Association and Dose-Response Relationship of Self-Reported Physical Activity and Disability Among Adults ≥50 Years: National Health and Nutrition Examination Survey, 2011-2016.

Disability is a tremendous public health challenge. No study has assessed whether meeting U.S. Physical Activity guidelines is associated with disability in mobility tasks, activities of daily living, and social participation among U.S. older adults. Using 2011-2016 National Health and Nutrition Examination Survey data, this study examined this relationship among 8,309 individuals aged ≥50 years. Most participants (n = 4,272) did not achieve guidelines, and 2,912 participants were completely inactive. People who did not meet guidelines had higher odds of disability compared with those who did (adjusted odds ratio [AOR] = 1.80) in addition to difficulty with mobility tasks (AOR = 1.85), activities of daily living (AOR = 1.66), and social participation (AOR = 2.09). There was a dose-response effect for each level of activity (inactive, insufficient, and meeting and exceeding recommendations). Among adults aged ≥50 years, meeting the U.S. guidelines was associated with better social and physical functioning.

Association Between Performance on an Interdisciplinary Stroke Assessment Battery and Falls in Patients With Acute Stroke in an Inpatient Rehabilitation Facility: A Retrospective Cohort Study.

OBJECTIVE: To explore the association between demographic factors and functional performance measures of patients with acute stroke in an inpatient rehabilitation facility (IRF) and falls during the IRF stay and to quantify the diagnostic accuracy of functional outcome measures in identifying fallers. DESIGN: Retrospective cohort study. SETTING: Inpatient rehabilitation facility. PARTICIPANTS: Individuals with acute stroke admitted to hospital-based IRF (N=139). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Odds ratios were used to examine the relationship between fall frequency and functional outcome measures (National Institute of Stroke Scale, neglect [Item #11], Berg Balance Scale, Stroke Rehabilitation Assessment of Movement mobility and Stroke Rehabilitation Assessment of Movement lower extremity subscales [STREAM-LE], Montreal Cognitive Assessment, Dynamic Gait Index, and Stroke Impact Scale). Receiver operator characteristic analysis with area under the curve, sensitivity, specificity, and diagnostic odds ratio were used to assess the diagnostic accuracy of each functional outcome measure to distinguish patients who fell vs those who did not fall in the IRF. RESULTS: A total of 23 patients (16.2%) fell during the IRF hospitalization. Patients who did and did not fall did not differ in terms of age, sex, stroke type, or stroke location. Only the STREAM-LE was associated with falls (odds ratio, 0.93; 95% CI, 0.86-0.99). Area under the curve was 0.67 (95% CI, 0.51-0.82). With a positivity cutoff point of 12, sensitivity and specificity were 73.3% (95% CI, 54.6%-92.2%) and 50.0% (95% CI, 39.9%-59.2%), respectively. The diagnostic odds ratio was 3.4. CONCLUSIONS: The STREAM-LE score at admission to IRF may identify patients with acute stroke who are more likely to fall during their stay. However, the search for measures with greater diagnostic accuracy should continue.

Oxygen Consumption Deficits in Patients With Residual Fatigue After Primary Coccidioidomycosis.

Patients with coccidioidomycosis often report prolonged and debilitating fatigue after other evidence of infection has resolved. In this study, we quantify fatigue, muscle weakness, and impaired aerobic capacity in 5 such individuals. A closer examination of the cardiorespiratory system may contribute to a better understanding of underlying mechanisms and potential interventions.

A Comparative Study to Determine Functional and Clinical Outcome Differences Between Patients Receiving Outpatient Direct Physical Therapy Versus Home Physical Therapy Followed by Outpatient Physical Therapy After Total Knee Arthroplasty.

BACKGROUND: Rehabilitation outcomes for patients with total knee arthroplasty (TKA) after hospital discharge are not well understood. PURPOSE: The purpose of this retrospective cohort study was to describe outpatient physical therapy (PT) after TKA and compare short-term (2 months) functional and clinical outcomes of patients following TKA who were discharged from the hospital to home and received (a) outpatient PT immediately (OP) or (b) home health PT before outpatient PT (HH). METHODS: The medical records of 109 men and women postoperative TKA discharged home were abstracted for the 6-minute walk test (6MWT), Knee Osteoarthritis and Outcome Score (KOOS), and knee range of motion (ROM) preoperatively and after discharge from all postoperative PT. Patients received outpatient clinic-based PT immediately after discharge from the hospital (OP) (n = 87) or home health PT before continued rehabilitation in an outpatient setting (HH) (n = 22). RESULTS: Despite demographic differences between OP and HH preoperatively, adjusted models revealed no significant differences among KOOS, 6MWT, or knee ROM between OP and HH upon completion of postoperative PT. Patients in OP completed PT on average 20 days sooner (p = .0007), although the amount of time in outpatient PT (p = .55) and the number of outpatient PT visits (p = .68) were similar between groups. CONCLUSION: Gains in function were achieved by patients in OP and HH independent of the postoperative PT setting, although OP achieved gains sooner.

The association between social participation and lower extremity muscle strength, balance, and gait speed in US adults.

Social participation is associated with healthy aging, and although associations have been reported between social participation and demographics, no published studies have examined a relationship between social participation and measures amenable to intervention. The purpose was to explore the association between self-reported social participation and lower extremity strength, balance, and gait speed. A cross-sectional analysis of US adults (n = 2291; n = 1,031 males; mean ± standard deviation age 63.5 ± 0.3 years) from the 2001-2 National Health and Nutrition Examination Survey was conducted. Two questions about self-reported difficulty with social participation were categorized into limited (yes/no). The independent variables included knee extension strength (n = 1537; classified as tertiles of weak, normal, and strong), balance (n = 1813; 3 tests scored as pass/fail), and gait speed (n = 2025; dichotomized as slow [less than 1.0 m/s] and fast [greater than or equal to 1.0 m/s]). Logistic regression, accounting for the complex survey design and adjusting for age, sex, physical activity, and medical conditions, was used to estimate the odds of limitation in social participation with each independent variable. Alpha was decreased to 0.01 due to multiple tests. Slower gait speed was significantly associated with social participation limitation (odds ratio = 3.1; 99% confidence interval: 1.5-6.2). No significant association was found with social participation and lower extremity strength or balance. The odds of having limitation in social participation were 3 times greater in those with slow gait speed. Prospective studies should examine the effect of improved gait speed on levels of social participation.

Distal Vibration Perception Threshold in Children Who Toe Walk.

PURPOSE: To compare distal vibratory perception threshold and sensation in children who toe walked (TW) and controls. METHODS: Vibration perception threshold was measured at the metacarpal and metatarsal phalangeal (MCP and MTP) joints in 11 TW and 15 age-matched controls. Mean vibratory threshold (MVT) was calculated for each site; a Pearson correlation coefficient was determined for MVT at MCP and MTP joints. Groups were compared using a Mann-Whitney U test. Parent/caregiver responses on the Short Sensory Profile (SSP) were compared using a χ test. RESULTS: MVTs at the MCP and MTP joints were highly correlated in both groups. MVT was higher in TW compared with controls at each site. Children who TW were more likely to have a total SSP score in the "probable difference" or "definite difference" categories compared with the "no difference" category. CONCLUSION: Sensation should not be overlooked in the evaluation and clinical management of toe walking.

Uphill both ways: Fatigue and quality of life in valley fever.

Primary pulmonary coccidioidomycosis is characterized by prolonged respiratory and systemic symptoms and fatigue. We prospectively administered the fatigue severity scale (FSS) and Short Form-36 Health Status Questionnaire (SF-36) to patients with proven or probable primary pulmonary coccidioidomycosis to quantify disease effect on quality of life (QOL). The 24-week observational study did not specify whether antifungal treatment would be provided; the treating physician made treatment decisions. FSS and SF-36 were completed at 4-week intervals. Thirty-six patients participated, of whom 20 received antifungal treatment. At onset of coccidioidal illness, mean FSS score was higher (ie, more fatigue) in the treatment group. However, in early illness, both groups had higher fatigue levels than reference populations with other diseases (eg, multiple sclerosis). FSS scores gradually improved, and scores in each group were below the severe fatigue level at week 12 and week 16 in the nontreatment and treatment groups, respectively. By week 24, mean FSS score of the nontreatment group equaled the general population. SF-36 component and profile scores were lower (with more symptoms) in the treatment group at each time point than the nontreatment group; both groups showed similar improvement. Mental and emotional health SF-36 scores were not as severely affected as physical scores. Most patients reached a physical functioning level similar to the general population at week 12. Pulmonary coccidioidomycosis causes severe fatigue and substantially affects physical abilities. Fatigue was found to be prolonged, with gradual improvement in QOL, regardless of antifungal administration.

Health-related fitness in children and adolescents.

PURPOSE: The American Physical Therapy Association Section on Pediatrics developed a task force to summarize fitness guidelines for children and adolescents. The purposes of this article were to review components, measurement methods, and consequences of physical fitness, and to summarize evidence-based activity recommendations for youth. SUMMARY OF KEY POINTS: Health-related fitness is comprised of body composition, flexibility, cardiorespiratory endurance, and muscular strength and endurance. Each of these components is reviewed in terms of definition, assessment, normative values, and recommendations. CONCLUSIONS: The task force supports the guidelines of the US Department of Health and Human Services, which state that to promote overall health and wellness, youth should participate in 60 minutes or more of physical activity every day. RECOMMENDATIONS FOR CLINICAL PRACTICE: Physical therapists should apply research relevant to health-related fitness when treating youth. Promoting fitness, health, and wellness in our communities is a responsibility all therapists should assume.

Fuel oxidation at the walk-to-run-transition in humans.

Multiple factors (including anthropometric, kinetic, mechanical, kinematic, perceptual, and energetic factors) are likely to play a role in the walk-to-run transition in humans. The primary purpose of the present study was to consider an additional factor, the metabolic fuel source. Indirect calorimetry was used to measure fuel oxidation, and perception of effort was recorded as 10 overnight-fasted adults locomoted on a level treadmill at speeds progressing from 1.56 to 2.46 m s(-1) in increments of 0.11 m s(-1) and 10.0 minutes under 3 conditions: (1) unconstrained choice of gait, (2) walking at all speeds, and (3) running at all speeds. The preferred transition speed was 2.08 ± 0.03 m s(-1). Gait transition from walking to running increased oxygen consumption rate, decreased the perception of effort, and decreased the rate of carbohydrate oxidation. We propose that, in an evolutionary context, gait transition, guided by the perception of effort, can be viewed as a carbohydrate-sparing strategy.

Temporal characteristics of lower extremity moment generation in children with cerebral palsy.

Lower extremity weakness has been documented in children with cerebral palsy (CP). However, the temporal characteristics of moment generation have not been characterized, and they may be important to function. This study tested ankle, knee, and hip flexion and extension moment generation capabilities in children with CP and in able-bodied children. Maximum voluntary isometric contractions (MVIC), the maximum rates of moment development and relaxation, and the time to produce and reduce the moments were quantified. Relationships between the temporal measures, Gross Motor Function Measure-66 (GMFM-66), and MVICs were also examined. Children with CP had significantly reduced MVICs, maximum development, and relaxation rates, and increased times to produce and reduce moments. The maximum rates of moment development and relaxation at some joints were correlated with the GMFM-66 and MVICs. These results suggest that both the magnitude and temporal characteristics of moment generation need to be targeted during therapeutic interventions for children with CP.

A comprehensive joint replacement program for total knee arthroplasty: a descriptive study.

BACKGROUND: Total knee arthroplasty (TKA) is a commonly performed surgical procedure in the US. It is important to have a comprehensive inpatient TKA program which maximizes outcomes while minimizing adverse events. The purpose of this study was to describe a TKA program - the Joint Replacement Program (JRP) - and report post-surgical outcomes. METHODS: 74 candidates for a primary TKA were enrolled in the JRP. The JRP was designed to minimize complications and optimize patient-centered outcomes using a team approach including the patient, patient's family, and a multidisciplinary team of health professionals. The JRP consisted of a pre-operative class, standard pathways for medical care, comprehensive peri-operative pain management, aggressive physical therapy (PT), and proactive discharge planning. Measures included functional tests, knee range of motion (ROM), and medical record abstraction of patient demographics, length of stay, discharge disposition, and complications over a 6-month follow-up period. RESULTS: All patients achieved medical criteria for hospital discharge. The patients achieved the knee flexion ROM goal of 90 degrees (91.7 +/- 5.4 degrees ), but did not achieve the knee extension ROM goal of 0 degrees (2.4 +/- 2.6 degrees ). The length of hospital stay was two days for 53% of the patients, with 39% and 7% discharged in three and four days, respectively. All but three patients were discharged home with functional independence. 68% of these received outpatient physical therapy compared with 32% who received home physical therapy immediately after discharge. Two patients (< 3%) had medical complications during the inpatient hospital stay, and 9 patients (12%) had complications during the 6-month follow-up period. CONCLUSION: The comprehensive JRP for TKA was associated with satisfactory clinical outcomes, short lengths of stay, a high percentage of patients discharged home with outpatient PT, and minimal complications. This JRP may represent an efficient, effective and safe protocol for providing care after a TKA.

Muscle metabolism during overground walking in persons with poststroke hemiparesis.

PURPOSE: Muscle energy metabolism is associated with speed, endurance, and effort during walking, yet data regarding muscle metabolism during walking in persons with poststroke hemiparesis have not been published. The primary purpose of this study was to compare the energy metabolism during overground walking in persons with poststroke hemiparesis to controls. The secondary purpose was to determine whether the walking behavior of persons with poststroke hemiparesis conforms to the fuel selection patterns previously observed in controls. METHOD: O2 consumption and CO2 production were measured as 7 individuals with poststroke hemiparesis and 7 age-matched controls walked at self-selected preferred and fast speeds. Indirect calorimetry was used to measure fuel oxidation. RESULTS: Walking speeds and economy were lower in the clinical cohort, although VO2 and fuel oxidation were consistent between groups. Fat was the dominant fuel source at preferred speeds; whereas, carbohydrate rates increased substantially at fast speeds. CONCLUSIONS: Within each condition, similar contributions of fat and carbohydrate were observed despite a wide disparity in speeds. It is hypothesized that fuel selection contributed to preferred walking speeds in the individuals with poststroke hemiparesis and that high rates of carbohydrate oxidation may have prevented higher, more functional, preferred walking speeds.

Intersegmental dynamics during the swing phase of gait: a comparison of knee kinetics between 7 year-old children and adults.

Existing literature suggests that kinetic patterns associated with children's gait may not be adult-like until after 7 years of age. The development of adult-like kinetic patterns, especially those involving non-muscular interaction moments, occurs with time and experience. We tested the hypothesis that compared to adults, 7 year-old children would demonstrate a relatively larger contribution of muscle moment and a smaller contribution of interaction moment to the net knee joint moment during the swing phase of gait was tested. Net knee joint moments and the contributions of muscle and interaction moments to the net moments were compared between 7 year-old children and adults. Knee kinematics and net joint moments were similar between the two groups. Also, the contributions of the muscle and interaction moments to the net joint moment were similar (P > 0.05), suggesting that the ability to employ interaction moments during the swing phase of gait did not differ between the two groups.

Fuel oxidation during human walking.

Human adults walk at a characteristic speed, but the mechanisms responsible for this ubiquitous and reproducible behavior remain unknown. In this study, preferred walking speed (PWS) was 4.7 +/- 0.1 km h -1 in 12 overnight-fasted adults, mean age 30.0 +/- 2.6 years. Indirect calorimetry was used to measure fuel oxidation during level treadmill walking from 3.2 to 7.2 km h -1 progressively increased at increments of 0.8 km h -1 and 10.0-min intervals. Corroborating many previous reports, the O2 cost of transport (mL O2 kg -1 km -1 ) was numerically lowest at 4.8 km h -1 , near PWS, but was not significantly different than 5.6 km h -1 . The impact of walking speed on the fuel selection of skeletal muscle was much more dramatic. At speeds less than or equal to PWS, muscle carbohydrate (CHO) oxidation rates were quite low, in the range that could be matched by gluconeogenesis. Above 4.8 km h -1 , CHO oxidation rate increased abruptly and tracked the perception of effort (RPE). Stepwise linear regression revealed that CHO oxidation explained 70% of the variance in RPE, and speed provided an additional 4%. In contrast, the other variables included in the analysis, fat oxidation rate, heart rate, and O2 cost of transport, contributed no additional explained variance in RPE. We conclude that PWS is just below a threshold speed, above which CHO oxidation abruptly increases. The central nervous system may be guided by the perception of effort in selecting a PWS that minimizes dependence on CHO oxidation. We further conclude that skeletal muscle metabolic control is an important factor to be taken into account by the central nervous system motor control of human locomotion.

Gait kinematics and kinetics of 7-year-old children: a comparison to adults using age-specific anthropometric data.

The purpose of this study was to determine if sagittal plane gait kinematics and kinetics of 7-year-old children differed from those of adults when age-specific anthropometrics were used in the calculations. Joint angles, moments, and power obtained during level walking in 7-year-old children (n=15) were compared to data from adults (n=15). Calculations were performed using age-specific anthropometric data obtained from dual energy X-ray absorptiometry. For most of the variables examined, 7-year-olds were similar to adults, however children demonstrated a diminished peak plantar flexor moment and less peak power absorption and generation at the ankle during late stance. These results provide support for the hypothesis that children lack the neuromuscular maturity, especially at the ankle, to produce an adult-like gait pattern.

Interactive multimodal biofeedback for task-oriented neural rehabilitation.

Previous studies have suggested that task-oriented biofeedback training may be effective for functional motor improvement. The purpose of this project was to design an interactive, multimodal biofeedback system for the task-oriented training of goal-directed reaching. The central controller, based on a user context model, identifies the state of task performance using multisensing data and provides augmented feedback, through interactive 3D graphics and music, to encourage the patients' self-regulation and performance of the task. The design allows stroke patients to train with functional tasks, and receive real-time performance evaluation through successful processing of multimodal sensory feedback. In addition, the environment and training task is customizable. Overall, the system delivers an engaging training experience. Preliminary results of a pilot study involving stroke patients demonstrate the potential of the system to improve patients' reaching performance.

Anthropometric parameters in children: a comparison of values obtained from dual energy x-ray absorptiometry and cadaver-based estimates.

Anthropometric data used in gait analysis for children are often estimated from older adult cadavers. The extent to which these estimates accurately represent children or affect the calculation of net joint moments during gait analysis is unknown. The purpose of this study was: (1) to compare dual energy X-ray absorptiometry (DXA)-derived anthropometric parameters to cadaver-based estimates in children, and (2) to determine if DXA-derived anthropometric data alter the results of gait analyses in children. Using DXA, the mass, center of mass location, and moment of inertia of the foot, shank, and thigh were obtained from 7 to 13 year-old children (n=50) and compared to cadaver-based estimates. Additionally, lower extremity net joint moments were calculated (inverse dynamics equations) for three children during gait using (a) DXA-derived, and (b) cadaver-based estimates of anthropometric parameters. Statistically significant differences were identified for most DXA-derived and cadaver-based anthropometric values. However, based on gait analysis of three children, it is likely that the differences between DXA-derived and cadaver-based anthropometric estimates would have a negligible effect on the calculation of net joint moments during gait in 7-13 year-old children.