Comparison of three single-person manual patient techniques for bed-to-wheelchair transfers.

The uniqueness of the home environment still requires home health clinicians to lift and transfer patients manually, tasks that are known to cause back injuries. Three manual patient transfers were evaluated to establish the technique with the least risk to the low back. Patient and worker perceptions as well as preferences, exposure duration, and a biomechanical low back evaluation are presented, together with transfer technique recommendations.

Torsion deformity and joint loading for medial knee osteoarthritis.

PURPOSE: The consequences of lower limb torsion deformity on knee loading in knee osteoarthritis are poorly understood. The purpose of this study was to quantify the associations between the mechanical axis, tibial torsion and knee loading in subjects with medial knee OA and in controls. METHODS: Twenty-four subjects: end-staged medial knee osteoarthritis (OA) with apparent torsion deformity (TKO, n=6) and without torsion deformity (KOA, n=8) and controls (CON, n=10) were imaged using long standing lower extremity (LSLE) radiographs and computed tomography (CT). Medial knee loading was assessed using the internal knee varus moment determined by gait analysis. The LSLE mechanical axis, CT tibial torsion and the foot progression angle were used to predict medial knee loading. RESULTS: The TKOs had significantly greater mechanical axis varus and knee varus moment compared to KOAs and CONs. The regression model predicting medial knee loading using the mechanical axis (ß=0.898), tibial torsion (ß=0.264) and foot progression angle (ß=-0.369) showed a goodness of fit of 0.774. CONCLUSIONS: Medial knee loading was predicted by the mechanical axis and the foot progression angle. Future longitudinal studies are needed to assess the role of tibial intorsion during disease progression and following total knee replacement surgery.

A multivariate statistical ranking of clinical and gait measures before and after total knee replacement.

The purpose of this study was to assess the use of a multivariate statistical method to rank clinical and gait variables, thus describing a ranking of patient dysfunction prior to and following total knee replacement (TKR) surgery. Twenty end-stage knee osteoarthritis (KOA) subjects scheduled for TKR and 20 healthy controls performed level walking and stair ascent twice: pre- (P1) and 6 months post-surgery (P2). Clinical and gait measures were entered into a principle component analysis (PCA) to determine orthogonal principle components (PCs). The PCs were entered into a discriminant function analysis to determine the best predictors of group membership. The PCA extracted three PCs for both the P1 and P2 data sets. Three orthogonal dimensions were formed: "knee dysfunction", "gait dysfunction", and "stair ascent dysfunction". For P1 the "knee dysfunction" dimension composed of both subjective and objective measures, best discriminated between end-stage knee osteoarthritis patients and controls. For P2, the "stair ascent dysfunction" dimension best discriminated between 6 months post-TKR patients and controls. The results of this study suggest that a multivariate statistical method provides a clinically relevant ranking of patient dysfunction prior to and following TKR. This ranking of dysfunction could serve to identify rehabilitation priorities.