Knowledge translation in rehabilitation settings in low, lower-middle and upper-middle-income countries: a scoping review.

PURPOSE: This review aims to identify the barriers and facilitators to knowledge use and Knowledge Translation (KT) strategies in rehabilitation in low, lower-middle, and upper-middle-income countries (LMICs). MATERIALS AND METHODS: A scoping review of studies of KT in rehabilitation in LMICs contexts using the Arksey and O'Malley Framework was conducted. A comprehensive search of MEDLINE and 10 other databases was undertaken to identify studies conducted primarily in LMICs. RESULTS: From the initial 15.606 titles identified; 27 articles were included for final analysis. Our analysis identified the following themes: Professional culture and context; KT interventions; and the conceptualization and application of KT and Evidence Based Practice (EBP). Individual-level barriers to KT included lack of skills, knowledge about EBP and English language, lack of motivation, and decision-making power. Facilitators to KT included positive attitudes and motivation. Organization-level barriers included lack of time, lack of financial resources, limited access to scientific journals, and applicability of research to rural settings. Facilitators included adequate financial and physical resources, a supportive management environment, and the existence of training and continuing education programs. CONCLUSION: This review identified common and unique barriers and facilitators to KT in LMICs when compared to KT studies conducted in high-income settings.IMPLICATIONS FOR REHABILITATIONKnowledge Translation from academic institutions to rehabilitation clinical practice in low and upper-middle-income countries is important to support evidence-based practice and patient outcomes.Barriers at the individual level include professionals' ability to understand English and knowledge of the evidence-based practice.Organization-level barriers included lack of time to access and implement new practices, lack of financial and personal resources, limited access to scientific journals, and applicability of research to rural settings.Training and continuing education programs are needed to support rehabilitation professionals' efforts to achieve the application of evidence-based practice in clinical practice.

Culturally sensitive palliative care in humanitarian action: Lessons from a critical interpretive synthesis of culture in palliative care literature.

OBJECTIVE: There is growing recognition of the importance of increasing preparedness for and the provision of palliative care in humanitarian crises. The primary objective of this review is to interpret the existing literature on culture and palliative care to query the recommendation that humanitarian healthcare providers, teams, and organizations integrate palliative care into their practice in ways that are attentive to and respectful of cultural differences. METHODS: A critical interpretive synthesis was applied to a systematic literature review guided by the PRISMA framework. Analysis was based on directed data extraction and was team based, to ensure rigor and consistency. RESULTS: In total, 112 articles covering 51 countries and 9 major worldviews met inclusion criteria. This literature describes culture as it influences perspectives on death and dying, expectations of palliative care, and challenges to providing culturally sensitive care. A key pattern highlighted in articles with respect to the culture and palliative care literature is that culture is invoked in this literature as a sort of catch-all for non-white, non-Christian, indigenous practices, and preferences for palliative care. It is important that humanitarian healthcare providers and organizations aiming to enact their commitment of respect for all persons through attention to potential culturally specific approaches to pain management, suffering, and dying in specific crisis settings do so without reproducing Othering and reductionistic understandings of what culturally sensitive care in humanitarian crises settings involves. SIGNIFICANCE OF RESULTS: This paper clarifies and unpacks the diverse influences of culture in palliative care with the goal of supporting the preparedness and capacity of humanitarian healthcare providers to provide palliative care. In doing so, it aids in thinking through what constitutes culturally sensitive practice when it comes to palliative care needs in humanitarian crises. Providing such care is particularly challenging but also tremendously important given that healthcare providers from diverse cultures are brought together under high stress conditions.

Are biomechanics during gait associated with the structural disease onset and progression of lower limb osteoarthritis? A systematic review and meta-analysis.

OBJECTIVE: To evaluate if gait biomechanics are associated with increased risk of structurally diagnosed disease onset or progression of lower limb osteoarthritis (OA). METHOD: A systematic review of Medline and Embase was conducted from inception to July 2021. Two reviewers independently screened records, extracted data and assessed risk of bias. Included studies reported gait biomechanics at baseline, and either structural imaging or joint replacement occurrence in the lower limb at follow-up. The primary outcome was the Odds Ratio (OR) (95% confidence interval (CI)) of the association between biomechanics and structural OA outcomes with data pooled for meta-analysis. RESULTS: Twenty-three studies reporting 25 different biomechanical metrics and 11 OA imaging outcomes were included (quality scores ranged 12-20/21). Twenty studies investigated knee OA progression; three studies investigated knee OA onset. Two studies investigated hip OA progression. 91% of studies reported a significant association between at least one biomechanical variable and OA onset or progression. There was an association between frontal plane biomechanics with medial tibiofemoral and hip OA progression and sagittal plane biomechanics with patellofemoral OA progression. Meta-analyses demonstrated increased odds of medial tibiofemoral OA progression with greater baseline peak knee adduction moment (KAM) (OR: 1.88 [95%CI: 1.08, 3.29]) and varus thrust presence (OR: 1.97 [95%CI: 1.32, 2.96]). CONCLUSION: Evidence suggests that certain gait biomechanics are associated with an increased odds of OA onset and progression in the knee, and progression in the hip. REGISTRATION NUMBER: PROSPERO CRD42019133920.

Magnetic charge propagation upon a 3D artificial spin-ice.

Magnetic charge propagation in spin-ice materials has yielded a paradigm-shift in science, allowing the symmetry between electricity and magnetism to be studied. Recent work is now suggesting the spin-ice surface may be important in mediating the ordering and associated phase space in such materials. Here, we detail a 3D artificial spin-ice, which captures the exact geometry of bulk systems, allowing magnetic charge dynamics to be directly visualized upon the surface. Using magnetic force microscopy, we observe vastly different magnetic charge dynamics along two principal directions. For a field applied along the surface termination, local energetics force magnetic charges to nucleate over a larger characteristic distance, reducing their magnetic Coulomb interaction and producing uncorrelated monopoles. In contrast, applying a field transverse to the surface termination yields highly correlated monopole-antimonopole pairs. Detailed simulations suggest it is the difference in effective chemical potential as well as the energy landscape experienced during dynamics that yields the striking differences in monopole transport.

Frontal plane knee alignment mediates the effect of frontal plane rearfoot motion on knee joint load distribution during walking in people with medial knee osteoarthritis.

OBJECTIVE: To examine the nature of differences in the relationship between frontal plane rearfoot kinematics and knee adduction moment (KAM) magnitudes. DESIGN: Cross-sectional study resulting from a combination of overground walking biomechanics data obtained from participants with medial tibiofemoral osteoarthritis at two separate sites. Statistical models were created to examine the relationship between minimum frontal plane rearfoot angle (negative values = eversion) and different measures of the KAM, including examination of confounding, mediation, and effect modification from knee pain, radiographic disease severity, static rearfoot alignment, and frontal plane knee angle. RESULTS: Bivariable relationships between minimum frontal plane rearfoot angle and the KAM showed consistent negative correlations (r = -0.411 to -0.447), indicating higher KAM magnitudes associated with the rearfoot in a more everted position during stance. However, the nature of this relationship appears to be mainly influenced by frontal plane knee kinematics. Specifically, frontal plane knee angle during gait was found to completely mediate the relationship between minimum frontal plane rearfoot angle and the KAM, and was also an effect modifier in this relationship. No other variable significantly altered the relationship. CONCLUSIONS: While there does appear to be a moderate relationship between frontal plane rearfoot angle and the KAM, any differences in the magnitude of this relationship can likely be explained through an examination of frontal plane knee angle during walking. This finding suggests that interventions derived distal to the knee should account for the effect of frontal plane knee angle to have the desired effect on the KAM.

Electron Compton scattering and the measurement of electron momentum distributions in solids.

Electron Compton scattering is a technique that gives information on the electron momentum density of states and is used to characterize the ground state electronic structure in solids. Extracting the momentum density of states requires us to assume the so-called 'impulse approximation', which is valid for large energy losses. Here, the robustness of the impulse approximation in the low energy transfer regime is tested and confirmed on amorphous carbon films. Compared to traditional Compton measurements, this provides additional benefits of more efficient data collection and a simplified way to probe valence electrons, which govern solid state bonding. However, a potential complication is the increased background from the plasmon signal. To overcome this, a novel plasmon background subtraction routine is proposed for samples that are resistant to beam damage. LAY DESCRIPTION: Properties of solids depend on their electronic structure which can be studied using electron Compton scattering technique. Here, an electron beam is used to penetrate a very thin sample. During the interaction between the electrons in the beam and electrons in the sample, the former transfer a part of their energy to the latter, resulting in a measurable energy loss of the transmitted beam. The amount of the energy transfer depends on the angle of incidence between the beam and the sample. Typically, the experiments are carried out using high tilt angles and high energy transfer; however, in this work, we show that even smaller angles of incidence are suitable, which improve the signal quality and ease data processing procedures.

Osteoarthritis year in review 2019: mechanics.

Mechanics play a critical - but not sole - role in the pathogenesis of osteoarthritis, and recent research has highlighted how mechanical constructs are relevant at the cellular, joint, and whole-body level related to osteoarthritis outcomes. This review examined papers from April 2018 to April 2019 that reported on the role of mechanics in osteoarthritis etiology, with a particular emphasis on studies that focused on the interaction between movement and tissue biomechanics with other clinical outcomes relevant to the pathophysiology of osteoarthritis. Studies were grouped by themes that were particularly prevalent from the past year. Results of the search highlighted the large exposure of knee-related research relative to other body areas, as well as studies utilizing laboratory-based motion capture technology. New research from this past year highlighted the important role that rate of exerted loads and rate of muscle force development - rather than simply force capacity (strength) - have in OA etiology and treatment. Further, the role of muscle activation patterns in functional and structural aspects of joint health has received much interest, though findings remain equivocal. Finally, new research has identified potential mechanical outcome measures that may be related to osteoarthritis disease progression. Future research should continue to combine knowledge of mechanics with other relevant research techniques, and to identify mechanical markers of joint health and structural and functional disease progression that are needed to best inform disease prevention, monitoring, and treatment.

Kinetic risk factors of running-related injuries in female recreational runners.

Our objective was to prospectively investigate the association of kinetic variables with running-related injury (RRI) risk. Seventy-four healthy female recreational runners ran on an instrumented treadmill while 3D kinetic and kinematic data were collected. Kinetic outcomes were vertical impact transient, average vertical loading rate, instantaneous vertical loading rate, active peak, vertical impulse, and peak braking force (PBF). Participants followed a 15-week half-marathon training program. Exposure time (hours of running) was calculated from start of program until onset of injury, loss to follow-up, or end of program. After converting kinetic variables from continuous to ordinal variables based on tertiles, Cox proportional hazard models with competing risks were fit for each variable independently, before analysis in a forward stepwise multivariable model. Sixty-five participants were included in the final analysis, with a 33.8% injury rate. PBF was the only kinetic variable that was a significant predictor of RRI. Runners in the highest tertile (PBF < -0.27 BW) were injured at 5.08 times the rate of those in the middle tertile and 7.98 times the rate of those in the lowest tertile. When analyzed in the multivariable model, no kinetic variables made a significant contribution to predicting injury beyond what had already been accounted for by PBF alone. Findings from this study suggest PBF is associated with a significantly higher injury hazard ratio in female recreational runners and should be considered as a target for gait retraining interventions.

Clinical and biomechanical changes following a 4-month toe-out gait modification program for people with medial knee osteoarthritis: a randomized controlled trial.

OBJECTIVE: To compare changes in knee pain, function, and loading following a 4-month progressive walking program with or without toe-out gait modification in people with medial tibiofemoral knee osteoarthritis. DESIGN: Individuals with medial knee osteoarthritis were randomized to a 4-month program to increase walking activity with (toe-out) or without (progressive walking) concomitant toe-out gait modification. The walking program was similar between the two groups, except that the gait modification group was trained to walk with 15° more toe-out. Primary outcomes included: knee joint pain (WOMAC), foot progression angles and knee joint loading during gait (knee adduction moment (KAM)). Secondary outcomes included WOMAC function, timed stair climb, and knee flexion moments during gait. RESULTS: Seventy-nine participants (40 in toe-out group, 39 in progressive walking group) were recruited. Intention-to-treat analysis showed no between-group differences in knee pain, function, or timed stair climb. However, the toe-out group exhibited significantly greater changes in foot progression angle (mean difference = -9.04° (indicating more toe-out), 95% CI: -11.22°, -6.86°; P < 0.001), late stance KAM (mean difference = -0.26 %BW*ht, 95% CI: -0.39 %BW*ht, -0.12 %BW*ht, P < 0.001) and KAM impulse (-0.06 %BW*ht*s, 95% CI: -0.11 %BW*ht*s, -0.01 %BW*ht*s; P = 0.031) compared to the progressive walking group at follow-up. The only between-group difference that remained at a 1-month retention assessment was foot progression angle, with greater changes in the toe-out group (mean difference = -6.78°, 95% CI: -8.82°, -4.75°; P < 0.001). CONCLUSIONS: Though both groups experienced improvements in self-reported pain and function, only the toe-out group experienced biomechanical improvements. TRIALS REGISTRY NUMBER: NCT02019108.

Physiological arousal accompanying postural responses to external perturbations after stroke.

OBJECTIVE: The purpose of this study was to examine simultaneously the level of physiological arousal and the postural response to external perturbations in people post-stroke compared to age-matched controls to build a more comprehensive understanding of the effect of stroke on postural control and balance self-efficacy. METHODS: Participants stood with each foot on separate force platforms. Ten applications of loads of 2% body weight at the hips perturbed the participant anteriorly under two conditions: investigator-triggered or self-triggered (total 20). Electrodermal activity (EDA; measurement of physiological arousal), electromyography (EMG) of the ankle plantarflexor muscles and anterior-posterior center of pressure measurements were taken pre-perturbation (anticipatory) and post-perturbation (response) and compared between the initial (first two) and final (last two) perturbations. RESULTS: Participants post-stroke demonstrated significantly higher levels of anticipatory EDA and anticipatory paretic plantarflexor EMG during both self- and investigator-triggered conditions compared to controls. Anticipatory EDA levels were higher in the final perturbations in participants post-stroke in both conditions, but not in controls. Habituation of the EDA responses post-perturbation was exhibited in the self-triggered perturbations in controls, but not in participants post-stroke. CONCLUSIONS: Physiological arousal and postural control strategies of controls revealed habituation in response to self-triggered perturbations, whereas this was not seen in participants post-stroke. SIGNIFICANCE: Understanding the physiological arousal response to challenges to standing balance post-stroke furthers our understanding of postural control mechanisms post-stroke.

Shelf life of fresh meat products under LED or fluorescent lighting.

Enhanced pork loin chops, beef longissimus lumborum steaks, semimembranosus steaks (superficial and deep portions), ground beef, and ground turkey were displayed under light emitting diode (LED) and fluorescent (FLS) lighting in two multi-shelf, retail display cases with identical operating parameters. Visual and instrumental color, internal product temperature, case temperature, case cycling, thiobarbituric acid reactive substances (TBARS), and Enterobacteriaceae and aerobic plate counts were evaluated. Under LED, beef products (except the deep portion of beef semimembranosus steaks) showed less (P<0.05) visual discoloration. Pork loin chops had higher (P<0.05) L* values for LED lighting. Other than beef longissimus lumborum steaks, products displayed under LED lights had colder internal temperatures than products under FLS lights (P<0.05). Under LED, pork loin chops, ground turkey, and beef semimembranosus steaks had higher (P<0.05) values for TBARS. LED provides colder case and product temperatures, more case efficiency, and extended color life by at least 0.5d for longissimus and semimembranosus steaks; however, some LED cuts showed increased lipid oxidation.

Assessment of volatile compounds, neutral and polar lipid fatty acids of four beef muscles from USDA Choice and Select graded carcasses and their relationships with consumer palatability scores and intramuscular fat content.

Fatty acids (FA) in neutral and polar lipids (NL and PL) and volatile compounds were determined in Gluteus medius (GM), Longissimus lumborum (LL), Serratus ventralis (SV), and Semimembranosus (SM) muscles from upper 2/3 USDA Choice and Select quality grades (QG). Concentrations of NL FA (mg/g) were influenced by intramuscular fat (IMF) content being greater in upper 2/3 Choice compared with Select. The SV contained greater concentrations of NL FA; meanwhile, the SM contained the lowest quantities of NL FA. Percentages (g/100g of total FA) of NL SFA and MUFA were increased in beef with greater IMF content. Concentrations and percentages of PL FA had muscle specific differences between QG. Volatile compounds were primarily affected by muscle. Increases in SFA and MUFA were related with consumer liking, regardless of lipid fraction. Overall the influence of QG on SFA and MUFA was muscle specific. Therefore, each muscle may require specific considerations when considering FA, volatile compounds, and ultimately consumer liking.

Unbalanced Peptidergic Inhibition in Superficial Neocortex Underlies Spike and Wave Seizure Activity.

Slow spike and wave discharges (0.5-4 Hz) are a feature of many epilepsies. They are linked to pathology of the thalamocortical axis and a thalamic mechanism has been elegantly described. Here we present evidence for a separate generator in local circuits of associational areas of neocortex manifest from a background, sleep-associated delta rhythm in rat. Loss of tonic neuromodulatory excitation, mediated by nicotinic acetylcholine or serotonin (5HT3A) receptors, of 5HT3-immunopositive interneurons caused an increase in amplitude and slowing of the delta rhythm until each period became the "wave" component of the spike and wave discharge. As with the normal delta rhythm, the wave of a spike and wave discharge originated in cortical layer 5. In contrast, the "spike" component of the spike and wave discharge originated from a relative failure of fast inhibition in layers 2/3-switching pyramidal cell action potential outputs from single, sparse spiking during delta rhythms to brief, intense burst spiking, phase-locked to the field spike. The mechanisms underlying this loss of superficial layer fast inhibition, and a concomitant increase in slow inhibition, appeared to be precipitated by a loss of neuropeptide Y (NPY)-mediated local circuit inhibition and a subsequent increase in vasoactive intestinal peptide (VIP)-mediated disinhibition. Blockade of NPY Y1 receptors was sufficient to generate spike and wave discharges, whereas blockade of VIP receptors almost completely abolished this form of epileptiform activity. These data suggest that aberrant, activity-dependent neuropeptide corelease can have catastrophic effects on neocortical dynamics.

Behavior of medial gastrocnemius motor units during postural reactions to external perturbations after stroke.

OBJECTIVE: This study investigated the behavior of medial gastrocnemius (GM) motor units (MU) during external perturbations in standing in people with chronic stroke. METHODS: GM MUs were recorded in standing while anteriorly-directed perturbations were introduced by applying loads of 1% body mass (BM) at the pelvis every 25-40s until 5% BM was maintained. Joint kinematics, surface electromyography (EMG), and force platform measurements were assessed. RESULTS: Although external loads caused a forward progression of the anterior-posterior centre of pressure (APCOP), people with stroke decreased APCOP velocity and centre of mass (COM) velocity immediately following the highest perturbations, thereby limiting movement velocity in response to perturbations. MU firing rate did not increase with loading but the GM EMG magnitude increased, reflecting MU recruitment. MU inter spike interval (ISI) during the dynamic response was negatively correlated with COM velocity and hip angular velocity. CONCLUSIONS: The GM utilized primarily MU recruitment to maintain standing during external perturbations. The lack of MU firing rate modulation occurred with a change in postural central set. However, the relationship of MU firing rate with kinematic variables suggests underlying long-loop responses may be somewhat intact after stroke. SIGNIFICANCE: People with stroke demonstrate alterations in postural control strategies which may explain MU behavior with external perturbations.

Sensory evaluation of tender beef strip loin steaks of varying marbling levels and quality treatments.

The palatability of tender [Warner-Bratzler shear force values <33.34N (3.4kg)] beef strip loins of 10 different treatments [USDA Prime, High Choice (upper 1/3 Choice), Low Choice (lower 1/3 Choice), Select, Standard, Australian Wagyu, American Wagyu, Holstein Select, Holstein Top Choice (upper 2/3 Choice) and Grass-finished] was evaluated by consumers and a trained flavor panel. In general, tenderness, juiciness, flavor, and overall liking ratings as well as acceptability percentage for each trait, increased with increased fat levels. Moreover, overall liking was highly correlated (P<0.01) with flavor liking (r=0.96) as well as fat percentage (r=0.79). Beef flavor scores were positively associated (P<0.01) with fat-like (r=0.67) and umami (r=0.59) flavors. Fat level was the primary driver of beef flavor acceptability in all samples when no undesirable off-flavors were present.

Motor unit recruitment and firing rate in medial gastrocnemius muscles during external perturbations in standing in humans.

There is limited investigation of the interaction between motor unit recruitment and rate coding for modulating force during standing or responding to external perturbations. Fifty-seven motor units were recorded from the medial gastrocnemius muscle with intramuscular electrodes in response to external perturbations in standing. Anteriorly directed perturbations were generated by applying loads in 0.45-kg increments at the pelvis every 25-40 s until 2.25 kg was maintained. Motor unit firing rate was calculated for the initial recruitment load and all subsequent loads during two epochs: 1) dynamic response to perturbation directly following each load drop and 2) maintenance of steady state between perturbations. Joint kinematics and surface electromyography (EMG) from lower extremities and force platform measurements were assessed. Application of the external loads resulted in a significant forward progression of the anterior-posterior center of pressure (AP COP) that was accompanied by modest changes in joint angles (<3°). Surface EMG increased more in medial gastrocnemius than in the other recorded muscles. At initial recruitment, motor unit firing rate immediately after the load drop was significantly lower than during subsequent load drops or during the steady state at the same load. There was a modest increase in motor unit firing rate immediately after the load drop on subsequent load drops associated with regaining balance. There was no effect of maintaining balance with increased load and forward progression of the AP COP on steady-state motor unit firing rate. The medial gastrocnemius utilized primarily motor unit recruitment to achieve the increased levels of activation necessary to maintain standing in the presence of external loads.

Effects of subprimal type, quality grade, and aging time on display color of ground beef patties.

A factorial design was used to evaluate the effects of two subprimal types (chuck roll and knuckle), two quality grades (Premium Choice and Select), and three vacuum-storage aging times before processing (7, 21, and 42d) ground beef patty display color attributes. Patties from chuck roll and Premium Choice subprimals had brighter red visual color scores, less discoloration, and higher L*, a*, b*, and chroma values than those from knuckle and Select subprimals, respectively. With an increased display time, patties became darker red, more discolored, and had decreased L*, a*, b*, and chroma values. Therefore, aging Premium Choice chuck rolls for less time (fewer than 21d) could maximize display color life.

Consumer assessment of beef palatability from four beef muscles from USDA Choice and Select graded carcasses.

Consumer sensory analysis was conducted to determine differences in beef palatability between two quality grade categories [Upper 2/3 (Top) Choice and Select] and four muscles [longissimus lumborum (LL), gluteus medius (GM), serratus ventralis (SV), and semimembranosus (SM)]. Generally, tenderness, flavor, and overall liking scores were more desirable for Top Choice compared to Select, regardless of muscle. Consumers rated LL as more tender (P<0.05) than SV and SM, but similar to GM (P=0.52). Overall and flavor acceptability were similar (P>0.05) between LL, GM, and SV, regardless of quality grade. Consumer overall liking was most highly correlated with flavor liking (r=0.85). When tenderness was acceptable, flavor and juiciness played a major role in determining overall acceptability. Overall liking of GM and SV from Top Choice carcasses was superior to LL from Select carcasses and comparable to LL from Top Choice carcasses.

Effects of a 10-week toe-out gait modification intervention in people with medial knee osteoarthritis: a pilot, feasibility study.

OBJECTIVE: To examine the feasibility of a 10-week gait modification program in people with medial tibiofemoral knee osteoarthritis (OA), and to assess changes in clinical and biomechanical outcomes. DESIGN: Fifteen people with medial knee OA completed 10 weeks of gait modification focusing on increasing toe-out angle during stance 10° compared to their self-selected angle measured at baseline. In addition to adherence and performance difficulty outcomes, knee joint symptoms (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and total score, numerical rating scale (NRS) of pain), and knee joint loading during gait (late stance peak knee adduction moment (KAM)) were assessed. RESULTS: Participants were able to perform the toe-out gait modification program with minimal to moderate difficulty, and exhibited significant increases in self-selected toe-out angle during walking (P < 0.001). Joint discomfort was reported by five participants (33%) in the hip or knee joints, though none lasted longer than 2 weeks. Participants reported statistically significant reductions in WOMAC pain (P = 0.02), NRS pain (P < 0.001), WOMAC total score (P = 0.02), and late stance KAM (P = 0.04). CONCLUSIONS: These preliminary findings suggest that toe-out gait modification is feasible in people with medial compartment knee OA. Preliminary changes in clinical and biomechanical outcomes provide the impetus for conducting larger scale studies of gait modification in people with knee OA to confirm these findings.

Lateral trunk lean gait modification increases the energy cost of treadmill walking in those with knee osteoarthritis.

OBJECTIVE: To compare the energy expenditure of increased lateral trunk lean walking - a suggested method of reducing medial compartment knee joint load - compared to normal walking in a population of older adults with medial knee osteoarthritis (OA). METHOD: Participants completed two randomly-presented treadmill walking conditions: 15 min of normal walking or walking with ten degrees of peak lateral trunk lean. Lateral trunk lean angle was displayed in front of the participant in real-time during treadmill conditions. Energy expenditure (VO2 and METs), heart rate (HR), peak lateral trunk lean angle, knee pain and perceived exertion were measured and differences between conditions were compared using paired t-tests. RESULTS: Twelve participants (five males, mean (standard deviation (SD)) age 64.1 (9.4) years, body mass index (BMI) 28.3 (4.9) kg/m²) participated. All measures were significantly elevated in the lateral trunk lean condition (P < 0.008), except for knee pain (P = 0.22). Oxygen consumption (VO2) was, on average 9.5% (95% CI 4.2-14.7%) higher, and HR was on average 5.3 beats per minute (95% CI 1.7-9.0 bpm) higher during increased lateral trunk lean walking. CONCLUSION: Increased lateral trunk lean walking on a treadmill resulted in significantly higher levels of steady-state energy expenditure, HR, and perceived exertion, but no difference in knee pain. While increased lateral trunk lean has been shown to reduce biomechanical measures of joint loading relevant to OA progression, it should be prescribed with caution given the potential increase in energy expenditure experienced when it is employed.