficulties, commonly presented by poor postural control. Postural control is necessary for all motor behaviors. However, findings concerning the effect of visual motion on postural control and the age progression of postural control in individuals with ASD are inconsistent. The aims of the present study were to examine postural responses to optic flow in children and adults with and without ASD, postural responses to optic flow in the central and peripheral visual fields, and the changes in postural responses between the child and adult groups. Thirty-three children (8-12 years old) and 33 adults (18-50 years old) with and without ASD were assessed on quiet standing for 60 seconds under conditions of varying optic flow illusions, consisting of different combinations of optic flow directions and visual field display. The results showed that postural responses to most optic flow conditions were comparable between children with and without ASD and between adults with and without ASD. However, adults with ASD appeared more responsive to forward-moving optic flow in the peripheral visual field compared with typically developed adults. The findings suggest that children and adults with ASD may not display maladaptive postural responses all the time. In addition, adults in the ASD group may have difficulties prioritizing visual information in the central visual field over visual information in the peripheral visual field when in unfamiliar environments, which may have implications in understanding their motor behaviors in new surroundings.

Viewpoints of pedestrians with and without cognitive impairment on shared zones and zebra crossings.

BACKGROUND: Shared zones are characterised by an absence of traditional markers that segregate the road and footpath. Negotiation of a shared zone relies on an individual's ability to perceive, assess and respond to environmental cues. This ability may be impacted by impairments in cognitive processing, which may lead to individuals experiencing increased anxiety when negotiating a shared zone. METHOD: Q method was used in order to identify and explore the viewpoints of pedestrians, with and without cognitive impairments as they pertain to shared zones. RESULTS: Two viewpoints were revealed. Viewpoint one was defined by "confident users" while viewpoint two was defined by users who "know what [they] are doing but drivers might not". DISCUSSION: Overall, participants in the study would not avoid shared zones. Pedestrians with intellectual disability were, however, not well represented by either viewpoint, suggesting that shared zones may pose a potential barrier to participation for this group.

Standing Postural Control in Individuals with Autism Spectrum Disorder: Systematic Review and Meta-analysis.

Impairments in postural control affect the development of motor and social skills in individuals with autism spectrum disorder (ASD). This review compared the effect of different sensory conditions on static standing postural control between ASD and neurotypical individuals. Results from 19 studies indicated a large difference in postural control between groups across all sensory conditions. This review revealed sensorimotor and multiple sensory processing deficits in ASD. The tendency for individuals with ASD to be more susceptible to postural instability with use of visual information compared with somatosensory information suggests perinatal alterations in sensory development. There is further scope for studies on the use of sensory information and postural control to provide additional evidence about sensorimotor processing in ASD.

Hypermobility and Musculoskeletal Pain in Adolescents.

OBJECTIVE: To determine the prevalence of generalized joint hypermobility (GJH) in a large cohort of Australian children and determine the associations between GJH and musculoskeletal pain. STUDY DESIGN: This is a cross-sectional analysis of the Western Australian Pregnancy Cohort (Raine) Study. Hypermobility was measured in 1584 participants at 14 years of age using the Beighton scoring system, along with a range of other factors including musculoskeletal pain status. Logistic regression models were used to assess independent associations of GJH with factors of interest. RESULTS: The prevalence of GJH was 60.6% and 36.7% in girls and boys, respectively, when defined as a Beighton score of ≥4; when defined as ≥6, it was 26.1% and 11.5%. In girls, positive associations between GJH and higher socioeconomic status and better motor competence were observed. In boys, positive associations between GJH and lower body mass index were observed. After adjusting for potential confounders, an association between number of pain areas in the last month and made worse with sport were identified in boys but not girls. CONCLUSION: The high prevalence rates of GJH as defined by commonly used Beighton cutoff values in this cohort highlight the need to question the appropriateness of these cutoffs in future studies. Future prospective studies of the association between GJH and musculoskeletal pain should be adjusted for confounding variables identified in this study, and be powered for sex-specific analyses owing to the differing prevalence rates and hypermobility correlates in male and female samples.

Reliability of dynamometry to quantify isometric strength following traumatic brain injury.

OBJECTIVE: To investigate the within-session reliability and test-re-test reliability of hand-held dynamometry (HHD) to quantify strength in hip flexors, quadriceps, plantarflexors and triceps brachii following traumatic brain injury (TBI). DESIGN: Within-session reliability was examined across six consecutive trials of HHD. Test-re-test reliability was examined between two sessions separated by 7 days. SETTING: Private physical therapy practice, Melbourne, Australia. PARTICIPANTS: Ten adults with TBI with a mean age of 32.5 years (range = 19-63, SD = 12.8) and mean time after injury of 12.2 years (range = 2.3-26, SD = 8.6). MAIN OUTCOME MEASURES: Isometric strength measured by HHD. RESULTS: Test-re-test reliability of HHD following TBI was good when repeated tests occurred within a single session. Within a session, the first trial was the most variable out of the six examined. Of the four muscles examined, re-test measures of strength for the quadriceps, plantarflexors and triceps were the most reliable. For the hip flexors an increase greater than 3.1 kg (28%) was needed before real change could be detected. Test-re-test reliability was higher for muscles tested on the more affected side (ICC((2,1)) = 0.55-0.93) than muscles tested on the less affected side (ICC((2,1)) = 0.09-0.86). CONCLUSIONS: To gain a representative measure of isometric strength using HHD in a single session, three trials are recommended. The first is for familiarization and trials 2 and 3 are averaged to provide a typical measure of isometric muscle strength. Further research needs to occur but alternative methods to quantify muscle strength might be needed if repeated measures are to be performed over a 7-day interval.

Outcomes of progressive resistance strength training following stroke: a systematic review.

OBJECTIVE: To determine whether progressive resistance strength training reduces impairments, activity limitations and participation restrictions after stroke. METHODS: Electronic databases were searched to find trials conducted from 1966 to 2002. Articles were assessed independently by two reviewers according to the following inclusion criteria: (1) population: adults with stroke, (2) intervention: progressive resistive strength training in isolation, and (3) outcomes: changes in body function, physical activity or societal participation. RESULTS: From the 350 articles initially identified, eight met the criteria for detailed review. Three were randomized controlled trials, with the remainder being single-case time-series analyses or pre-post trials. The five trials that measured impairments of muscle strength showed positive outcomes for progressive resistance strength training, with large effect sizes (d = 1.2-4.5). Few negative effects of strength training were reported, and these were minor. Only three of the eight trials that measured activity limitations reported improvements in activities such as walking and stair climbing. The effects of strength training on societal participation could not be determined due to insufficient data. CONCLUSIONS: There is preliminary evidence that progressive resistance strength training programmes reduce musculoskeletal impairment after stroke. Whether strengthening enhances the performance of functional activities or participation in societal roles remains unknown.