Anterior cruciate ligament injury patterns and their relationship to fatigue and physical fitness levels - a cross-sectional study.

ABSTRACT: Anterior cruciate ligament (ACL) injury is one of the most common knee injuries that leads to many consequences such as early osteoarthritis and knee joint instability.To explore the association of the types of ACL tear (complete and partial) and side of injury (dominant vs nondominate) with types of playing surfaces, sports, shoes, and mechanism of injuries as well as to determine whether higher levels of fatigue and physical fitness are risk factors for complete ACL tear.This cross-sectional study used a questionnaire to collect information from young male adults with a confirmed ACL injury who were attending rehabilitation programs. The outcomes of interest were patterns of ACL injury, levels of fatigue before the injury on a 0 to 10 scale, and levels of physical fitness (hours per week). Mann-Whitney U and Kruskal Wallis tests were used to assess the differences between groups, while the odds ratios were calculated to evaluate risk factors for complete ACL tear.One hundred thirteen young male adults with a confirmed ACL injury were enrolled. Most of the reported ACL injuries in this study were complete tear (80.5%) and occurred more frequently in the dominant leg (74.6%) due to noncontact mechanism (63.6%). More ACL injuries happened while playing soccer (97.2%) on artificial turf (53.3%). The level of fatigue before ACL injury was significantly higher in partial ACL tear injuries compared to complete ACL tear injuries (P = .014). For every 1-point increase in the level of fatigue on a 0-10 scale, there was a 25% reduction in complete ACL injury risk (P = .023).The pattern of ACL types of tear and side of injury varies in different playing surfaces and mechanisms of injuries. Higher levels of fatigue seem to be associated with a partial tear of the ACL and reduction of a complete ACL tear risk factor.

Effect of home-based rehabilitation on activities of daily living and gait in older adults with heart failure at risk for falling: A retrospective cohort study.

PURPOSE: The purpose of this study is to describe improvement in activities of daily living (ADL) and gait speed, and associated factors in subjects receiving home-based rehabilitation after hospital admission for heart failure. METHODS: A total of 1,055 patients (mean age 82 ± 8 years SD) receiving post-admission home care services for heart failure. Subjects were included if they were referred for home-care rehabilitation after inpatient admission with ICD-9 code indicating heart failure at inpatient discharge, primary home care, or co-morbid diagnosis on admission Outcome and Assessment Information Set version-C (OASIS-C). Change in total ADL score was described and adjusted for significant baseline factors/covariates using a generalized linear model. Factors predictive of exceeding the ADL score Minimal Detectable Change (MDC) were identified with multiple variable logistic regression. RESULTS: Mean change in total ADL score from admission to discharge was 1.6 ± 1.2, the mean change for gait speed was 0.17 ± 0.21 m/s, and the minimum detectable change (MDC) (1.3) was exceeded by 57% of subjects. Improvement in mean ADL score was significantly predicted by age, baseline total ADL score, baseline gait speed score, cognitive-behavioral status, and living situation (R2 = 42%). CONCLUSIONS: Patients with heart failure receiving home-based rehabilitation services make significant improvements in ADL function and gait performance. Greater ADL improvements are associated with younger age, faster gait speed at baseline, and greater impairment of baseline ADL scores. Age, baseline gait speed, and ADL composite score are significantly related to making a change beyond measurement error in ADL change score.

Predictors of functional and gait outcomes for persons poststroke undergoing home-based rehabilitation.

BACKGROUND: The literature on the impact of home-based rehabilitation on functional outcomes for patients after stroke is limited. The purpose of this study was to describe the outcomes of home-based rehabilitation (HBR) on functional and gait performance for patients after stroke and associated factors that contribute to better outcomes after an episode of care. METHODS: The nature of the study design was retrospective and the settings used were home care services. The total number of subjects receiving home care services after stroke was 213 (mean age 76.5 ± 9 years, 51% female). Treatment records for patients receiving HBR in 2010 were reviewed at the start of care and discharge. The primary outcome measure was a change in a gait speed and activities of daily living (ADL) performance between admission and discharge from home health care services. The composite score to calculate overall functional status (Outcome Information and Assessment Set-version C [OASIS-C]) was used. Mean change in ADL and gait scores and factors predictive of improvement were identified using an analysis of covariance and multivariate linear models. The main outcome measures were change in the OASIS-C composite scores and gait speed. RESULTS: After adjustment for age and ADL score at the start of care, discharge from skilled nursing or long-term facilities, presence of confusion most of the times, cognitive impairment, and memory deficits were negatively associated with an improvement in functional scores (ADL). Living in congregate facilities was also negatively associated with an improvement in gait speed. The best multivariate model included age, baseline ADL composite scores, confusion status, and gait speed at the start of care, which predicted 41% of the variance in ADL score changes over the course of intervention. CONCLUSIONS: Gait speed and ADL scores at the start of care had largest influence on functional and gait improvement. Type of discharge facility, confusion status, and living arrangement had effects on HBR outcomes for stroke survivors.