Is hip morphology a risk factor for developing hip osteoarthritis? A systematic review with meta-analysis.

OBJECTIVE: To appraise the highest evidence on hip morphology as a risk factor for developing hip osteoarthritis (OA). DESIGN: We searched for studies evaluating the association between radiological hip morphology parameters and the prevalence, incidence or progression of hip OA (based on different radiographic and clinical criteria) in the MEDLINE, EMBASE, Web of Science, Scopus, Cochrane Library and PEDro databases from inception until June 2020. Prospective and cross-sectional studies were separately evaluated. Data are presented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: We included 9 prospective and 21 cross-sectional studies in the meta-analysis, and evaluated 42,831 hips from 25,898 individuals (mean age: 59 years). Prospective studies showed that, compared with control hips, hips with cam morphology (alpha angle >60°; OR = 2.52, 95% CI: 1.83 to 3.46, P < 0.001) or hip dysplasia (lateral center-edge angle (LCEA) <25°; OR = 2.38, 95% CI: 1.84 to 3.07, P < 0.001), but not hips with pincer morphology (LCEA >39°; OR = 1.08, 95% CI: 0.57 to 2.07, P = 0.810), were more likely to develop hip OA than hips without these morphologies. Cross-sectional studies showed a greater prevalence of pincer morphology (LCEA >39°, OR = 3.71, 95% CI: 2.98 to 4.61, P < 0.001) and acetabular retroversion (crossover sign; OR = 2.65, 95% CI: 1.17 to 6.03, P = 0.020) in hips with OA than in control hips. CONCLUSION: Cam morphology and hip dysplasia were consistently associated with the development of hip OA. Pincer morphology was associated with hip OA in cross-sectional but not in prospective studies. The heterogeneous quantification of pincer morphology on radiographs limits a clear conclusion on its association with hip OA.

Statistical shape modeling of the hip and the association with hip osteoarthritis: a systematic review.

OBJECTIVE: To summarize available evidence on the association between hip shape as quantified by statistical shape modeling (SSM) and the incidence or progression of hip osteoarthritis. DESIGN: We conducted a systematic search of five electronic databases, based on a registered protocol (available: PROSPERO CRD42020145411). Articles presenting original data on the longitudinal relationship between radiographic hip shape (quantified by SSM) and hip OA were eligible. Quantitative meta-analysis was precluded because of the use of different SSM models across studies. We used the Newcastle-Ottawa Scale (NOS) for risk of bias assessment. RESULTS: Nine studies (6,483 hips analyzed with SSM) were included in this review. The SSM models used to describe hip shape ranged from 16 points on the femoral head to 85 points on the proximal femur and hemipelvis. Multiple hip shape features and combinations thereof were associated with incident or progressive hip OA. Shape variants that seemed to be consistently associated with hip OA across studies were acetabular dysplasia, cam morphology, and deviations in acetabular version (either excessive anteversion or retroversion). CONCLUSIONS: Various radiographic, SSM-defined hip shape features are associated with hip OA. Some hip shape features only seem to increase the risk for hip OA when combined together. The heterogeneity of the used SSM models across studies precludes the estimation of pooled effect sizes. Further studies using the same SSM model and definition of hip OA are needed to allow for the comparison of outcomes across studies, and to validate the found associations.

Factors influencing bilateral deficit and inter-limb asymmetry of maximal and explosive strength: motor task, outcome measure and muscle group.

PURPOSE: The purpose of the present study was to investigate the influence of strength outcome [maximal voluntary contraction (MVC) torque vs. rate of torque development (RTD)], motor task (unilateral vs. bilateral) and muscle group (knee extensors vs. flexors) on the magnitude of bilateral deficits and inter-limb asymmetries in a large heterogeneous group of athletes. METHODS: 259 professional/semi-professional athletes from different sports (86 women aged 21 ± 6 years and 173 men aged 20 ± 5 years) performed unilateral and bilateral "fast and hard" isometric maximal voluntary contractions of the knee extensors and flexors on a double-sensor dynamometer. Inter-limb asymmetries and bilateral deficits were compared across strength outcomes (MVC torque and multiple RTD measures), motor tasks and muscle groups. RESULTS: Most RTD outcomes showed greater bilateral deficits than MVC torque for knee extensors, but not for knee flexors. Most RTD outcomes, not MVC torque, showed higher bilateral deficits for knee extensors compared to knee flexors. For both muscle groups, all RTD measures resulted in higher inter-limb asymmetries than MVC torque, and most RTD measures resulted in greater inter-limb asymmetries during unilateral compared to bilateral motor tasks. CONCLUSIONS: The results of the present study highlight the importance of outcome measure, motor task and muscle group when assessing bilateral deficits and inter-limb asymmetries of maximal and explosive strength. Compared to MVC torque and bilateral tasks, RTD measures and unilateral tasks could be considered more sensitive for the assessment of bilateral deficits and inter-limb asymmetries in healthy professional/semi-professional athletes.

Reproducibility and validity of the Italian version of the International Physical Activity Questionnaire in obese and diabetic patients.

PURPOSE: Aims of this study were to evaluate the agreement between the short and long versions of the International Physical Activity Questionnaire (IPAQ: Italian versions), their reproducibility (agreement and reliability) and construct validity (relative to pedometry) in a clinical population. METHODS: Ninety patients affected by obesity (N = 39), type 2 diabetes mellitus (N = 26) or both (N = 25) were recruited. They were asked to maintain their usual physical activity habits during two consecutive weeks and to fill the questionnaires twice (at the end of each week). They were also asked to wear a pedometer for 7 consecutive days after the first administration of the questionnaires. RESULTS: We found acceptable agreement between the IPAQ short and long versions (ICC2,1 values were 0.81 and 0.77 for the 1st and 2nd administration), uncertain reproducibility (acceptable reliability but poor agreement) and inadequate validity relative to pedometry (the correlation coefficients between all IPAQ scores and daily steps were <0.50) for both IPAQ short and IPAQ long. CONCLUSIONS: The IPAQ use may be justified in daily clinical practice and in clinical research (e.g., in cross-sectional studies) for a simple and rapid evaluation of the physical activity level for discriminative purposes. However, the use of these questionnaires does not appear suitable for prospective interventional studies in which the level of physical activity of the recruited patients has to be assessed over time.

Direct and crossed effects of somatosensory electrical stimulation on motor learning and neuronal plasticity in humans.

PURPOSE: Sensory input can modify voluntary motor function. We examined whether somatosensory electrical stimulation (SES) added to motor practice (MP) could augment motor learning, interlimb transfer, and whether physiological changes in neuronal excitability underlie these changes. METHODS: Participants (18-30 years, n = 31) received MP, SES, MP + SES, or a control intervention. Visuomotor practice included 300 trials for 25 min with the right-dominant wrist and SES consisted of weak electrical stimulation of the radial and median nerves above the elbow. Single- and double-pulse transcranial magnetic stimulation (TMS) metrics were measured in the intervention and non-intervention extensor carpi radialis. RESULTS: There was 27 % motor learning and 9 % (both p < 0.001) interlimb transfer in all groups but SES added to MP did not augment learning and transfer. Corticospinal excitability increased after MP and SES when measured at rest but it increased after MP and decreased after SES when measured during contraction. No changes occurred in intracortical inhibition and facilitation. MP did not affect the TMS metrics in the transfer hand. In contrast, corticospinal excitability strongly increased after SES with MP + SES showing sharply opposite of these effects. CONCLUSION: Motor practice and SES each can produce motor learning and interlimb transfer and are likely to be mediated by different mechanisms. The results provide insight into the physiological mechanisms underlying the effects of MP and SES on motor learning and cortical plasticity and show that these mechanisms are likely to be different for the trained and stimulated motor cortex and the non-trained and non-stimulated motor cortex.

Hip flexor muscle fatigue in patients with symptomatic femoroacetabular impingement.

PURPOSE: Patients with symptomatic femoroacetabular impingement (FAI) have considerable hip muscle weakness, in particular, hip flexion and hip adduction. In addition, they experience disabilities while performing prolonged dynamic tasks. It was therefore postulated that, besides hip flexor muscle weakness, patients with symptomatic FAI would show greater hip flexor fatigue compared with healthy controls. METHODS: Hip flexor fatigue was evaluated in two different experiments. Fifteen patients with symptomatic FAI and 15 age-matched healthy controls were tested in each experiment. In the first one, changes in hip flexor torque fluctuations and electromyographic (EMG) activity were measured during a sustained submaximal isometric contraction. In the second experiment, hip flexor torque decline was measured during a series of 20 maximal dynamic contractions. RESULTS: Patients with FAI exhibited hip flexor weakness under both isometric (P = 0.02) and isokinetic conditions (P = 0.03). Fatigue-induced changes in isometric hip flexor torque fluctuations, EMG root mean square and median frequency did not differ significantly between patients and controls (P > 0.05). Similarly, isokinetic hip flexor torque decline was comparable in patients with FAI and controls (P > 0.05). CONCLUSIONS: None of the hip flexor fatigue outcomes considered here differed between patients with symptomatic FAI and controls. Therefore, the disabilities that patients experience while performing prolonged dynamic tasks do not seem to be caused by exaggerated hip flexor muscle fatigue.

Hip muscle weakness in patients with symptomatic femoroacetabular impingement.

OBJECTIVE: Femoroacetabular impingement (FAI) is a pathomechanical process, which may cause hip pain, disability and early development of hip osteoarthritis (OA) in young and active adults. Patients with FAI experience functional disability during dynamic weight-bearing activities, which could originate from weakness of the hip muscles. The objective of this study was to compare hip muscle strength between patients with symptomatic FAI and healthy controls. It was hypothesized that patients would present overall hip muscle weakness compared to controls. METHODS: A total of 22 FAI patients and 22 controls matched for gender, age, and body mass participated in the study. We evaluated isometric maximal voluntary contraction (MVC) strength of all hip muscle groups using hand-held and isokinetic dynamometry, and electromyographic (EMG) activity of the rectus femoris (RF) and tensor fasciae latae (TFL) muscles during active flexion of the hip. RESULTS: FAI patients had significantly lower MVC strength than controls for hip adduction (28%), flexion (26%), external rotation (18%) and abduction (11%). TFL EMG activity was significantly lower in FAI patients compared with controls (P=0.048), while RF EMG activity did not differ significantly between the two groups (P=0.056). CONCLUSIONS: Patients with symptomatic FAI presented muscle weakness for all hip muscle groups, except for internal rotators and extensors. Based on EMG recordings, it was demonstrated that patients with symptomatic FAI have a reduced ability to activate TFL muscle during hip flexion. These findings provide orthopedic surgeons with objective information about the amount and specificity of hip muscle weakness in patients with FAI. Future research should investigate the relationship between hip muscle weakness, functional disability and overuse injury risks, as well as the effects of hip muscle strengthening on clinical outcomes in individuals with symptomatic FAI.

Differences in twitch potentiation between voluntary and stimulated quadriceps contractions of equal intensity.

This study compared the extent of twitch and M-wave potentiation (POT) between voluntary and stimulated quadriceps contractions performed at the same intensity. Sixteen healthy men completed 10-s isometric knee extensions at 40% of the maximal voluntary contraction torque under electrical stimulation and voluntary conditions. Single stimuli were delivered to the femoral nerve to evoke twitches before (PRE) and from 3 to 600 s after the end of each conditioning contraction. Changes in twitch contractile properties and M-wave characteristics were compared between the conditions. The extent of twitch peak torque POT was smaller for the stimulated (122+/-20% of PRE) than for the voluntary condition (133+/-20% of PRE). The magnitude of POT for the maximal rate of twitch torque development was also smaller for the stimulated trial. Rectus femoris M-wave amplitude was potentiated by the voluntary but not by the stimulated contraction. It was concluded that stimulated contractions resulted in smaller twitch and M-wave POT than voluntary contractions, despite equivalent torque output and duration. The spatially and temporally fixed recruitment of motor units with electrical stimulation and therefore the lower number of activated motor units compared with voluntary actions of equal intensity could explain the present findings.

Early vs. late rate of torque development: Relation with maximal strength and influencing factors.

We re-examined the relationship between rate of torque development (RTD) and maximal voluntary contractions (MVC) torque, and investigated some possible neuromuscular determinants of early (≤100 ms) and late (≥200 ms) RTD. Seventeen healthy men performed maximal explosive isometric knee extensions at five joint angles, from which MVC torque, RTD at different time intervals (50-250 ms), and early quadriceps EMG activity (EMG50) were evaluated. Quadriceps muscle thickness (MT) was quantified by longitudinal ultrasonography. The relationship between MVC torque, EMG50 and MT against RTD was assessed with Pearson's and repeated measures correlation coefficients. Moderate-to-strong correlation coefficients were observed between MVC torque and RTD (r = 0.50-0.88, p < 0.001), with stronger relationships for late RTD than for early RTD. Weak-to-strong correlation coefficients were observed amongst RTD and EMG50 (r = 0.37-0.83, p < 0.001), with stronger relationships for early RTD than for late RTD. Only late RTD was significantly correlated with MT, though only moderately (r = 0.50-0.52, p < 0.05). These findings suggest that early and late knee extension RTD are potentially governed by different neuromuscular factors. Neuromuscular activation seems to have a greater influence on early RTD than on late RTD, and vice versa for muscle mass.

Deficits in rate of torque development are accompanied by activation failure in patients with knee osteoarthritis.

Aim of this study was to investigate if knee extensor maximal voluntary contraction (MVC) torque and rate of torque development (RTD) deficits are accompanied by neuromuscular activation failure in patients with knee osteoarthritis (KOA). Nineteen patients with unilateral KOA completed gradual MVCs, from which MVC torque, voluntary activation and maximal EMG activity were recorded, and explosive MVCs, from which RTD and rate of EMG rise were recorded. For gradual MVCs, MVC torque (-28%), voluntary activation (-6%) and maximal EMG activity (-30%) were lower on the involved than on the uninvolved side (p < 0.001). Asymmetries in MVC torque and maximal EMG activity were positively correlated (r = 0.70; p < 0.001). For explosive MVCs, involved-side RTD (-19%) and rate of EMG rise (-20%) were lower compared to the uninvolved side (p < 0.05-0.001). Asymmetries in RTD and rate of EMG rise were positively correlated (r = 0.61-0.80; p < 0.01). Deficits in isometric knee extensor strength were accompanied by neuromuscular activation failure during gradual MVCs and, more importantly, during the early phase of explosive MVCs. Such inability to rapidly activate the quadriceps may have functional consequences and warrants greater attention in the evaluation and rehabilitation of patients with KOA.

Changes in body composition, physical performance and cardiovascular risk factors after a 3-week integrated body weight reduction program and after 1-y follow-up in severely obese men and women.

OBJECTIVE: To investigate the short- and medium-term (ie, at 1-y follow-up) effects of a hospital-based body weight reduction (BWR) program lasting 3 weeks in severely obese individuals. DESIGN: Longitudinal, clinical intervention study entailing energy-restricted diet, tailored aerobic-strength exercise, psychological counselling and nutritional education during a 3-week period followed by 49 weeks of indirect supervision at home. SUBJECTS: In all, 45 women and 19 men aged 30.2 +/- 7.2 y (mean +/- s.d.) with severe obesity (BMI: 41.3 +/- 4.3 kg/m(2)), classified as weight losers (final < initial weight) and regainers (final> or =initial weight). INTERVENTIONS: Body composition, physical performance and cardiovascular risk factors before and after the BWR program and at follow-up. RESULTS: The large majority of the experimental subjects obtained a clinical success after the 1-y period, and the rate was higher in females (n = 37/45, ie, 82.2%) than in males (n = 11/19, ie, 57.9%). At follow-up, weight losers had higher percent fat-free mass, muscle strength, HDL-cholesterol and self-reported physical activity level and lower total cholesterol and glucose levels than weight regainers (P < 0.05-0.01). Males displayed significantly larger fat-free mass losses than females at post-BWR and at follow-up. CONCLUSIONS A 3-week hospital-based integrated BWR program resulted in a high rate of clinical success in severely obese individuals at 1-y follow-up (particularly in females), that was associated with increased levels of self-reported physical activity and improved muscle strength and lipid profile. Further research is needed to establish the long-term effects (ie, at 2-5 y) associated to this treatment.

Electrical and mechanical H(max)-to-M(max) ratio in power- and endurance-trained athletes.

The aim of this study was to compare the mechanical and electromyographic (EMG) characteristics of soleus motor units activated during maximal H reflex and direct M response among subjects with different histories of physical activity. Power-trained athletes produced stronger twitches, with a higher rate of twitch tension buildup and relaxation, than their endurance counterparts for both maximal H-reflex and maximal M-wave responses. The maximal H-reflex-to-maximal M-wave ratios for both force output (twitch) and EMG wave amplitude were significantly lower in power-trained than endurance-trained athletes. However, power-trained athletes exhibited a significantly greater twitch-to-EMG ratio for the reflexly activated motor units with respect to the entire motor pool, whereas endurance-trained athletes had comparable twitch-to-EMG ratios for both reflexly and directly activated units. Power training increases the force output of the whole ensemble of the motor units, thereby compensating for the lower efficacy of the reflex transmission between Ia spindle afferent input and soleus alpha-motoneuron. On the other hand, the lower level of force evoked by the reflexly activated units in endurance-trained athletes is associated with a greater motor pool reflex excitability. Therefore, endurance-trained athletes produce the necessary force by recruitment of more slow-twitch units than do other subjects for comparable levels of force and type of task.

Alterations of neuromuscular function after an ultramarathon.

Neuromuscular fatigue of the knee extensor (KE) and plantar flexor (PF) muscles was characterized after a 65-km ultramarathon race in nine well-trained runners by stimulating the femoral and tibial nerves, respectively. One week before and immediately after the ultramarathon, maximal twitches were elicited from the relaxed KE and PF. Electrically evoked superimposed twitches of the KE were also elicited during maximal voluntary contractions (MVCs) to determine maximal voluntary activation. MVC and maximal voluntary activation decreased significantly after the ultramarathon (-30.2 +/- 18.0% and -27.7 +/- 13.0%, respectively; P < 0.001). Surprisingly, peak twitch increased after the ultramarathon from 15.8 +/- 6.3 to 19.7 +/- 3.3 N. m for PF (P < 0.01) and from 131.9 +/- 21.2 to 157.1 +/- 35.9 N for KE (P < 0.05). Also, shorter contraction and half-relaxation times were observed for both muscles. The compound muscle action potentials (M wave) were not significantly altered by the ultramarathon with the exception of the soleus, which showed a slightly higher M-wave amplitude after the running. From these results, it can be concluded that 65 km of running 1) severely depressed the maximal voluntary force capacity mainly because of a decrease in maximal voluntary activation, 2) potentiated the twitch mechanical response, and 3) did not change significantly the M-wave characteristics.

The relative contribution to the plantar-flexor torque of the soleus motor units activated by the H reflex and M response in humans.

This study proposes a method of quantifying the relative contribution to the plantar-flexor torque of soleus H and M responses evoked by tibial nerve stimulation. For ten subjects, the amplitude of the twitch produced by the H wave was plotted against the corresponding potential, for stimuli producing H without M (i.e. in the ascending portion of the H-recruitment curve). It was then assumed that the contribution of H to twitches produced by M plus H was similar for similar H waves on the curve-descending portion. Hence, the contribution of M was estimated, for the range of M waves including those accompanying H(max). The estimated mechanical contributions of H and M wave increase linearly with their potentials, the slope of the relationship being greater for H than M. The interpretation of this finding is discussed. A simple formula for assessing the contribution of the H wave to the twitch torque is given.

Progressive versus rapid rate of contraction during 7 wk of isometric resistance training.

PURPOSE: The aim of this study was to compare the effects of isometric training performed with progressive versus rapid rate of contraction on the knee extensor neuromuscular properties over a 7-wk period. METHODS: Sixteen healthy male subjects trained quadriceps femoris muscle in a leg extension machine three times a week during 7 wk. The training sessions consisted of six sets of six maximal isometric contractions. A first group trained by performing progressive contractions lasting 4 s, whereas a second group performed contractions with a rapid rate of contraction (i.e., ballistic contractions) lasting about 1 s. RESULTS: Both groups significantly increased the isometric and isokinetic voluntary torque, and the respective absolute or relative gains were comparable. Isometric training performed with progressive rate of contraction affected the evoked action potential (M wave) of the vastus lateralis muscle and not the related twitch properties. On the other hand, the isometric training completed with ballistic contractions significantly modified the twitch contractile properties of the knee extensors and not the associated M waves of both vastus medialis and vastus lateralis. CONCLUSION: Knee extensors adapted specifically their neuromuscular properties to the type of rate of contraction performed during 7-wk isometric resistance training. Progressive isometric contractions produced modifications of the nervous system at peripheral level (i.e., muscle membrane electrical activity), whereas ballistic isometric contractions affected the knee extensor contractile muscle properties (i.e., excitation-contraction coupling).

Effect of cycling cadence on contractile and neural properties of knee extensors.

PURPOSE: This study investigated the effect of prior prolonged cycling exercise performed at different cadences on subsequent neuromuscular characteristics. METHODS: Eight well-trained triathletes sustained 80% of their maximal aerobic power during 30 min at three cadences: the freely chosen cadence (FCC), FCC-20%, and FCC+20%. Maximal isometric and concentric (120 degrees x s(-1) and 240 degrees x s(-1)) torques were recorded before and after the exercise. Central activation, neural (M-wave), and contractile (isometric muscular twitch) parameters of quadriceps muscle were also analyzed by electrical stimulation of the femoral nerve. RESULTS: Reductions in maximal isometric (P < 0.01) and concentric torques at 120 degrees x s(-1) (P < 0.05) were found after exercise. Central activation levels fell significantly (P < 0.05) by 13-16% depending on the pedaling rate. Although the M-wave did not significantly change after exercise, the ratio EMG RMS/M-wave amplitude decreased significantly (P < 0.01) on both vastus lateralis and vastus medialis muscles for FCC-20% and FCC but not for FCC+20%. Significant decreases in maximal twitch tension (P < 0.01), maximal rate of twitch development (P < 0.01), and time to half relaxation (P < 0.01) were observed postexercise with no effect of cadence. CONCLUSIONS: These findings suggest that force reduction after prolonged cycling is attributable to both central and peripheral factors but is not influenced by the pedaling rate in a range of FCC +/- 20%.

Differences in proprioception, muscle force control and comfort between conventional and new-generation knee and ankle orthoses.

The aim of this study was to compare muscle force control and proprioception between conventional and new-generation experimental orthoses. Sixteen healthy subjects participated in a single-blind controlled trial in which two different types of orthosis were applied to the dominant knee or ankle, while the following variables were evaluated: muscle force control (accuracy), joint position sense, kinesthesia, static balance as well as subjective outcomes. The use of experimental orthoses resulted in better force accuracy during isometric knee extensions compared to conventional orthoses (P=0.005). Moreover, the use of experimental orthoses resulted in better force accuracy during concentric (P=0.010) and eccentric (P=0.014) ankle plantar flexions and better knee joint kinesthesia in the flexed position (P=0.004) compared to conventional orthoses. Subjective comfort (P<0.001) and preference scores were higher with experimental orthoses compared to conventional ones. In conclusion, orthosis type affected static and dynamic muscle force control, kinesthesia, and perceived comfort in healthy subjects. New-generation experimental knee and ankle orthoses may thus be recommended for prophylactic joint bracing during physical activity and to improve the compliance for orthosis use, particularly in patients who require long-term bracing.

Assessment of quadriceps muscle weakness in patients after total knee arthroplasty and total hip arthroplasty: methodological issues.

The aim of this exploratory study was to verify whether the evaluation of quadriceps muscle weakness is influenced by the testing modality (isometric vs. isokinetic vs. isoinertial) and by the calculation method (within-subject vs. between-subject comparisons) in patients 4-8months after total knee arthroplasty (TKA, n=29) and total hip arthroplasty (THA, n=30), and in healthy controls (n=19). Maximal quadriceps strength was evaluated as (1) the maximal voluntary contraction (MVC) torque during an isometric contraction, (2) the peak torque during an isokinetic contraction, and (3) the one repetition maximum (1-RM) load during an isoinertial contraction. Muscle weakness was calculated as the difference between the involved and the uninvolved side (within-subject comparison) and as the difference between the involved side of patients and controls (between-subject comparison). Muscle weakness estimates were not significantly affected by the calculation method (within-subject vs. between-subject; P>0.05), whereas a significant main effect of testing modality (P<0.05) was observed. Isometric MVC torque provided smaller weakness estimates than isokinetic peak torque (P=0.06) and isoinertial 1-RM load (P=0.008), and the clinical occurrence of weakness (proportion of patients with large strength deficits) was also lower for MVC torque. These results have important implications for the evaluation of quadriceps muscle weakness in TKA and THA patients 4-8months after surgery.

Validity of resting myotonometric assessment of lower extremity muscles in chronic stroke patients with limited hypertonia: a preliminary study.

The aim of this preliminary study was to examine the validity of a recently-introduced tool (MyotonPRO) for the assessment of mechanical parameters of the main lower extremity muscles in patients with chronic stroke. Thigh and shank muscles of 20 stroke patients with limited hypertonia (11 men and 9 women; mean age: 52±11yrs) and 20 healthy controls (11 men and 9 women; mean age: 53±10yrs) were bilaterally evaluated with (i) MyotonPRO for muscle stiffness, tone and elasticity, (ii) ultrasonography for muscle and subcutaneous thickness, and (iii) dynamometry for isometric muscle strength. MyotonPRO parameters of stroke patients were reassessed a week later (inter-day test-retest design). For all the investigated muscles, MyotonPRO variables did not differ between the more affected and the less affected side of patients (P>0.05 for main side effect), and neither differed between patients and controls (P>0.05 for main group effect), except for gastrocnemius medialis stiffness that was higher in patients (300±51N/m) than in controls (281±29N/m; P<0.05). Thigh muscle stiffness was negatively correlated to subcutaneous thickness (r=-0.84 for the vastus lateralis; P<0.001), while only tibialis anterior stiffness and tone correlated positively with muscle thickness (both r=0.46; P<0.01). Test-retest reliability of MyotonPRO parameters was adequate, except for muscle elasticity. The validity of MyotonPRO for the evaluation of thigh muscles in chronic stroke patients is partially challenged by the poor discriminant ability and by the considerable impact of subcutaneous tissue thickness (sex-dependent) on mechanical parameters. The potential validity of MyotonPRO for the assessment of shank muscles requires further investigation.