Chronic Pain in the Lower Extremities and Low Back is Associated With Recurrent Falls in Community-Dwelling Japanese People Aged 40-74 Years.

OBJECTIVE: To determine the longitudinal association between chronic pain in the lower extremities and low back and the odds of recurrent falls in middle-aged and older people. DESIGN: A cohort study. SETTING: Communities in Japan. PARTICIPANTS: Participants were 7540 community-dwelling volunteers aged 40-74 years (N=7540). The baseline survey was a self-administered questionnaire conducted between 2011-2013. Predictors were presence of chronic pain in the knee, foot or ankle, and low back, with the degree of pain categorized as none, very mild/mild, moderate, or severe/very severe. Covariates in the multivariate model of chronic pain in a site were demographics, body mass index, physical activity level, disease history, and chronic pain in the other 2 sites. Logistic regression analysis was used to calculate odds ratios (ORs). INTERVENTIONS: None. MAIN OUTCOME MEASURE(S): Recurrent falls in the year before the 5-year follow-up survey. RESULTS: Mean participant age was 60.2 years. Higher degrees of chronic pain were associated with higher odds of recurrent falls for the knee (P=.0002) with a higher OR of 1.48 (95% CI: 1.11-1.97), for the foot or ankle (P=.0001) with a higher OR of 1.97 (95% CI: 1.36-2.86), and for the low back (P=.0470) with a higher OR of 1.45 (95% CI: 1.09-1.91) in those with any degree of pain relative to those without pain. Higher degrees of chronic knee pain were associated with higher odds of recurrent falls in women (P=.0005), but not in men (P=.0813). Meanwhile, higher degrees of chronic low back pain were associated with the odds of recurrent falls in men (P=.0065), but not in women (P=.8735). CONCLUSIONS: Chronic pain in the knee, foot or ankle, and lower back was independently and dose-dependently associated with a higher risk of recurrent falls. A marked sex-dependent difference was also noted in the association.

Effects of high-heeled shoes on lower extremity biomechanics and balance in females: a systematic review and meta-analysis.

BACKGROUND: High-heeled shoes (HHS) are widely worn by women in daily life. Limited quantitative studies have been conducted to investigate the biomechanical performance between wearing HHS and wearing flat shoes or barefoot. This study aimed to compare spatiotemporal parameters, kinematics, kinetics and muscle function during walking and balance between wearing HHS and flat shoes or barefoot. METHODS: According to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, PubMed Medline, Cochrane, EMBASE, CINAHL Complete and Web of Science databases were searched from the earliest record to December 2021. A modified quality index was applied to evaluate the risk of bias, and effect sizes with 95% confidence intervals were calculated as the standardized mean differences (SMD). Potential publication bias was evaluated graphically using funnel plot and the robustness of the overall results was assessed using sensitivity analyses. RESULTS: Eighty-one studies (n = 1501 participants) were included in this study. The reduced area of support requires the body to establish a safer and more stable gait pattern by changing gait characteristics when walking in HHS compared with walking in flats shoes or barefoot. Walking in HHS has a slight effect on hip kinematics, with biomechanical changes and adaptations concentrated in the knee and foot-ankle complex. Females wearing HHS performed greater ground reaction forces earlier, accompanied by an anterior shift in plantar pressure compared with those wearing flat shoes/barefoot. Furthermore, large effect sizes indicate that wearing HHS resulted in poor static and dynamic balance. CONCLUSION: Spatiotemporal, kinematic, kinetic and balance variables are affected by wearing HHS. The effect of specific heel heights on women's biomechanics would benefit from further research.

Editor's Choice - Systematic Review and Meta-Analysis of Lower Extremity Vascular Complications after Arterial Access for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): An Inevitable Concern?

OBJECTIVE: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporise non-compressible torso haemorrhage. Recent data have suggested that vascular access complications secondary to REBOA placement are higher than initially anticipated. This updated systematic review and meta-analysis aimed to determine the pooled incidence rate of lower extremity arterial complications after REBOA. DATA SOURCES: PubMed, Scopus, Embase, conference abstract listings, and clinical trial registries. REVIEW METHODS: Studies including more than five adults undergoing emergency REBOA for exsanguinating haemorrhage that reported access site complications were eligible for inclusion. A pooled meta-analysis of vascular complications was performed using the DerSimonian-Laird weights for the random effects model, presented as a Forest plot. Further meta-analyses compared the relative risk of access complications between different sheath sizes, percutaneous access techniques, and indications for REBOA. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies (MINORS) tool. RESULTS: No randomised controlled trials were identified, and the overall study quality was poor. Twenty-eight studies including 887 adults were identified. REBOA was performed for trauma in 713 cases. The pooled proportion rate of vascular access complications was 8.6% (95% confidence interval 4.97 - 12.97), with substantial heterogeneity (I2 = 67.6%). There was no significant difference in the relative risk of access complications between 7 and > 10 F sheaths (p = .54), or between ultrasound guided and landmark guided access (p = .081). However, traumatic haemorrhage was associated with a significantly higher risk of complications compared with non-traumatic haemorrhage (p = .034). CONCLUSION: This updated meta-analysis aimed to be as comprehensive as possible considering the poor quality of source data and high risk of bias. It suggested that lower extremity vascular complications were higher than originally suspected after REBOA. While the technical aspects did not appear to impact the safety profile, a cautious association could be drawn between REBOA use for traumatic haemorrhage and a higher risk of arterial complications.

Anomalías rotacionales en mujeres con hallux valgus. Estudio observacional / Rotational anomalies in women with hallux valgus. Observational study

Objetivos: Analizar las diferencias de lateralidad en el movimiento de rotación y torsión en la extremidad inferior y su posible influencia en el desarrollo del hallux abductus valgus.Pacientes y métodos: La muestra incluyó 129 mujeres. Se evaluó el grado de severidad del hallux abductus valgus, la rotación de cadera, la torsión tibial, la movilidad de la primera articulación metatarsofalángica, el índice postural del pie y el ángulo de progresión del pie. Resultados: Nuestros resultados mostraron que existían diferencias en la rotación externa entre ambas caderas de 2.34° (p < 0.001) y entre la rotación interna y externa de la cadera izquierda de 4.11° (p < 0.002). También se encontró una diferencia del ángulo de progresión del pie de 3° (p < 0.001), pero no hubo diferencias significativas entre la torsión tibial y el índice postural del pie (p > 0.05). Se encontró una diferencia en el rango de movimiento entre ambas primeras articulaciones metatarsofalángicas de 6.30° (p < 0.001), y se halló una relación entre la extensión y el rango de movimiento de la primera articulación metatarsofalángica y el hallux abductus valgus (p < 0.05). Conclusiones: En base a los resultados obtenidos en esta muestra, los datos apuntan a un mayor rango de movimiento de la primera articulación metatarsofalángica en el pie izquierdo. Los resultados también indican un probable predominio de rotación interna de la extremidad izquierda y de rotación externa de la extremidad derecha, que no mostraron asociación con el estadio del hallux abductus valgus en este estudio (AU)

Objectives: To analyze differences in laterality in rotational and torsional movement in the lower extremity and its possible influence on the development of hallux abductus valgus. Patients and methods: The sample included 129 women. The degree of severity of hallux abductus valgus, hip rotation, tibial torsion, mobility of the first metatarsophalangeal joint, foot posture index, and foot progression angle were evaluated. Results: Our results showed that there were differences in external rotation between both hips of 2.34° (p < 0.001) and between internal and external rotation of the left hip of 4.11° (p < 0.002). We also found a difference of the foot progression angle between feet of 3° (p < 0.001), but there was no significant difference between tibial torsion and foot posture index (p > 0.05). A difference in range of motion was found between both first metatarsophalangeal joints of 6.30° (p < 0.001), and a relationship was found between extension and range of motion of the first metatarsophalangeal joint and hallux abductus valgus (p < 0.05). Conclusions: Based on the results obtained in this sample, the data points to a greater range of motion of the first metatarsophalangeal joint in the left foot. The results also indicate a probable predominance of internal rotation of the left extremity and external rotation of the right extremity, which did not show asociation with the degree of hallux aductus valgus in this study (AU)

Theoretical discrimination index of postural instability in amyotrophic lateral sclerosis.

To assess the usefulness of a theoretical postural instability discrimination index (PIth) in amyotrophic lateral sclerosis (ALS). Prospective regression analyzes were performed to identify the biomechanical determinants of postural instability unrelated to lower limb motor deficits from gait initiation factors. PIth was constructed using a logit function of biomechanical determinants. Discriminatory performance and performance differences were tested. Backward displacement of the pression center (APAamplitude) and active vertical braking of the mass center (Braking-index) were the biomechanical determinants of postural instability. PIth = - 0.13 × APAamplitude - 0.12 × Braking-index + 5.67, (P < 0.0001, RSquare = 0.6119). OR (APAamplitude) and OR (Braking-index) were 0.878 and 0.887, respectively, i.e., for a decrease of 10 mm in APAamplitude or 10% in Braking-index, the postural instability risk was 11.391 or 11.274 times higher, respectively. PIth had the highest discriminatory performance (AUC 0.953) with a decision threshold value [Formula: see text] 0.587, a sensitivity of 90.91%, and a specificity of 83.87%, significantly increasing the sensitivity by 11.11%. PIth, as objective clinical integrator of gait initiation biomechanical processes significantly involved in dynamic postural control, was a reliable and performing discrimination index of postural instability with a significant increased sensitivity, and may be useful for a personalized approach to postural instability in ALS.

Efficacy of Enzyme Replacement Therapy on the range of motion of the upper and lower extremities in 16 Polish patients with mucopolysaccharidosis type II: A long-term follow-up study.

BACKGROUND: Enzyme replacement therapy (ERT) with idursulfase is available for patients with mucopolysaccharidosis (MPS) type II, and improvements in certain somatic signs and symptoms have been reported. The aim of the study was to assess the effectiveness of ERT with idursulfase (Elaprase®) on the passive joint range of motion (JROM) in the upper and lower extremities of patients with MPS II. METHODS: The study included 16 Polish patients diagnosed with MPS II and followed in our Institute in the years 2009-2016. The study group was divided for groups of neuronopathic (group 1, n=12) and non-neuronopathic (group 2, n=4) patients. A passive JROM was measured with a goniometer by one physiotherapist, while in group 1 it was assessed at baseline and after both short-term (52 weeks) and long-term (mean 230 weeks, range: 108-332 weeks) ERT. In group 2, it was assessed at baseline and after short-term ERT (68-85 weeks, no data for long-term ERT). RESULTS: In group 1, after 52 weeks of ERT, we observed some improvement of passive ROM in wrist flexion (5/12 patients), shoulder abduction and wrist extension (3/12 patients), shoulder flexion, elbow and knee extension (2/12 patients). After long-term ERT (mean 230 weeks), the improvement in JROM was observed only in 2 patients. There was no improvement in the shoulder abduction, elbow flexion and extension, hip and knee extension. In group 2, the improvement in passive ROM was observed in several joints: shoulder flexion, wrist flexion and extension improved (2/4 patients) and shoulder abduction (1/4 patients). CONCLUSION: ERT is of low efficacy on correcting the range of motion of joints in MPS II patients.

Correlation between frail status and lower extremity function in elderly inpatients with hypertension / Correlación entre estado frágil y función muscular de pacientes ancianos hospitalizados con hipertensión

Introduction: the frail status of elderly hypertensive patients easily damages the function of many physiological systems. Objectives: we aimed to investigate the correlation between the frail status and lower extremity function of elderly hospitalized patients with hypertension Methods: a total of 336 eligible subjects were assigned to frail, pre-frail and non-frail groups according to the “Frail” scale. Lower extremity function was assessed by the Short Physical Performance Battery including chair-sit-to-stand, three-posture balance and 6-meter gait speed tests. The influences of factors on frailty were evaluated using the Cox multivariate regression analysis. The correlation between frailty score and lower extremity function score was explored by Spearman's analysis. The values of factors for predicting frail status were analyzed by plotting receiver operating characteristic (ROC) curves. Results: the three groups had similar age, systolic blood pressure, and nutritional, sleepiness and lower extremity function statuses (p < 0.05). Compared with the non-frail group, the lower extremity function score of the frail group was lower (p < 0.05). Age, systolic blood pressure and sleepiness status were the independent risk factors of frailty (p < 0.05), and lower extremity function parameters were independent protective factors (p < 0.05). There were negative correlations between frail status and lower extremity function parameters (p < 0.05). The area under the ROC curve was 0.850, and the optimal cutoff value was 7.80. Lower extremity function had a high value for predicting frail status. Conclusions: lower extremity function is negatively correlated with the frail status of elderly hospitalized patients with hypertension, as a protective factor of frailty, which can be used to predict frail status (AU)

Introducción: el estado frágil de los pacientes hipertensos de edad avanzada daña fácilmente la función de muchos sistemas fisiológicos. Objetivos: nuestro objetivo fue investigar la correlación entre el estado frágil y la función muscular de pacientes ancianos hospitalizados con hipertensión. Métodos: un total de 336 sujetos elegibles fueron asignados a grupos de frágiles, pre-frágiles y no frágiles de acuerdo con la escala de fragilidad. La función muscular se evaluó mediante la batería de rendimiento físico corto, que incluye las pruebas de sentarse y levantarse de una silla, equilibrio de tres posturas y velocidad de marcha de 6 metros. Las influencias de los factores sobre la fragilidad se evaluaron mediante el análisis de regresión multivariante de Cox. La correlación entre el puntaje de fragilidad y el puntaje de función muscular se exploró con el análisis de Spearman. Los valores de los factores para predecir el estado frágil se analizaron mediante el trazado de curvas características de funcionamiento del receptor (ROC). Resultados: los tres grupos tenían edades similares y valores similares de presión arterial sistólica y estado nutricional, somnolencia y función muscular (p < 0,05). En comparación con el grupo no frágil, la puntuación de la función muscular del grupo frágil fue menor (p < 0,05). La edad, la presión arterial sistólica y el estado de somnolencia fueron los factores de riesgo independientes de fragilidad (p < 0,05), y los parámetros de función muscular fueron factores protectores independientes (p < 0,05). Hubo correlaciones negativas entre el estado frágil y los parámetros de la función muscular (p < 0,05). El área bajo la curva ROC fue de 0,850 y el valor de corte óptimo fue de 7,80. La función muscular tuvo un valor alto para predecir el estado frágil (AU)

Neural coupling between upper and lower limb muscles in Parkinsonian gait.

OBJECTIVE: To explore to what extent neuronal coupling between upper and lower limb muscles during gait is preserved or affected in patients with Parkinson's Disease (PD). METHODS: Electromyography recordings were obtained from the bilateral deltoideus anterior and bilateral rectus femoris and biceps femoris muscles during overground gait in 20 healthy participants (median age 69 years) and 20 PD patients (median age 68.5 years). PD patients were able to walk independently (Hoehn and Yahr scale: Stage 2-3), had an equally distributed symptom laterality (6 left side, 7 both sides and 7 right side) and no cognitive problems or tremor dominant PD. Time-dependent directional intermuscular coherence analysis was employed to compare the neural coupling between upper and lower limb muscles between healthy participants and PD patients in three different directions: zero-lag (i.e. common driver), forward (i.e. shoulders driving the legs) and reverse component (i.e. legs driving the shoulders). RESULTS: Compared to healthy participants, PD patients exhibited (i) reduced intermuscular zero-lag coherence in the beta/gamma frequency band during end-of-stance and (ii) enhanced forward as well as reverse directed coherence in the alpha and beta/gamma frequency bands around toe-off. CONCLUSIONS: PD patients had a reduced common cortical drive to upper and lower limb muscles during gait, possibly contributing to disturbed interlimb coordination. Enhanced bidirectional coupling between upper and lower limb muscles on subcortical and transcortical levels in PD patients suggests a mechanism of compensation. SIGNIFICANCE: These findings provide support for the facilitating effect of arm swing instructions in PD gait.

Factors associated with response to compression-based physical therapy for secondary lower limb lymphedema after gynecologic cancer treatment: a multicenter retrospective study.

BACKGROUND: Lower limb lymphedema (LLL) is one of the most refractory and debilitating complications related to gynecological cancer treatment. We investigated factors associated with response to compression-based physical therapy (CPT) for secondary LLL after gynecologic cancer treatment. METHODS: We performed a multicenter retrospective study using the records of seven medical institutions from 2002 and 2014. Patients who developed LLL after gynecological cancer treatment were included. Limb volumes were calculated from the lengths of the limb circumferences at four points. All participants underwent compression-based physical therapy for LLL. Factors, including MLD, indicative of circumference reductions in LLL were determined. RESULTS: In total, 1,034 LLL met the required criteria of for the study. A multivariate linear regression analysis identified age; body mass index (BMI); endometrial cancer; radiotherapy; and initial limb circumference as significant independent prognostic factors related to improvement in LLL. In analysis of covariance for improvement in LLL adjusted by the initial limb circumference and stratified by BMI and radiotherapy, patients with BMI 28 kg/m2 or higher and receiving radiation rarely responded to CPT. CONCLUSIONS: Improvements in the lower limb circumference correlated with clinical histories and physical characteristics, which may be used as independent prognostic factors for successful CPT for LLL after gynecological cancer treatment.

Spinal muscular atrophy with predominant lower extremity (SMA-LED) with no signs other than pure motor symptoms at the intersection of multiple overlap syndrome.

BACKGROUND: Mutations in the cytoplasmic dynein 1 heavy chain gene (DYNC1H1) have been associated with spinal muscular atrophy with predominant lower extremity involvement (SMA-LED), Charcot-Marie-Tooth 2O (CMT2O) disease, cortical migration anomalies, and autosomal dominant mental retardation13. SMA-LED phenotype-related mutation was found in the DYNC1H1 gene in the patient who applied with the complaint of gait disturbance. METHODS: Pathogenic heterozygous c.1678G > A (p.Val560Met) mutation was detected in the DYNC1H1 gene by next-generation targeted gene analysis in the patient who had no phenotypic findings except delayed motor milestones, lumbar lordosis, and lower extremity muscle weakness. The patient's creatinine phosphokinase enzyme level and brain magnetic resonance imaging (MRI) were normal. Electromyography (EMG) had pure motor findings. CONCLUSION: It should be kept in mind that DYNC1H1 mutation, which we are accustomed to seeing with accompanying findings such as orthopedic and ocular dysmorphic findings, sensorineural EMG findings, and intellectual disability, can also observe with pure motor findings such as muscular dystrophy examination findings.

Effectiveness of a Novel Contralaterally Controlled Neuromuscular Electrical Stimulation for Restoring Lower Limb Motor Performance and Activities of Daily Living in Stroke Survivors: A Randomized Controlled Trial.

Background: Contralaterally controlled neuromuscular electrical stimulation (CCNMES) is a novel electrical stimulation treatment for stroke; however, reports on the efficacy of CCNMES on lower extremity function after stroke are scarce. Objective: To compare the effects of CCNMES versus NMES on lower extremity function and activities of daily living (ADL) in subacute stroke patients. Methods: Forty-four patients with a history of subacute stroke were randomly assigned to a CCNMES group and a NMES group (n = 22 per group). Twenty-one patients in each group completed the study per protocol, with one subject lost in follow-up in each group. The CCNMES group received CCNMES to the tibialis anterior (TA) and the peroneus longus and brevis muscles to induce ankle dorsiflexion motion, whereas the NMES group received NMES. The stimulus current was a biphasic waveform with a pulse duration of 200 µs and a frequency of 60 Hz. Patients in both groups underwent five 15 min sessions of electrical stimulation per week for three weeks. Indicators of motor function and ADL were measured pre- and posttreatment, including the Fugl-Meyer assessment of the lower extremity (FMA-LE) and modified Barthel index (MBI). Surface electromyography (sEMG) assessments included average electromyography (aEMG), integrated electromyography (iEMG), and root mean square (RMS) of the paretic TA muscle. Results: Values for the FMA-LE, MBI, aEMG, iEMG, and RMS of the affected TA muscle were significantly increased in both groups after treatment (p < 0.01). Patients in the CCNMES group showed significant improvements in all the measurements compared with the NMES group after treatment. Within-group differences in all post- and pretreatment indicators were significantly greater in the CCNMES group than in the NMES group (p < 0.05). Conclusion: CCNMES improved motor function and ADL ability to a greater extent than the conventional NMES in subacute stroke patients.

Measuring Effects on Pain and Quality of Life after Abobotulinum Toxin A Injections in Children with Cerebral Palsy.

Sixty-seven percent of children with cerebral palsy (CCP) experience pain. Pain is closely interrelated to diminished quality of life. Despite this, pain is an overlooked and undertreated clinical problem. The objective of this study was to examine the analgesic effect of a single lower extremity intramuscular injection of Abobotulinum toxin A/Dysport in CCP. Twenty-five CCP with at least moderate pain (r-FLACC ≥ 4) during passive range of motion were included. Localized pain and pain in everyday living were measured by r-FLACC and the Paediatric Pain Profile (PPP), respectively. Functional improvements were evaluated by the goal attainment scale (SMART GAS). Quality of life was evaluated by either the CPCHILD or the CP-QOL. The subjects were evaluated at baseline before injection, then after 4, 12, and 28 weeks. Twenty-two subjects had a significant mean and maximum localized pain reduction (p < 0.001) at four weeks post-treatment in 96% (21/22). The reduction was maintained at 12 (19/19) and 28 weeks (12/15). Daily pain evaluated by the PPP was significantly reduced and functional SMART GAS goals were significantly achieved from 4 to 28 weeks. Quality of life improved significantly at four weeks (CPCHILD). Significant functional gains and localized and daily pain reduction were seen from 4 to 28 weeks.

Impact of Internal Malrotation of the Femur Followed by Derotational Osteotomy as Demonstrated by 3D Gait Analysis: A Case Report.

CASE: An 18-year-old man with 48° of internal malrotation of the femur after nailing underwent derotational osteotomy with gait dynamics and electromyography data collected preoperatively and postoperatively. Hip abduction and internal foot progression angles were significantly deviated from normal preoperatively compared with the contralateral side. At 10 months postoperatively, the hip was abducted and externally rotated throughout the entire gait cycle. His Trendelenburg gait had resolved, and he reported no residual functional concerns. Before corrective osteotomy, walking velocity was significantly slower with shorter stride lengths. CONCLUSION: Significant internal malrotation of the femur impairs hip abduction and foot progression angles as well as gluteus medius activation during ambulation. Derotational osteotomy considerably corrected these values.

Elevated Kinesiophobia Is Associated With Reduced Recovery From Lower Extremity Musculoskeletal Injuries in Military and Civilian Cohorts.

OBJECTIVE: The purpose of this study was to examine associations between level of kinesiophobia and improvement in physical function during recovery from lower extremity injury. METHODS: A total 430 adults (mean [SD]: age = 27.3 [6.4] years; sex = 70.5% men; body mass index = 27.6 [5.2] kg/m2) were included in the analyses. Using the Patient-Reported Outcomes Measurement Information System, physical function was evaluated in parallel with treatment from a physical therapist at the initial visit and every 3 weeks until final visit or up to 6 months. A Tampa Scale of Kinesiophobia (TSK-17) score of >41 indicated elevated TSK. Four TSK groups were identified: (1) TSK score improved from >41 at initial visit to <41 by final visit (TSK_I), (2) TSK score was <41 at initial and final visits (TSK-), (3) TSK score was >41 at initial and final visits (TSK+), and (4) TSK score worsened from <41 at initial visit to ≥41 by final visit (TSK_W). Linear mixed effects models were used to examine differences between groups in improved physical function over time, with adjustment for depression and self-efficacy. RESULTS: Groups with elevated kinesiophobia at the final visit had smaller positive improvements in physical function (mean change [95% CI]: TSK+ = 7.1 [4.8-9.4]; TSK_W: 6.0 [2.6-9.4]) compared with groups without elevated kinesiophobia at the final visit (TSK_I = 9.8 [6.4-13.3]; TSK- = 9.7 [8.1-11.3]) by 12 weeks. CONCLUSIONS: Elevated kinesiophobia that persists or develops over the course of care is associated with less improvement in physical function within military and civilian cohorts. IMPACT: The findings of this prospective longitudinal study support the need to assess for elevated kinesiophobia throughout the course of care because of its association with decreased improvement in physical function. LAY SUMMARY: To help improve your physical function, your physical therapist can monitor the interaction between fear of movement and your clinical outcomes over the course of treatment.

Psychometric Properties of Lower Limb Somatosensory Function and Body Awareness Outcome Measures in Children with Upper Motor Neuron Lesions: A Systematic Review.

PURPOSE: A systematic review of the psychometric properties and feasibility of outcome measures assessing lower limb somatosensory function and body awareness in children with upper motor neuron lesion. METHODS: We followed the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. Two raters independently judged the quality and risk of bias of each study. Data synthesis was performed, and aspects of feasibility were extracted. RESULTS: Twelve studies investigated eleven somatosensory function measures quantifying four modalities and eight body awareness measures quantifying two modalities. The best evidence synthesis was very low to low for somatosensory function modalities and low for body awareness modalities. Few feasibility aspects were reported (e.g., the percentage or minimum age of participants able to perform the tests). CONCLUSION: Current evidence on the psychometric characteristics of somatosensory function and body awareness outcome measures are relatively sparse. Further research on psychometric properties and practical application is needed.

Quality of life evaluation and lack of correlation with volumetric results after lymphovenous anastomoses in lymphedema therapy of the lower extremity.

OBJECTIVE: Chronic primary or secondary lymphedema has huge effects on patients' quality of life (QOL) because of the associated swelling and pain, decreased range of motion, and depression and anxiety and generally requires numerous adaptations. Many studies have shown a positive objective effect of lymphovenous anastomoses (LVAs) on chronic lymphedema. In the present study, we assessed the effect of LVAs on QOL in patients with primary or secondary lymphedema of the lower extremity at 6 months after surgery and examined the correlation between changes in the QOL and volumetric measurements. METHODS: Only patients with either primary or secondary lymphedema of the lower extremity who had undergone LVAs were included in the present study. To assess QOL, a specially designed questionnaire based on the Lymphedema Quality of Life Inventory was used to evaluate the subjective therapeutic results from the patients' perspective. Objective therapy success was assessed using three-dimensional volumetric measurements of the lower leg. The measuring points, for both the subjective and the objective measurements, were the day before and 6 months after therapy. RESULTS: The mean change in volume at 6 months after LVA was -6.5% ± 5.6% (P < .001). Significantly better QOL in terms of physical (37.6% ± 25.2%) and psychosocial (27.0% ± 43.0%) domains and practical restrictions (22.3% ± 24.8%) was found (P < .001 for all). No correlation was found between QOL improvement and volume decrease (P > .05). CONCLUSIONS: For patients with lymphedema of the lower extremity, LVAs can lead to a significant volumetric decrease and QOL improvement at 6 months after treatment with no demonstrable relationship between QOL improvement and volume reduction.

Improvements in lower-extremity patient-reported outcomes after lumbar interbody fusion.

OBJECTIVE: Recently, new patient-reported outcome measures (PROMs) of the spine were designed to overcome the limitations of previous spinal PROMs and to consider the whole spine as a single kinetic functional unit. Owing to the significance of spine-hip-knee and global body balance, the spine and lower extremities cannot be considered separately. However, no reports have evaluated lower-extremity functional outcome using PROMs after lumbar spine surgery. The authors aimed to elucidate changes in hip and knee PROMs after lumbar interbody fusion and to evaluate the sagittal spinopelvic radiographic parameters that were most strongly correlated with lower-extremity PROMs. METHODS: In 2018, the authors consecutively evaluated patients who underwent lumbar interbody fusion surgery with at most three levels. Preoperative and 1-year postoperative clinical and radiographic data were assessed. Spinal functional outcomes were measured with the Oswestry Disability Index (ODI), visual analog scale (VAS) for pain, and Scoliosis Research Society-22r (SRS-22r) questionnaire. Lower-extremity functional outcomes were evaluated with the Harris Hip Score (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Linear regression was used to evaluate the relationship between spinal and lower-extremity PROMs and spinopelvic radiographic parameters. RESULTS: The authors enrolled 67 patients, with a mean age of 66.4 years. The average number of surgical levels was 1.7. All assessed PROMs improved significantly after surgery (p < 0.001 for ODI, p < 0.001 for VAS, p = 0.017 for SRS-22r, p = 0.042 for HHS, and p = 0.033 for WOMAC). Spinopelvic parameters, including lumbar lordosis (LL), pelvic tilt (PT), C7 sagittal vertical axis, and sagittal radiographic parameters of hip and knee, significantly improved after surgery. On linear regression analysis, HHS and WOMAC correlated with LL and PT, respectively (ß = 0.554 and p = 0.043 for correlation of HHS with LL; ß = 1.573 and p = 0.021 for correlation of WOMAC with PT). CONCLUSIONS: The current study demonstrated that lumbar fusion surgery may induce postoperative improvements in lower-extremity functional and radiological outcomes. However, among radiographic parameters, changes in LL and PT were the most strongly associated with lower-extremity PROMs.