Influence of comorbidities on functional outcomes in patients with surgically treated fragility hip fractures: a retrospective cohort study.

BACKGROUND: The incidence and number of fragility hip fractures are gradually increasing, resulting in a wide consumption of medical resources. Various factors affecting functional recovery in patients with fragility hip fractures are known, and comorbid diseases are one of them. The purpose of this study is to determine the effect of comorbidities on functional outcomes in patients surgically treated for fragility hip fractures, thereby contributing to the efficient distribution of medical resources. METHODS: This was a retrospective cohort study performed in the three tertiary rehabilitation facilities. A total of 211 patients (50 men and 161 women; average age 81.6 ± 6.7 years) who had undergone surgery for fragility hip fractures were followed up from immediately after transfer to the Department of Rehabilitation Medicine to 6 months postoperatively. Comorbidities referred to a summary of the following conditions: hypertension, diabetes mellitus, chronic liver disease, dementia, cerebrovascular accident, and osteoporosis. Functional outcomes included Koval's grade, Functional Ambulatory Category (FAC), Functional Independence Measure (FIM)-locomotion, Modified Rivermead Mobility Index, Berg Balance Scale (BBS), 4-Meter Walking speed Test (4MWT), the Korean version of the Mini-Mental State Examination(K-MMSE), Geriatric Depression Scale (GDS), EuroQol Five-Dimension (EQ-5D) questionnaire, the Korean version of the Modified Barthel Index (K-MBI), the Korean version of the Instrumental Activities of Daily Living (K-IADL), and Korean version of Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight scale (K-FRAIL). For all tests, each patient was assessed immediately after transfer and 6 months post-surgery. RESULTS: Multivariate linear regression analyses adjusted for age, sex, the initial variable of the functional outcomes, and comorbidities revealed that dementia had a significant negative impact on Koval's grade and K-FRAIL 6 months postoperatively. Diabetes mellitus had a significant negative impact on the FAC, GDS, EQ-5D, K-IADL, and K-FRAIL 6 months postoperatively. Patients with osteoporosis showed a significant negative outcome of FIM-locomotion 6 months postoperatively. A cerebrovascular accident revealed a significant negative impact on the BBS 6 months postoperatively. In addition, hypertension led to significantly less favorable outcomes of the K-FRAIL 6 months postoperatively. CONCLUSIONS: This study confirmed that comorbidities, particularly dementia and diabetes mellitus, significantly influence functional outcomes 6 months after fragility hip fracture surgeries.

Clinical effectiveness of the sequential 4-channel NMES compared with that of the conventional 2-channel NMES for the treatment of dysphagia in a prospective double-blind randomized controlled study.

BACKGROUND: To date, conventional swallowing therapies and 2-channel neuromuscular electrical stimulation (NMES) are standard treatments for dysphagia. The precise mechanism of 2-channel NMES treatment has not been determined, and there are controversies regarding the efficacy of this therapy. The sequential 4-channel NMES was recently developed and its action is based on the normal contractile sequence of swallowing-related muscles. OBJECTIVE: To evaluate and compare the rehabilitative effectiveness of the sequential 4-channel NMES with that of conventional 2-channel NMES. METHODS: In this prospective randomized case-control study, 26 subjects with dysphagia were enrolled. All participants received 2- or 4-channel NMES for 2-3 weeks (minimal session: 7 times, treatment duration: 300-800 min). Twelve subjects in the 4-channel NMES group and eleven subjects in the 2-channel NMES group completed the intervention. Initial and follow-up evaluations were performed using the videofluoroscopic dysphagia scale (VDS), the penetration-aspiration scale (PAS), the MD Anderson dysphagia inventory (MDADI), the functional oral intake scale (FOIS), and the Likert scale. RESULTS: The sequential 4-channel NMES group experienced significant improvement in their VDS (oral, pharyngeal, and total), PAS, FOIS, and MDADI (emotional, functional, and physical subsets) scores, based on their pretreatment data. VDS (oral, pharyngeal, and total) and MDADI (emotional and physical subsets) scores, but not PAS and FOIS scores, significantly improved in the 2-channel NMES group posttreatment. When the two groups were directly compared, the 4-channel NMES group showed significant improvement in oral and total VDS scores. CONCLUSIONS: The sequential 4-channel NMES, through its activation of the suprahyoid and thyrohyoid muscles, and other infrahyoid muscles mimicking physiological activation, may be a new effective treatment for dysphagia. TRIAL REGISTRATION: clinicaltrial.gov, registration number: NCT03670498, registered 13 September 2018, https://clinicaltrials.gov/ct2/show/NCT03670498?term=NCT03670498&draw=2&rank=1 .

Comorbidities in Patients With End-Stage Knee OA: Prevalence and Effect on Physical Function.

OBJECTIVE: To investigate the prevalence of comorbidities and their effect on physical function, quality of life (QOL), and pain, in patients with end-stage knee osteoarthritis (OA). DESIGN: A cross-sectional study. SETTING: A rehabilitation facility at university hospital. PARTICIPANTS: Patients (N=577; 503 women and 74 men) diagnosed with end-stage knee OA between October 2013 and June 2018. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Comorbidities were as follows: osteoporosis, presarcopenia, degenerative spine disease, diabetes, and hypertension. All patients completed the following performance-based physical function tests: stair-climbing test (SCT), 6-minute walk test (6MWT), timed Up and Go (TUG) test, and gait analysis. Self-reported physical function and pain were measured using Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and a visual analog scale (VAS), respectively, and self-reported QOL was measured using EuroQoL 5 dimensions (EQ-5D) questionnaire. RESULTS: Univariate analyses revealed that patients with osteoporosis had significantly higher scores in SCT ascent, SCT descent, TUG, WOMAC pain tests, and lower scores in 6MWT, gait speed, and cadence tests than those without osteoporosis. Patients with presarcopenia recorded higher scores in SCT ascent, TUG, EQ-5D, and lower scores in 6MWT and gait speed tests than those without presarcopenia. Patients with degenerative spine disease showed higher scores in WOMAC pain and lower scores in gait speeds than those without degenerative spine disease. Patients with diabetes showed higher scores in SCT ascent than those without diabetes, and patients with hypertension showed lower scores in 6MWT than those without hypertension. After adjusting age, sex, and body mass index, SCT descent retained significant association with osteoporosis, SCT ascent showed independent association with presarcopenia and diabetes, and WOMAC pain revealed significant association with degenerative spine disease. CONCLUSION: The results confirm associations between comorbidities, performance-based and self-reported physical functions, and QOL in patients with end-stage knee OA.

Can Lowering the Guidance Force of Robot-Assisted Gait Training Induce a Sufficient Metabolic Demand in Subacute Dependent Ambulatory Patients With Stroke?

OBJECTIVE: To assess the effects of guidance force (GF) and gait speed (GS) on cardiorespiratory responses and energy cost in subacute dependent ambulatory patients with stroke. DESIGN: Cross-sectional study. SETTING: University rehabilitation hospital. PARTICIPANTS: Patients with subacute stroke (N=10; mean age, 64.50±19.20y) who were dependent ambulators (functional ambulation category ≤2). INTERVENTIONS: Patients participated in cardiorespiratory tests during robot-assisted gait training. Subjects walked at a fixed percentage (50%) of body weight support and various percentages of GF (100%, 80%, and 60%) and GS (1.4 and 1.8km/h). The therapist encouraged patients to maximize their locomotor ability. MAIN OUTCOME MEASURES: During the cardiorespiratory tests, oxygen consumption (V˙o2), heart rate, and respiratory exchange ratio were measured continuously to assess cardiometabolic demands. RESULTS: There were no significant differences in cardiometabolic demands according to GS (1.4 vs 1.8km/h). There were no significant differences in cardiometabolic demands according to GF at a GS of 1.4km/h. However, lowering GF decreased V˙o2 when comparing GFs of 100% (6.89±2.38mL/kg/min), 80% (6.46±1.73mL/kg/min), and 60% (5.77±1.71mL/kg/min) at a GS of 1.8km/h (P=.03). CONCLUSIONS: Lowering the GF of robot-assisted gait training at a higher GS cannot induce a sufficient cardiometabolic demand for subacute dependent ambulatory patients with stroke. This implies that it is important to take the patient's functional ability into consideration when choosing training protocols.

Arterial Stiffness in Subacute Stroke: Changing Pattern and Relationship with Functional Recovery.

BACKGROUND: To examine changing patterns in arterial stiffness and functional outcome in patients with subacute stroke, and to determine which parameter shows a strong correlation with the reversal of arterial stiffness, during a 3-month period of comprehensive rehabilitation therapy. METHODS: This descriptive, observational cohort study enrolled 60 patients (43 male and 17 female; average age, 62.7 years), and all received conventional rehabilitation therapy, during a 3-month period. Brachial-ankle pulse wave velocity (baPWV) was measured as an index of arterial stiffness. Functional assessments included the 6-minute walk test (6MWT), Fugl-Meyer Assessment of hemiparetic upper and lower limbs, the functional ambulatory category, the Berg balance scale, the Korean Mini-Mental Status Examination, and the Korean-Modified Barthel Index. All measurements were conducted at baseline and 1 and 3 months after stroke onset. RESULTS: Rehabilitation therapy resulted in a statistically significant improvement in baPWV since 3 months post stroke. Another functional outcome measure showed statistically significant improvements since 1 month after rehabilitation. Multivariable linear regression analysis revealed that a change in baPWV was significantly correlated with changes in the 6MWT. CONCLUSIONS: Three months of comprehensive rehabilitation therapy led to statistically significant improvements in arterial stiffness and functional outcomes during the subacute phase of stroke. Thus, the comprehensive rehabilitation focused on improving gait endurance would be warranted in subacute stroke patients.

Clinical application of circuit training for subacute stroke patients: a preliminary study.

[Purpose] To investigate how task-oriented circuit training for the recovery motor control of the lower-extremity, balance and walking endurance could be clinically applied to subacute stroke inpatient group therapy. [Subjects and Methods] Twenty subacute stroke patients were randomly assigned to the intervention group (n=10) or the control group (n=10). The intervention consisted of a structured, progressive, inpatient circuit training program focused on mobility and gait training as well as physical fitness training that was performed for 90 minutes, 5 days a week for 4 weeks. The control group received individual physiotherapy of neurodevelopmental treatment for 60 minutes, 5 days a week for 4 weeks. Outcome measures were lower-extremity motor control, balance, gait endurance and activities of daily living before and after 4 weeks. [Results] There were no significant differences at baseline between the two groups. After 4 weeks, both groups showed significant improvements in all outcome measures, but there were no significant differences between the two groups during the invention period. [Conclusion] In spite of the small sample size, these findings suggest that task-oriented circuit training might be used as a cost-effective and alternative method of individual physiotherapy for the motor recovery of lower-extremity, balance and walking endurance of subacute stroke patients.

Case report of meningiomatosis with aspiration of a dental bridge improved by comprehensive rehabilitation therapy.

[Purpose] The aim of this study was to ascertain the effect of comprehensive rehabilitation therapy on a quadriplegic patient with meningiomatosis and severe dysphagia. [Subject and Methods] Meningiomatosis is defined as multiple meningiomas involved in several intracranial regions, which occurs more frequently in elderly patients. The prognosis of meningiomatosis is mostly reported as benign, but the prognosis for some malignant cases can be poor. Furthermore, dysphagia in elderly patients with brain lesions may lead to foreign body aspiration, which can be fatal. The removable type of dental prosthesis is a common cause of aspiration, but aspiration is rare with the fixed type. [Results] This report presents a rare case of bronchial aspiration involving a fixed dental prosthesis in an elderly meningiomatosis patient that was improved following comprehensive rehabilitation therapy. [Conclusion] Thorough evaluation and individualized assessment of rehabilitation goals is recommended for the care of severe comorbid elderly patients.

Preoperative physical performance predictors of self-reported physical function and quality of life in patients scheduled for total knee arthroplasty.

[Purpose] To determine the preoperative self-reported and performance-based physical function of patients with end-stage knee osteoarthritis who awaited total knee arthroplasty. The preoperative physical performance factors that predicted self-reported physical function and quality of life were also identified. [Subjects and Methods] All adults with end-stage knee osteoarthritis awaiting surgery were enrolled. Before surgery, self-reported disease-specific physical function and self-reported pain were measured using the Western Ontario McMaster Universities Osteoarthritis Index, self-reported quality of life was measured using the EuroQOL five dimensions questionnaire, and physical performance tests were performed, the 6 minute walk test, the timed up-and-go test, instrumental gait analysis, and measurement of isometric knee flexor and extensor strength of the surgical and nonsurgical knees. [Results] In total, 55 adults (49 females; 73.3 ± 6.1 years) were included. This study showed that several preoperative self-reported and physical performance factors were predictive of self-reported physical function and quality of life. [Conclusion] In patients with end-stage knee osteoarthritis, preoperative pain and dynamic balance ability were the most powerful predictors of self-reported physical function. Preoperative pain and exercise tolerance were the most powerful predictors of quality of life. Preoperative rehabilitation strategies that focus on dynamic balance, aerobic, and resistance exercises may improve surgical outcomes.

The effect of mechanical massage on early outcome after total knee arthroplasty: a pilot study.

[Purpose] The aim of this study was to evaluate the efficacy of mechanical massage via Endermologie(®) after total knee arthroplasty in reducing edema and pain and improving knee range of motion, in the early postoperative period. [Subjects and Methods] Eighteen patients with knee edema following total knee arthroplasty were randomly assigned to the intervention group (n=8) or the control group (n=10). The intervention group received mechanical massage therapy using Endermologie(®) and the control group received conventional physical therapy for 20 minutes a day, 5 times a week from the seventh day postsurgery. Clinical assessments included active knee flexion and extension range of motion, knee pain using a numeric rating scale, the operated limb circumference, the soft tissue cross-sectional area using ultrasonography, the extracelluar fluid volume, and single frequency bioimpedance analysis at 5 kHz using bioelectrical impedance spectroscopy. [Results] Both groups showed significant reduction in edema and pain, and improvement in active knee flexion at the end of treatment. There were no significant inter-group differences before or after treatment. [Conclusion] Mechanical massage could be an alternative way of managing knee edema after total knee arthroplasty in early postoperative recovery.

Effect of high- and low-frequency repetitive transcranial magnetic stimulation on visuospatial neglect in patients with acute stroke: a double-blind, sham-controlled trial.

OBJECTIVE: To compare the therapeutic effect of low- and high-frequency repetitive transcranial magnetic stimulation (rTMS) of the posterior parietal cortex (PPC) in patients with acute stroke with visuospatial neglect. DESIGN: This study was a prospective, double-blind, sham-controlled trial. Data are presented from 27 patients (15 men, 12 women; mean age, 67.0y) randomly assigned to receive 10 sessions of low-frequency (1Hz) rTMS over the nonlesioned PPC, high-frequency (10Hz) rTMS over the lesioned PPC, or sham stimulation. SETTING: National university hospital. PARTICIPANTS: Patients (N=27) diagnosed with visuospatial neglect after stroke. INTERVENTION: Ten sessions of rTMS over a 2-week period. MAIN OUTCOME MEASURES: The severity of visuospatial neglect was assessed pre- and posttreatment using the Motor-Free Visual Perception Test, line bisection test, star cancellation test, and Catherine Bergego Scale. RESULTS: When comparing the differences in the Motor-Free Visual Perception Test, line bisection test, star cancellation test, Catherine Bergego Scale, and Korean-Modified Barthel Index (K-MBI) scores before and after treatment according to group, we found that changes in the line bisection test and K-MBI scores were significantly different between 3 groups. In the post hoc analysis, the improvement in the line bisection test score in the high-frequency rTMS group was statistically significant compared with that in the sham stimulation group (high vs sham P=.03, low vs sham P=.09, high vs low P=.58), and the improvements in the K-MBI scores of the 2 rTMS groups were statistically significant compared with those in the sham stimulation group (high vs sham P<.01, low vs sham P=.02, high vs low P=.75). CONCLUSIONS: These results indicate that high-frequency rTMS is effective in the treatment of visuospatial neglect in patients with acute stroke.

Factors predictive of functional outcomes and quality of life in patients with fragility hip fracture: A retrospective cohort study.

To determine the predictors of functional outcomes and quality of life (QoL) of patients who were surgically treated for fragility hip fracture. This was a retrospective cohort study performed in the 3 tertiary rehabilitation facilities. A total of 165 patients who had undergone surgery for fragility hip fracture were followed up to 6 months postoperatively. The factors expected to be related to the functional outcomes and QoL at 6 months post-surgery were as follows: baseline demographics, fracture site, operation type, fall characteristics including fall location and fall direction, comorbidities, and initial functional status. The following were comorbidities: hypertension, diabetes mellitus, dementia, cerebrovascular accident, and osteoporosis. Functional outcome and QoL measures were represented using the Koval grade, functional ambulatory category (FAC), Berg balance scale, 4-m walking speed test, the Korean version of Mini-Mental State Examination, EuroQol 5-dimension (EQ-5D) questionnaire, the Korean version of Modified Barthel Index, and the Korean version of instrumental activities of daily living (K-IADL). For all tests, each patient was assessed immediately after transfer and at 6 months post-surgery. Multivariable regression analyses adjusting for factors mentioned above were as follows. Old age led to a significantly less favorable outcome on FAC and K-IADL at 6 months. Intertrochanteric fracture had a significantly positive impact on Koval at 6 months compared to femur neck and intertrochanteric fractures. Total hip replacement arthroplasty and bipolar hemiarthroplasty had a significantly positive impact on EQ-5D and FAC at 6 months respectively compared to other operation types. Fall characteristics didn't reveal any significant impact on functional outcomes and QoL. Patients with hypertension and diabetes mellitus had a significantly negative outcome on EQ-5D and K-IADL respectively. Among initial assessments of function and QoL, initial 4-m walking speed test, Korean version of Mini-Mental State Examination, K-IADL, and Korean version of Modified Barthel Index were independent predictors of function and QoL at 6 months. This study confirmed that age, fracture site, operation type, comorbidities, and initial physical and cognitive function significantly influenced recovery of function and QoL at 6 months in patients with fragility hip fractures.

Effects of hip brace on coxa valga in nonambulatory children with cerebral palsy: A randomized controlled trial.

BACKGROUND: Coxa valga, measured as the neck-shaft angle (NSA) or head-shaft angle (HSA), is regarded as a potential risk factor for hip dislocation in patients with cerebral palsy. We investigated the effects of a novel hip brace on coxa valga. METHODS: A prospective, multicenter, assessor-blinded, randomized controlled trial was conducted from July 2019 to November 2021. Children with cerebral palsy aged 1 to 10 years with Gross Motor Function Classification System levels IV and V were recruited. The study group wore a hip brace for at least 12 hour a day. A lower strap of the hip brace was designed to prevent coxa valga biomechanically. The effectiveness of the hip brace on coxa valga was assessed by measurement of the NSA and head-shaft angle at enrollment and 6 and 12 months after enrollment. RESULTS: Sixty-six participants were enrolled, and 33 patients were assigned to each group. Changes in the mean NSA of both sides and the NSA of left side showed significant differences between the 2 groups over 12 months (mean NSA of both sides, -1.12 ± 3.64 in the study group and 1.43 ± 3.75 in the control group, P = .023; NSA of the left side, -1.72 ± 5.38 in the study group and 2.01 ± 5.22 in the control group, P = .008). CONCLUSIONS: The hip brace was effective in preventing the progression of coxa valga and hip displacement, suggesting that the prevention of coxa valga using hip brace is a contributing factor in prevention of hip displacement.

Fracture Liaison Service in Korea: 2022 Position Statement of the Korean Society for Bone and Mineral Research.

Osteoporosis and osteoporotic fractures cause socioeconomic concerns, and medical system and policies appear insufficient to prepare for these issues in Korea, where the older adult population is rapidly increasing. Many countries around the world are already responding to osteoporosis and osteoporotic fractures by adopting fracture liaison service (FLS), and such an attempt has only begun in Korea. In this article, we introduce the operation methods for institutions implementing FLS and characteristics of services, and activities of the FLS Committee for FLS implementation in the Korean Society for Bone and Mineral Research. In addition, we hope that the current position statement will contribute to the implementation of FLS in Korea and impel policy changes to enable a multidisciplinary and integrated FLS operated under the medical system.

Clinical Practice Guidelines for Oropharyngeal Dysphagia.

OBJECTIVE: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one's physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. METHODS: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. RESULTS: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. CONCLUSION: This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Fatigue assessment and rehabilitation outcomes in patients with brain tumors.

OBJECTIVES: This study seeks to investigate the fatigue severity and the relationship among fatigue and other associated factors in patients with brain tumors, and to evaluate the rehabilitation outcome on fatigue. DESIGN: We assessed 25 patients in whom brain tumors had been resected and transferred to the rehabilitation department of our hospital. Patients were evaluated for fatigue severity using the Piper Fatigue Scale (PFS) and the Brief Fatigue Inventory (BFI), for mood using the Beck Depression Inventory, for motor function using the Motricity Index (MI), for functional status using the Karnofsky Performance Status (KPS) scale and the Modified Barthel Index (MBI), and for quality-of-life using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 (EORTC QLQ-C30). We also measured the levels of serum hemoglobin, C-reactive protein, albumin, and creatine kinase; and anthropometric variables before and 4 weeks after rehabilitation. RESULTS: Of the 25 patients, 21 (84.0%) reported fatigue during the previous week. The average PFS score was 4.6 ± 1.8 and the average BFI score 5.2 ± 2.2, indicating the moderate level of fatigue. Patients with recurrent tumors had significantly higher PFS scores than did those with initial tumors. Fatigue correlated significantly with the KPS, MBI, and EORTC QLQ-C30 physical functioning and insomnia scales. In addition, insomnia was a significant predictor of fatigue before rehabilitation, and the baseline fatigue scales, MBI, MI, and EORTC QLQ-C30 physical functioning scale were the important independent predictors of fatigue after rehabilitation. During rehabilitation, the KPS, MBI, and MI scores improved significantly, whereas total PFS and BFI scores did not change. CONCLUSIONS: These findings suggest that patients with brain tumors commonly complain of moderate level of fatigue, which may reduce daily functioning and quality of life, with sleep disturbance being a significant predictor of fatigue. During rehabilitation, functional outcomes and motor power showed improvements in those patients, not aggravating fatigue.

The combination of osteoporosis and low lean mass correlates with physical function in end-stage knee osteoarthritis: A retrospective observational study.

We aimed to investigate the prevalence of osteoporosis and low lean mass, either together or in isolation, and their association with physical function, pain, and quality of life (QOL) in patients with end-stage knee osteoarthritis (OA). This retrospective cross-sectional observational study included 578 patients (77 males and 501 females) diagnosed with end-stage knee OA. Patients were divided into 4 groups based on body composition parameters: control, osteoporosis, low lean mass, and osteoporosis + low lean mass. All participants underwent performance-based physical function tests, including a stair climbing test (SCT), a 6-minute walk test, a timed up and go test, and instrumental gait analysis, to examine spatiotemporal parameters. Self-reported physical function and pain levels were measured using the Western Ontario McMaster Universities Osteoarthritis Index and visual analog scale, respectively. Self-reported QOL was measured using the EuroQOL 5 dimensions (EQ-5D) questionnaire. Of 578 patients, 268 (46.4%) were included in the control group, 148 (25.6%) in the osteoporosis group, 106 (18.3%) in the low lean mass group, and 56 (9.7%) in the osteoporosis + low lean mass group. Analysis of variance revealed that the scores for the osteoporosis + low lean mass group in the SCT-ascent, SCT-descent, and timed up and go test were significantly higher, whereas those for the 6-minute walk test, gait speed, and cadence were significantly lower than those for the other groups (P < .05). After adjusting for age, sex, and body mass index, multiple linear regression analysis identified SCT-ascent (ß = 0.140, P = .001, R2 = 0.126), SCT-descent (ß = 0.182, P < .001, R2 = 0.124), gait speed (ß = -0.116, P = .005, R2 = 0.079), and cadence (ß = -0.093, P = .026, R2 = 0.031) as being significantly associated with osteoporosis + low lean mass. Thus, osteoporosis + low lean mass correlates with poor physical function, but not pain and QOL, in patients with end-stage knee OA.

Efficacy of a Hip Brace for Hip Displacement in Children With Cerebral Palsy: A Randomized Clinical Trial.

Importance: There is no consensus on interventions to slow the progress of hip displacement in patients with cerebral palsy. Objective: To investigate the efficacy of a novel hip brace in preventing progressive hip displacement in patients with cerebral palsy. Design, Setting, and Participants: This 2-group randomized clinical trial was conducted at 4 tertiary hospitals in South Korea from July 2019 to November 2021. Participants included children aged 1 to 10 years with nonambulatory cerebral palsy (Gross Motor Function Classification System level IV or V). Block randomization was used to assign an equal number of patients to the study and control groups via computerized random allocation sequences. Data were analyzed from November to December 2021. Interventions: The intervention group wore the hip brace for at least 12 hours a day for the study duration (ie, 12 months). Follow-up evaluations were performed after 6 and 12 months of wearing the brace. Both groups proceeded with conventional rehabilitation therapy during the trial. Main Outcomes and Measures: The primary outcome was the Reimers migration index (MI) on radiography, as assessed by 3 blinded investigators. Primary outcome variables were analyzed using linear mixed models. Secondary outcomes include change in the Caregiver Priorities & Child Health Index of Life with Disabilities, on which lower scores indicate better quality of life. Results: A total of 66 patients were included, with 33 patients (mean [SD] age, 68.7 [31.6] months; 25 [75.8%] boys) randomized to the intervention group and 33 patients (mean [SD] age, 60.7 [24.9] months; 20 [60.6%] boys) randomized to the control group. The baseline mean (SD) MI was 37.4% (19.3%) in the intervention group and 30.6% (16.3%) in the control group. The mean difference of the MI between the intervention group and control group was -8.7 (95% CI, -10.2 to -7.1) percentage points at 6 months and -12.7 (95% CI, -14.7 to -10.7) percentage points at 12 months. The changes in the Caregiver Priorities & Child Health Index of Life with Disabilities were favorable in the study group and reached statistical significance at the 6-month follow-up compared with the control group (difference, -14.2; 95% CI, -25.2 to -3.3). Conclusions and Relevance: In this randomized clinical trial, the novel hip brace was significantly effective in preventing the progression of hip displacement, compared with the control group. It effectively improved quality of life in patients with nonambulatory cerebral palsy. Therefore, hip brace use could be a promising treatment method to delay hip surgery and improve the quality of life of patients with nonambulatory cerebral palsy. Trial Registration: ClinicalTrials.gov Identifier: NCT04033289.

Relationship between cardiorespiratory fitness and preoperative evaluation findings in patients with morbid obesity undergoing sleeve gastrectomy: A cross-sectional study.

ABSTRACT: Evaluating various parameters, including preoperative cardiorespiratory fitness markers, is critical for patients with morbid obesity. Also, clinicians should prescribe suitable exercise and lifestyle guideline based on the tested parameters. Therefore, we investigated cardiorespiratory fitness and its correlation with preoperative evaluation in patients with morbid obesity scheduled for laparoscopic sleeve gastrectomy.A retrospective cross-sectional study was conducted with 38 patients (13 men and 25 women; mean age, 34.9 ±â€Š10.9 years) scheduled for laparoscopic sleeve gastrectomy. Cardiopulmonary exercise stress tests were also performed. Measured cardiopulmonary responses included peak values of oxygen consumption (VO2), metabolic equivalents (METs), respiratory exchange ratio, heart rate (HR), and rate pressure product. Body composition variables were analyzed using bioimpedance analysis, laboratory parameters (hemoglobin A1c, lipid profile, inflammatory markers), and comorbidities. In addition, self-reported questionnaires were administered, including the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), Short-Form Health Survey (SF-36), and Moorehead-Ardelt Quality of Life Questionnaire (MAQOL).The average body mass index (BMI) and percent body fat were 39.8 ±â€Š5.7 kg/m-2 and 46.2 ±â€Š6.1%, respectively. The VO2peak/kg, METs, RERpeak, HRpeak, RPPpeak, age-predicted HR percentage, and VO2peak percentage were 18.6 ±â€Š3.8 mL/min-1/kg-1, 5.3 ±â€Š1.1, 1.1 ±â€Š0.1, 158.5 ±â€Š19.8, 32,414.4 ±â€Š6,695.8 mm Hg/min-1, 85.2 ±â€Š8.8%, and 76.1 ±â€Š14.8%, respectively. BMI (P = .026), percent body fat (P = .001), HRpeak (P = .018), erythrocyte sedimentation rate (P = .007), total BDI (P = .043), HDRS (P = .025), SF-36 (P = .006), and MAQOL (P = .007) scores were significantly associated with VO2peak/kg. Body fat percentage (P < .001) and total SF-36 score (P < .001) remained significant in the multiple linear regression analysis.Various cardiorespiratory fitness markers were investigated in patients with morbid obesity who underwent the sleeve gastrectomy. Peak aerobic exercise capacity was significantly associated with preoperative parameters such as body fat composition and self-reported quality of life in these patients. These results could be utilized for preoperative and/or postoperative exercise strategies in patients with morbid obesity scheduled for laparoscopic sleeve gastrectomy.

Associations Between Obesity With Low Muscle Mass and Physical Function in Patients With End-Stage Knee Osteoarthritis.

OBJECTIVE: To investigate the prevalence of obesity with low muscle mass and its impact on physical function, quality of life (QOL) and pain in patients with end-stage knee osteoarthritis over 65 years old. METHODS: In this cross-sectional study, we assessed a total of 562 patients. After separating the group into males and females, we divided patients into 4 further groups: normal BMI with normal muscle mass, obesity with normal muscle mass, normal BMI with low muscle mass and obesity with low muscle mass. All patients completed stair climbing test (SCT), 6-minute walk test, timed up and go test (TUG), instrumental gait analysis, Western Ontario McMaster Universities Osteoarthritis Index, VAS, and EuroQOL 5 dimensions questionnaire. RESULTS: Obesity with low muscle mass was diagnosed in 6 males subjects (7.8%) and 9 female subjects (1.9%). Patients with obesity and low muscle mass performed the SCT-ascent and descent significantly slower than other body composition groups in both males and females. TUG in males and gait speed in females were also significantly slower in the obesity with low muscle mass group. Stepwise multiple linear regression analysis revealed that in males, obesity with low muscle mass was significantly predictive of SCT ascent (ß = 0.409, p < 0.001), SCT-descent (ß = 0.405, p < 0.001), and TUG (ß = 0.283, p = 0.009), and in females, obesity with low muscle mass was significantly predictive of SCT-ascent (ß = 0.231, p < 0.001), SCT-descent (ß = 0.183, p < 0.001), and gait speed (ß=-0.129, p = 0.004). CONCLUSIONS: This study confirms that the combination of obesity and low muscle mass is associated with impaired physical function in patients with end-stage knee osteoarthritis.

Performance-based physical function correlates with walking speed and distance at 3 months post unilateral total knee arthroplasty.

BACKGROUND: After total knee arthroplasty (TKA), walking speed and distance are main concerns of patients. RESEARCH QUESTION: Which physical functions affect walking speed and distance after TKA? METHODS: Cross-sectional data from 149 patients who underwent unilateral primary TKA and completed performance-based physical function tests. Instrumental gait evaluation for spatiotemporal parameters, isometric knee extensor and flexor strength of both knees, 6-minute walk test (6MWT), timed up-and-go (TUG) test, timed stair climbing test (SCT), and knee flexion and extension range of motion (ROM) of surgical knee were examined. Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and EuroQol five dimensions (EQ-5D) questionnaires were also performed. RESULTS: Univariate analyses revealed that post-operative walking speed showed significant positive correlations with cadence, stride length, propulsion index of surgical and non-surgical knee, peak torque (PT) of the extensor of surgical and non-surgical knee and flexor of surgical and non-surgical knee, 6MWT, EQ-5D, and significant negative correlations with gait cycle duration, TUG, SCT-ascent and descent, and WOMAC-pain scores. Post-operative walking distance had significant positive correlations with walking speed, cadence, stride length, swing phase duration, propulsion index of surgical and non-surgical knee, PT of the extensor of surgical and non-surgical knee, EQ-5D, and significant negative correlation with gait cycle duration, double support duration, TUG, SCT-ascent and descent. In the multivariate linear regression analyses, TUG, cadence, stride length and propulsion index of non-surgical knee were factor correlated with post-operative walking speed. The SCT-ascent and descent, TUG and propulsion index of surgical knee were factor correlated with post-operative walking distance. SIGNIFICANCE: Physical performance factors correlated with walking speed and distance at 3 months after surgery. Based on these observations, rehabilitation of bilateral muscle strength and functional mobility would be important for functional recovery after unilateral TKA.