Compliance with web content accessibility guidelines in ophthalmology social media posts.

This is a cross-sectional exploratory analysis of publicly available Internet data to examine compliance to web content accessibility guidelines (WCAG) on patient education social media posts in ophthalmology. WCAG ensures web content accessibility for those with disabilities (including visual impairment). A total of 100 social media posts were sampled from ten ophthalmology patient education social media pages and ten non-ophthalmology (cardiopulmonary) pages as the comparison group. Three independent graders evaluated the selected posts based on the WCAG 2 checklist by WebAIM, a non-profit affiliated with Utah State University, after its adaptation for social media posts. Validated accessibility standard labels: "0" for not meeting any standards, "1" or "A" for meeting bare minimum accessibility requirements, "2" or "AA" for meeting legal accessibility requirements, or "3" or "AAA" for exceeding accessibility requirements. There was not enough evidence to detect a difference in WCAG scores between ophthalmology and non-ophthalmology posts (p = 0.80). Forty-nine percent of scores for ophthalmology social media posts showed no compliance with any WCAG. The most common reasons that ophthalmology posts failed to meet criteria were due to color and contrast issues (39%). Most ophthalmology social media posts had low WCAG scores, indicating poor compliance to WCAG. Because social media is highly visual, reduced compliance to WCAG may create barriers for low vision individuals to successfully access patient education social media content.

Compliance with Web Content Accessibility Guidelines in Ophthalmology Social Media Posts.

This is a cross-sectional analysis of publicly available Internet data to examine compliance to Web Content Accessibility Guidelines (WCAG) on patient education social media posts in ophthalmology. WCAG ensures web content accessibility for those with disabilities (including visual impairment). Social media posts were sampled from 10 ophthalmology patient education social media pages and 10 non-ophthalmology (cardiopulmonary) pages as the comparison group. Three independent reviewers graded the selected posts based on the WebAIM© WCAG 2 checklist adapted for social media posts. Validated accessibility standard labels: "0" for not meeting any standards, "1" for meeting bare minimum accessibility requirements, "2" for meeting legal accessibility requirements, or "3" for exceeding accessibility requirements. There were no significant differences between ophthalmology and non-ophthalmology posts in receiving high vs. low WCAG grades. 49% of ratings for ophthalmology social media posts showed no compliance with any WCAG. The most common reasons that ophthalmology posts failed to meet criteria were due to color and contrast issues (38.9%). Most ophthalmology social media posts had low WCAG scores, indicating poor compliance to WCAG. Because social media is highly visual, reduced compliance to WCAG may create barriers for low vision individuals to successfully access patient education social media content.

Study in Parkinson's disease of exercise phase 3 (SPARX3): study protocol for a randomized controlled trial.

BACKGROUND: To date, no medication has slowed the progression of Parkinson's disease (PD). Preclinical, epidemiological, and experimental data on humans all support many benefits of endurance exercise among persons with PD. The key question is whether there is a definitive additional benefit of exercising at high intensity, in terms of slowing disease progression, beyond the well-documented benefit of endurance training on a treadmill for fitness, gait, and functional mobility. This study will determine the efficacy of high-intensity endurance exercise as first-line therapy for persons diagnosed with PD within 3 years, and untreated with symptomatic therapy at baseline. METHODS: This is a multicenter, randomized, evaluator-blinded study of endurance exercise training. The exercise intervention will be delivered by treadmill at 2 doses over 18 months: moderate intensity (4 days/week for 30 min per session at 60-65% maximum heart rate) and high intensity (4 days/week for 30 min per session at 80-85% maximum heart rate). We will randomize 370 participants and follow them at multiple time points for 24 months. The primary outcome is the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor score (Part III) with the primary analysis assessing the change in MDS-UPDRS motor score (Part III) over 12 months, or until initiation of symptomatic antiparkinsonian treatment if before 12 months. Secondary outcomes are striatal dopamine transporter binding, 6-min walk distance, number of daily steps, cognitive function, physical fitness, quality of life, time to initiate dopaminergic medication, circulating levels of C-reactive protein (CRP), and brain-derived neurotrophic factor (BDNF). Tertiary outcomes are walking stride length and turning velocity. DISCUSSION: SPARX3 is a Phase 3 clinical trial designed to determine the efficacy of high-intensity, endurance treadmill exercise to slow the progression of PD as measured by the MDS-UPDRS motor score. Establishing whether high-intensity endurance treadmill exercise can slow the progression of PD would mark a significant breakthrough in treating PD. It would have a meaningful impact on the quality of life of people with PD, their caregivers and public health. TRIAL REGISTRATION: ClinicalTrials.gov NCT04284436 . Registered on February 25, 2020.

Effect of Timing and Coordination Training on Mobility and Physical Activity Among Community-Dwelling Older Adults: A Randomized Clinical Trial.

Importance: Standard exercise interventions targeting underlying physiologic system impairments have limited success in improving walking. Augmenting standard interventions with timing and coordination training, which incorporates the principles of motor learning and integrates multiple systems, may be more successful. Objective: To determine whether a standard strength and endurance program incorporating timing and coordination training (standard-plus) improves gait speed more than strength and endurance training alone. Design, Setting, and Participants: The Program to Improve Mobility in Aging (PRIMA) study was an assessor-blinded, randomized, 2-group intervention trial that included a 12-week intervention and 24-week follow-up period. The trial was conducted at a university research clinic from 2016 to 2020. Participants included 249 community-dwelling older adults (aged ≥65 years) with gait speed between 0.60 and 1.20 m/s. Statistical analysis was performed from December 2020 to March 2021. Interventions: Participants were randomized to standard strength and endurance (n = 125) or standard-plus, including timing and coordination training (n = 124), 50 to 60 minutes, twice a week for 12 weeks. Main Outcomes and Measures: Primary outcome of gait speed and secondary outcomes representing components of the intervention (leg strength and power, 6-minute walk test, chair sit-and-reach test, and figure of 8 walk test) and activity and participation (Late Life Function and Disability Instrument and daily physical activity measured by accelerometry) were measured at 12, 24, and 36 weeks. Results: Among 249 randomized participants, 163 (65.5%) were female, 22 (8.8%) were Black, 219 (88.0%) were White; mean (SD) age was 77.4 (6.6) years; mean (SD) gait speed was 1.07 (0.16) m/s; and 244 (98.0%) completed the intervention. The 2 groups did not have significantly different improvements in gait speed or secondary outcomes representing the components of the intervention at any time point. For gait speed, individuals in the standard-plus group had a mean (SD) improvement of 0.079 (0.135) m/s over 12 weeks, 0.065 m/s (0.141) over 24 weeks, and 0.059 (0.150) m/s over 36 weeks; individuals in the standard group improved gait speed by 0.081 (0.124) m/s over 12 weeks, 0.051 (0.129) m/s over 24 weeks, and 0.065 (0.148) m/s over 36 weeks. Conclusions and Relevance: This randomized clinical trial found no difference in gait speed change between the standard and standard-plus intervention groups, and both groups showed sustained improvements in mobility 24 weeks after the intervention. Trial Registration: ClinicalTrials.gov Identifier: NCT02663778.

Program to improve mobility in aging (PRIMA) study: Methods and rationale of a task-oriented motor learning exercise program.

Walking difficulty is a common and costly problem in older adults. A potentially important yet unaddressed strategy to enhance walking ability through exercise intervention is to add a timing and coordination component in gait training (i.e. task specific timing and coordination exercise intervention) to the usual strength, endurance, and flexibility training. We describe the methods and rationale of a randomized single-blind, physical therapist supervised, exercise intervention trial to compare the effects of a standard strength, endurance, and flexibility program to a standard plus timing and coordination program in community-dwelling older adults walking slower than the desired gait speed of 1.2 m/s. Exercise sessions are twice weekly for 12 weeks. Participants are assessed at baseline, 12 weeks (post intervention), 24 weeks and 36 weeks. The primary outcome is gait speed, secondary outcomes represent components of the interventions (strength, endurance, flexibility, timing and coordination), and tertiary outcomes are measure of activity and participation (Late Life Function and Disability Instrument and physical activity). The findings of this trial will (1) establish if a standard-plus task specific timing and coordination program is superior to a standard strength and endurance program in improving mobility, activity and participation and (2) determine if the improvements are sustained over time. The information derived from this project will provide valuable insight into the prevention and management of walking difficulty, which is so common in older Americans.

A consensus-based process identifying physical therapy and exercise treatments for patients with degenerative meniscal tears and knee OA: the TeMPO physical therapy interventions and home exercise program.

BACKGROUND: Knee osteoarthritis (OA) is prevalent and often associated with meniscal tear. Physical therapy (PT) and exercise regimens are often used to treat OA or meniscal tear, but, to date, few programs have been designed specifically for conservative treatment of meniscal tear with concomitant knee OA. Clinical care and research would be enhanced by a standardized, evidence-based, conservative treatment program and the ability to study the effects of the contextual factors associated with interventions for patients with painful, degenerative meniscal tears in the setting of OA. This paper describes the process of developing both a PT intervention and a home exercise program for a randomized controlled clinical trial that will compare the effectiveness of these interventions for patients with knee pain, meniscal tear and concomitant OA. METHODS: This paper describes the process utilized by an interdisciplinary team of physical therapists, physicians, and researchers to develop and refine a standardized in-clinic PT intervention, and a standardized home exercise program to be carried out without PT supervision. The process was guided in part by Medical Research Council guidance on intervention development. RESULTS: The investigators achieved agreement on an in-clinic PT intervention that included manual therapy, stretching, strengthening, and neuromuscular functional training addressing major impairments in range of motion, musculotendinous length, muscle strength and neuromotor control in the major muscle groups associated with improving knee function. The investigators additionally achieved agreement on a progressive, protocol-based home exercise program (HEP) that addressed the same major muscle groups. The HEP was designed to allow patients to perform and progress the exercises without PT supervision, utilizing minimal equipment and a variety of methods for instruction. DISCUSSION: This multi-faceted in-clinic PT program and standardized HEP provide templates for in-clinic and home-based care for patients with symptomatic degenerative meniscal tear and concomitant OA. These interventions will be tested as part of the Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial. TRIAL REGISTRATION: The TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004 on February 14, 2017. TeMPO was also approved by the Institutional Review Board at Partners HealthCare/Brigham and Women's Hospital.

Effectiveness of Later-Stage Exercise Programs vs Usual Medical Care on Physical Function and Activity After Total Knee Replacement: A Randomized Clinical Trial.

Importance: Several functional limitations persist after total knee replacement (TKR). Intensive exercise programs could resolve these limitations but are not well tolerated by many patients until a later stage (>2 months) after surgery. Evidence for exercise at a later stage after TKR is limited. Objectives: To compare the effectiveness of later-stage exercise programs after TKR and to explore heterogeneity of treatment effects. Design, Setting, and Participants: Three-arm single-blind randomized clinical trial (January 7, 2015, to November 9, 2017) using an intent-to-treat approach with follow-ups at 3 months and 6 months. The setting was Allegheny County, Pennsylvania (an outpatient physical therapy clinic and 4 community centers). Participants had primary TKR performed more than 2 months previously, were 60 years or older, experienced moderate functional limitations, and were medically cleared to exercise. Interventions: Clinic-based physical therapy exercise (physical therapy arm), community-based group exercise (community arm), and usual care (control arm). The control arm continued their usual care, whereas the exercise arms participated in supervised exercise programs lasting 12 weeks. Main Outcomes and Measures: The primary outcome was arm differences in the Western Ontario and McMaster Universities Osteoarthritis Index-Physical Function (WOMAC-PF) at 3 months. The secondary outcomes included performance-based tests germane to knee replacement and additional surveys of physical function. Data were analyzed by linear mixed models and responder analysis. Results: A total of 240 participants (mean [SD] age, 70 [7] years; 61.7% female) were allocated to physical therapy (n = 96), community exercise (n = 96), or control (n = 48). All 3 arms demonstrated clinically important improvement. At 3 months, between-arm analyses for the WOMAC-PF demonstrated no differences between physical therapy and community (-2.2; 98.3% CI, -4.5 to 0.1), physical therapy and control (-2.1; 98.3% CI, -4.9 to 0.7), and community and control (0.1; 98.3% CI, -2.7 to 2.9). Performance-based tests demonstrated greater improvement in the physical therapy arm compared with both the community (0.1 z score units; 98.3% CI, 0.0-0.2) and control (0.3 z score units; 98.3% CI, 0.1-0.4) arms and the community arm compared with the control arm (0.2 z score units; 98.3% CI, 0.0-0.3). The physical therapy arm had more than 17.7% responders than the community arm and more than 19.0% responders than the control arm. There was no difference in responder rates between the community and control arms. Conclusions and Relevance: Based on the primary outcome, participation in late-stage exercise programs after TKR offered no benefit over usual care. The benefits of physical therapy identified by the secondary outcomes and responder analysis require confirmation. Trial Registration: ClinicalTrials.gov Identifier: NCT02237911.

The TeMPO trial (treatment of meniscal tears in osteoarthritis): rationale and design features for a four arm randomized controlled clinical trial.

BACKGROUND: Meniscal tears often accompany knee osteoarthritis, a disabling condition affecting 14 million individuals in the United States. While several randomized controlled trials have compared physical therapy to surgery for individuals with knee pain, meniscal tear, and osteoarthritic changes (determined via radiographs or magnetic resonance imaging), no trial has evaluated the efficacy of physical therapy alone in these subjects. METHODS: The Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial is a four-arm multi-center randomized controlled clinical trial designed to establish the comparative efficacy of two in-clinic physical therapy interventions (one focused on strengthening and one containing placebo) and two protocolized home exercise programs. DISCUSSION: The goal of this paper is to present the rationale behind TeMPO and describe the study design and implementation strategies, focusing on methodologic and clinical challenges. TRIAL REGISTRATION: The TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004 . on February 14, 2017.

Considerations for Assessment and Applicability of Studies of Intervention.

Evidence-based practice changed how health care professionals are taught medical practice. Despite all best intentions, many health care professionals have limited knowledge to assess the validity and usefulness of the medical literature. The goal of this article is to review the following basic considerations while appraising studies of intervention: (1) the hierarchy of evidence and the strengths and weaknesses of clinical studies, (2) the relevant elements of study design that impact validity of study results, and (3) the spectrum of efficacy and effectiveness of clinical studies and how these influence the applicability of study results to individual patients.

Effect of Comprehensive Behavioral and Exercise Intervention on Physical Function and Activity Participation After Total Knee Replacement: A Pilot Randomized Study.

OBJECTIVE: To test the feasibility of a comprehensive behavioral intervention (CBI) program that combines intense exercises with an education program, to be implemented at a later stage (3 months) following total knee replacement (TKR), and to get a first impression of the effects of the CBI as compared to a standard of care exercise (SCE) program on the outcomes of physical function and physical activity. METHODS: A total of 44 subjects participated in a 3-month program of either CBI or SCE, followed by 3 months of a home exercise program. Outcomes of physical function and physical activity were measured at baseline and at 6-month followup. Analysis of variance was used to compare statistical differences between groups, whereas responder analyses were used for clinically important differences. RESULTS: The CBI was found to be safe and well tolerated. As compared to the SCE group, the CBI group had less pain (P = 0.035) and better physical function based on the Short Form 36 health survey (P = 0.017) and the single-leg stance test (P = 0.037). The other outcome measures did not demonstrate statistically significant differences between the 2 groups. Results from the responder analysis demonstrated that the CBI group had a 36% higher rate of responders in physical function as compared to the SCE group. Also, the CBI group had 23% more responders in the combined domains of physical function and physical activity. CONCLUSION: The CBI program is feasible and improves physical function and physical activity in patients several months after TKR. Larger pragmatic randomized trials are needed to confirm the results of this study.

A randomized trial to compare exercise treatment methods for patients after total knee replacement: protocol paper.

BACKGROUND: Although the outcome of total knee replacement (TKR) is favorable, surgery alone fails to resolve the functional limitations and physical inactivity that existed prior to surgery. Exercise is likely the only intervention capable of improving these persistent limitations, but exercises have to be performed with intensity sufficient to promote significant changes, at levels that cannot be tolerated until later stages post TKR. The current evidence is limited regarding the effectiveness of exercise at a later stage post TKR. To that end, this study aims to compare the outcomes of physical function and physical activity between 3 treatment groups: clinic-based individual outpatient rehabilitative exercise during 12 weeks, community-based group exercise classes during 12 weeks, and usual medical care (wait-listed control group). The secondary aim is to identify baseline predictors of functional recovery for the exercise groups. METHODS/DESIGN: This protocol paper describes a comparative effectiveness study, designed as a 3-group single-blind randomized clinical trial. Two hundred and forty older adults who underwent TKR at least 2 months prior will be randomized into one of the three treatment approaches. Data will be collected at baseline, 3 months, and 6 months. The wait-listed control group will be randomized to one of the 2 exercise groups after 6 months of study participation, and will complete a 9-month follow-up. Primary outcome is physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index Physical Function Subscale (WOMAC-PF). Physical function is also measured by performance-based tests. Secondary outcomes include performance-based tests and physical activity assessed by a patient-reported survey and accelerometry-based physical activity monitors. Exploratory outcomes include adherence, co-interventions, attrition, and adverse events including number of falls. Linear mixed models will be fitted to compare the changes in outcome across groups. Logistic regression will identify patient characteristics that predict functional recovery in the exercise groups. Instrumental variable methods will be used to estimate the efficacy of the interventions in the presence of non-compliance. DISCUSSION: Results will inform recommendations on exercise programs to improve physical function and activity for patients at the later stage post TKR and help tailor interventions according with patients' characteristics. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT02237911.

Altered gait characteristics in individuals with knee osteoarthritis and self-reported knee instability.

STUDY DESIGN: Experimental laboratory study. OBJECTIVE: To characterize the differences in lower extremity gait biomechanics in individuals who have knee osteoarthritis (OA) with and without self-reported knee instability. BACKGROUND: Individuals with knee OA who experience episodes of knee instability often report gait difficulties that interfere with their daily lives. A better understanding of the alterations in gait biomechanics may help to mitigate symptomatic knee instability in this patient population. METHODS: Seventeen participants with knee OA and self-reported knee instability and 36 participants with knee OA and no self-reported knee instability underwent instrumented gait analysis on level ground. Knee-specific symptoms and functional limitations were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. RESULTS: Knee instability was associated with greater odds of reporting moderate to severe gait-related pain (odds ratio = 6.0; 95% confidence interval: 1.2, 28.9) and moderate to severe difficulty when walking on flat surfaces (odds ratio = 10.7; 95% confidence interval: 1.7, 69.2). During early stance, the group with self-reported knee instability walked with a greater knee flexion excursion (P = .02) and a smaller lower extremity support moment (P<.01), due to reduced contributions from the hip extensors (P<.01) and ankle plantar flexors (P = .04). The group with self-reported knee instability also walked with a greater knee extensor contribution to the lower extremity support moment (P = .04) during the initial knee extension phase of gait compared to their counterparts with good knee stability. CONCLUSION: These findings suggest that self-reported knee instability is associated with significant alterations in hip, knee, and ankle joint function during the stance phase of gait in individuals with knee OA.

Association of severity of coexisting patellofemoral disease with increased impairments and functional limitations in patients with knee osteoarthritis.

OBJECTIVE: To evaluate the association between severity of coexisting patellofemoral (PF) disease with lower extremity impairments and functional limitations in patients with tibiofemoral (TF) osteoarthritis (OA). METHODS: Radiographic views of the TF and PF compartments, knee extension strength, and knee range of motion were obtained for 167 patients with knee OA. Additionally, knee-specific symptoms and functional limitations were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Activities of Daily Living Scale (ADLS). RESULTS: Moderate/severe PFOA was associated with lower knee extension strength (mean ± SD 1.4 ± 0.5 Nm/body weight [BW]) compared to no PFOA (mean ± SD 1.8 ± 0.5 Nm/BW). Additionally, total knee range of motion was significantly lower for patients with moderate/severe PFOA (mean ± SD 120.8° ± 14.4°) compared to no PFOA (mean ± SD 133.5° ± 10.7°) and mild PFOA (mean ± SD 125.8° ± 13.0°). Moderate/severe PFOA and mild PFOA were also associated with less pain while standing (odds ratio [OR] 0.2, 95% confidence interval [95% CI] 0.1-0.7 and OR 0.2, 95% CI 0.1-0.6, respectively) on the WOMAC, and moderate/severe PFOA was associated with greater difficulty with going downstairs (OR 2.9, 95% CI 1.0-8.1) on the ADLS. CONCLUSION: It appears that knees with more severe coexisting PF disease demonstrate features distinct from those observed in TFOA in isolation or in combination with mild PF disease. Treatment strategies targeting the PF joint may be warranted to mitigate the specific lower extremity impairments and functional problems present in this patient population.

A relação de ajuda: percepção da criança dos 6-10 anos / The helping relationship: perception of the 6-10 year old child

Fundamentação: A relação de ajuda deve ser considerada como um foco de atenção em enfermagem pediátrica, de forma a definir estratégias adequadas à capacitação da criança/família, em prol do saudável desenvolvimento das crianças. O papel do enfermeiro e a importância da relação de ajuda é definida neste trabalho através das dimensões de nível de respeito, compreensão empática, incondicionalidade de respeito e congruência. Métodos: Tendo como objetivos analisar a perceção das crianças dos 6 aos10 anos acerca da relação de ajuda estabelecida com os enfermeiros nas diferentes unidades de saúde e analisar a influência das variáveis sócio demográficas nas diversas dimensões da relação de ajuda desenvolvemos um estudo de natureza quantitativa, transversal, descritivocorrelacional, com uma amostra não probabilística por conveniência de 71 crianças (37 meninos e 34 meninas) com uma média de idade de 8,46 anos. Para a colheita de dados utilizámos um instrumento de caracterização sócio demográfica da amostra e o inventário das relações de Barrett-Lennard (1986). Resultados: No que concerne às dimensões estudadas verificamos que as crianças pontuam com médias mais elevadas a dimensão de respeito e da dimensão compreensão empática apresentando médias mais baixas na dimensão da congruência. Os resultados evidenciaram ainda que não existiam diferenças estatisticamente significativas entre as dimensões da relação de ajuda e as variáveis sociodemográficas da criança e serviços de saúde. Somente as variáveis residência e motivo de recurso aos serviços é que apresentam diferenças estatisticamente significativas. Conclusão: Podemos concluir que as crianças da nossa população independentemente da idade, sexo, residência, número de irmãos e/ou escolaridade, percecionam e valorizam as dimensões da relação de ajuda no contato com os enfermeiros.

Reasons: The aid relationship should be considered as a focal point in pediatric nursing, in order to define appropriate strategies to capacitate the child/family, to support the healthy development of children. The nurse's role and the importance of the aid relat ionship is defined in this work/study through the dimensions of level of respect, empathy comprehension, unconditional respect and consistency. Methods: Having as the objective to examine the perception of children aged 6-10 years on the aid relationship established with the nurses throughout the different health facilities and analyze the influence of socio-demographic variables on the various dimensions of the aid relationship, we have developed a quantitative, transversal, correlational descriptive study, with a non- probabilistic sample of 71 children (37 girls and 34 boys) with an average age of 8.46 years. For the collection of data, we used a sample of the sociodemographic characterization instrument and the inventory of the Barrett-Lennard (1986) relations. Results: Regarding the dimensions studied, we found that the children score higher averages on the respect dimension followed by the empathic understanding dimension, showing lower averages on the consistency dimension. The results showed that there are no statistically significant differences between the aid relationship dimensions and the sociodemographic variables of the child and health services. Only the residence variables and the reason for the use of health services differ. Conclusion: We can conclude that the children of our population, regardless of age, sex, residence, number of siblings and/or education, perceive and value the aid relationship dimensions when in contact with the nurses. K

Are the kinematics of the knee joint altered during the loading response phase of gait in individuals with concurrent knee osteoarthritis and complaints of joint instability? A dynamic stereo X-ray study.

BACKGROUND: Joint instability has been suggested as a risk factor for knee osteoarthritis and a cause of significant functional decline in those with symptomatic disease. However, the relationship between altered knee joint mechanics and self-reports of instability in individuals with knee osteoarthritis remains unclear. METHODS: Fourteen subjects with knee osteoarthritis and complaints of joint instability and 12 control volunteers with no history of knee disease were recruited for this study. Dynamic stereo X-ray technology was used to assess the three-dimensional kinematics of the knee joint during the loading response phase of gait. FINDINGS: Individuals with concurrent knee osteoarthritis and joint instability demonstrated significantly reduced flexion and internal/external rotation knee motion excursions during the loading response phase of gait (P<0.01), while the total abduction/adduction range of motion was increased (P<0.05). In addition, the coronal and transverse plane alignment of the knee joint at initial contact was significantly different (P<0.05) for individuals with concurrent knee osteoarthritis and joint instability. However, the anteroposterior and mediolateral tibiofemoral joint positions at initial contact and the corresponding total joint translations were similar between groups during the loading phase of gait. INTERPRETATIONS: The rotational patterns of tibiofemoral joint motion and joint alignments reported for individuals with concurrent knee osteoarthritis and joint instability are consistent with those previously established for individuals with knee osteoarthritis. Furthermore, the findings of similar translatory tibiofemoral motion between groups suggest that self-reports of episodic joint instability in individuals with knee osteoarthritis may not necessarily be associated with adaptive alterations in joint arthrokinematics.

Repercusión del acceso vascular sobre la calidad de vida de los pacientes en tratamiento con hemodiálisis / Vascular access impact on quality of life of patients treated with hemodialysis

En todo paciente diagnosticado de insuficiencia renal crónia es imprescindible facilitar un tratamiento adecuado y evitar complicaciones derivadas. Solucionada esta premisa la atención se dirige a ayudar a estos pacientes a vivir lo mejor posible con su patología, en definitiva, mejorar su calidad de vida. Si el acceso vascular es clave para un buen tratamiento dialítico, podríamos pensar que sería un factor que pudiera influir en la calidad de vida del enfermo renal. Objetivo: Determinar en qué medida influye el acceso vascular sobre la calidad de vida relacionada con la salud de los pacientes en hemodiálisis. Metodología: Estudio descriptivo transversal en una población de 38 pacientes en programa de hemodiálisis. Para la evaluación del estado de salud percibido se utilizó la escala visual analógica del Euroqol 5D. Se solicitó a los pacientes que indicasen en la misma su estado de salud en el momento actual y sin los inconvenientes e incomodidades que les supone su acceso vascular. Resultados: Aquellos pacientes que se dializaban a través de fístula arteriovenosa interna alcanzaron una puntuación media en la EVA de 58,75±20,31 frente a 60,56±17,39 puntos que alcanzaron los portadores de catéteres venosos centrales, no resultando estadísticamente significativo. Conclusiones: Según nuestro estudio, no existe una influencia significativa del acceso vascular sobre la calidad de vida percibida por el paciente. Los mayores inconvenientes e incomodidades relacionados con el acceso vascular se producen en los portadores de catéteres venosos centrales que llevan más de 1 año en hemodiálisis (AU)

In all patients diagnosed with chronic renal failure is essential to facilitate an adequate treatment and to prevent complications. When this premise is resolved, the attention is directed to assist these patients to live as well as possible with their disease, improving their quality of life ultimately. Objective: To determine the extent vascular access influences the health related quality of life related of hemodialysis patients. Methodology: Cross-sectional study in a population of 38 hemodialysis patients. Euroqol 5D visual analogue scale was used to evaluate their perceived health status. Patients were asked about their health status at present time, and without the inconvenience and discomfort which gives them their vascular access. Results: Visual analogue scale mean score of patient with an arteriovenous fistula was 58.75 ± 20.31points vs60.56 ± 17.39 points of patients with central venous catheter (no statistically significant). Conclusions: According our study, there is no significant influence of the vascular access on the patient´s perceived quality of life. The major inconveniences and discomfort associated with vascular access occur in patients with a central venous catheter, who are treated with hemodialysis more than 1 year (AU)

Change in knee cartilage volume in individuals completing a therapeutic exercise program for knee osteoarthritis.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To characterize knee cartilage change in individuals with knee osteoarthritis (KOA) who have completed a therapeutic exercise program. BACKGROUND: While therapeutic exercise is frequently used successfully to improve pain and function in individuals with KOA, no studies have reported the volume of cartilage change or individual factors that may impact volume of cartilage change in those completing an exercise program for KOA. METHODS: Thirteen individuals with KOA underwent magnetic resonance imaging to quantify cartilage volume change in the weight-bearing regions of the medial and lateral femoral condyles and the entire surface of the tibial plateaus from baseline to 1-year follow-up. Body structure and function measures were taken for body mass index, knee axis alignment, knee motion, and knee strength. Activity limitations and activity levels were also measured prior to the therapeutic exercise program, using the Western Ontario and McMaster Universities Osteoarthritis Index and the Physical Activity Scale for the Elderly. At 6 months from baseline, follow-up clinical measurements of knee strength and motion were performed. At 1 year from baseline, imaging of the knee cartilage and knee alignment were performed, and participants completed the Western Ontario and McMaster Universities Osteoarthritis Index and Physical Activity Scale for the Elderly. RESULTS: The central region of the medial femoral condyle (cMF) had a median volume of cartilage loss of 3.8%. The other 3 knee tibiofemoral articular surfaces had minimal median cartilage volume change. Individuals were dichotomized into progressors (n = 6) and nonprogressors (n = 7), based on the standard error of measurement of cartilage volume change for the cMF. Progressors were younger, had a larger body mass index, had a higher Kellgren-Lawrence grade in the medial compartment of the knee, and had a greater increase in knee varus alignment from baseline to 1-year follow-up. The progressors also had frontal plane hip and knee kinetics during baseline gait analysis that potentially increased medial knee joint loading. CONCLUSION: The loss of cMF cartilage volume was highly variable and the median loss of cartilage was within the range previously reported. Seven of the 13 individuals did not have cMF cartilage volume loss greater than the standard error of measurement. Change in cartilage volume of the cMF may be influenced to a greater extent by personal factors than by completion of a therapeutic exercise program. Additional research is needed to decipher the interactions among therapeutic exercise and personal characteristics that impact knee cartilage loss.

Agility and perturbation training techniques in exercise therapy for reducing pain and improving function in people with knee osteoarthritis: a randomized clinical trial.

BACKGROUND: Impairment-based exercise programs have yielded only small to moderate benefits in reducing pain and improving function in people with knee osteoarthritis (OA). It has previously been proposed that adding agility and perturbation training to exercise programs for people with knee OA may improve treatment effects for pain and function. OBJECTIVE: The purpose of this study was to examine the effectiveness of adding agility and perturbation techniques to standard exercise therapy compared with the standard exercise program alone for people with knee OA. DESIGN: This was a single-blinded randomized controlled trial. SETTING: The study was conducted in the outpatient physical therapy clinic of a large, university-based health center. PARTICIPANTS: One hundred eighty-three people with knee OA (122 women, 61 men) participated. INTERVENTIONS: Participants were randomly assigned to either a group that received agility and perturbation training with standard exercise therapy or a group that received only the standard exercise program. MEASUREMENTS: The outcome measures were self-reported knee pain and function, self-reported knee instability, a performance-based measure of function, and global rating of change. RESULTS: Although both groups exhibited improvement in self-reported function and in the global rating of change at the 2-, 6-, and 12-month follow-up periods, there were no differences between groups on these outcomes. There was no reduction in knee pain or improvement in performance-based function in either group. LIMITATIONS: It is possible that more-intense application of the interventions or application of the interventions to participants with knee OA who were at greater risk for falling may have yielded additive effects of the agility and perturbation training approach. CONCLUSIONS: Both intervention groups exhibited improvement in self-reported function and the global rating of change. Our results, however, did not support an additive effect of agility and perturbation training with standard exercise therapy in our sample of individuals with knee OA. Further study is needed to determine whether there are subgroups of individuals who might achieve an added benefit with this approach.

Contribution of hip abductor strength to physical function in patients with total knee arthroplasty.

BACKGROUND: Investigating modifiable factors that contribute to functional limitations in patients with total knee arthroplasty (TKA) may guide changes in rehabilitation protocols and improve functional outcomes. Whereas quadriceps muscle weakness has been demonstrated to contribute to functional limitations in TKA, the role of hip abductor weakness has not received attention. OBJECTIVE: The purpose of this study was to determine whether hip abductor strength (force-generating capacity) contributes to physical function beyond what can be explained by quadriceps muscle strength in patients after a TKA. DESIGN: A cross-sectional design was used in the study. SETTING: The study was conducted in a clinical laboratory at an academic center. PATIENTS: Thirty-one people with TKA (74% female; mean age=68 years, SD=8; mean body mass index=31 kg/m(2), SD=5) participated in the study. MEASUREMENTS: Strength of quadriceps muscles and hip abductors was measured using an isokinetic dynamometer. Performance-based physical function was assessed with 4 measures: self-selected walking speed, the Figure-of-8 Walk Test, the Stair Ascend/Descend Test, and the 5-Chair Rise Test. Self-reported physical function was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index Physical Function Subscale. RESULTS: In hierarchical regression models, after accounting for demographic and anthropometric factors, quadriceps muscle strength was associated with performance on the Stair Ascend/Descend Test. After accounting for demographic, anthropometric, and quadriceps strength, hip abductor strength was associated with performance on the Stair Ascend/Descend Test, the Figure-of-8 Walk Test, and the 5-Chair Rise Test. LIMITATIONS: The study design precluded ascertainment of causal relationships. CONCLUSIONS: After TKA, hip abductor strength influenced physical function in participants more than did demographic or anthropometric measures or quadriceps strength. Longitudinal studies with larger samples are warranted. If findings are replicated, they will justify targeting the hip abductors during rehabilitation after TKA.

Interrater reliability and validity of the stair ascend/descend test in subjects with total knee arthroplasty.

OBJECTIVE: (1) To determine the interrater reliability and measurement error of an 11-step stair ascend/descend test (STTotal-11) and stair up (ascend) test (STUp-11); (2) to seek evidence for the STTotal-11 and STUp-11 as valid measures of physical function by determining if they relate to measures of physical function and do not relate to measures not of physical function; and (3) to explore if the STTotal-11 and STUp-11 scores relate to lower-extremity muscle weakness and knee range of motion (ROM) in subjects with total knee arthroplasty (TKA). DESIGN: Cross-sectional study. SETTING: Academic center. PARTICIPANTS: Subjects (N=43, 30 women; mean age, 68+/-8y) with unilateral TKA. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: STTotal-11 and STUp-11 were performed twice, and scores were compared with scores on 4 lower extremity performance-based tasks, 2 patient-reported questionnaires of physical function, 3 psychologic factors, knee ROM, and strength of quadriceps, hip extensors, and abductors. RESULTS: Intraclass correlation coefficient was .94 for both the STTotal-11 and STUp-11, standard error of measurements were 1.14 seconds and .82 seconds, and minimum detectable change associated with 90% confidence interval was 2.6 seconds and 1.9 seconds, respectively. Correlations between stair tests and performance-based measures and knee and hip muscle strength ranged from Pearson correlation coefficient (r)=.40 to .78. STTotal-11 and STUp-11 had a small correlation with one of the patient-reported measures of physical function. Stair tests were not associated with psychologic factors and knee extension ROM and were associated with knee flexion ROM. CONCLUSIONS: STTotal-11 and STUp-11 have good interrater reliability and minimum detectable changes adequate for clinical use. The pattern of associations supports the validity of the stair tests in TKA.