A feasibility study to evaluate a purposeful walk intervention with a distance goal using a commercially available activity monitor in elderly people post total hip replacement surgery.

Introduction: Total hip replacement (THR) is performed in an increasing number of individuals around the world and while improvements in pain reduction and long-term enhancement of muscle strength are well documented, the improvement in daily activity does not follow the same trend. This study aimed to determine the feasibility of a 5-week intervention where a personalised outdoor walking distance is monitored using a commercial activity monitor (Fitbit Charge 4). Method: Data was collected on gait and activities of daily living using patient reported outcome measures. Following the completion of the intervention period, participants took part in a semi-structured interview to voice their opinion on the use of the activity monitor, their experiences, and any challenges in order to assess the feasibility of the intervention. All quantitative data were presented descriptively, using appropriate summary statistics. Interviews were analysed using thematic analysis. Results: Five participants who had undergone total hip replacement surgery within the postoperative period of 3 to 6 months were recruited from the local community. Conclusion: The findings suggest that the intervention was feasible and that it encouraged all participants to increase their daily activity. Therefore, it can be concluded that a follow-up effectiveness trial is warranted.

The reliability of video fluoroscopy, ultrasound imaging, magnetic resonance imaging and radiography for measurements of lumbar spine segmental range of motion in-vivo: A review.

BACKGROUND: Lower back pain (LBP) is a principal cause of disability worldwide and is associated with a variety of spinal conditions. Individuals presenting with LBP may display changes in spinal motion. Despite this, the ability to measure lumbar segmental range of motion (ROM) non-invasively remains a challenge. OBJECTIVE: To review the reliability of four non-invasive modalities: Video Fluoroscopy (VF), Ultrasound imaging (US), Magnetic Resonance Imaging (MRI) and Radiography used for measuring segmental ROM in the lumbar spine in-vivo. METHODS: The methodological quality of seventeen eligible studies, identified through a systematic literature search, were appraised. RESULTS: The intra-rater reliability for VF is excellent in recumbent and upright positions but errors are larger for intra-rater repeated movements and inter-rater reliability shows larger variation. Excellent results for intra- and inter-rater reliability are seen in US studies and there is good reliability within- and between-day. There is a large degree of heterogeneity in MRI and radiography methodologies but reliable results are seen. CONCLUSIONS: Excellent reliability is seen across all modalities. However, VF and radiography are limited by radiation exposure and MRI is expensive. US offers a non-invasive, risk free method but further research must determine whether it yields truly consistent measurements.

Can a Purposeful Walk Intervention with a Distance Goal Using an Activity Monitor Improve Individuals' Daily Activity and Function Post Total Hip Replacement Surgery. A Randomized Pilot Trial.

Individuals have increasingly high expectations of return to activity following total hip replacement (THR) surgery. The current literature demonstrates marked improvements in pain following THR. However, there is limited evidence showing objective improvement in daily activity. This randomized pilot trial aimed to determine the effect of an intervention where outdoor walking distance is used as a goal to increase daily activity of older adults using a commercial activity monitor at 3 to 6 months post THR. Findings suggested that the participants in the intervention group had higher activity levels after THR, compared to those in the control group. The Cohen's effect sizes were larger for the changes in the gait, Hip Disability and Osteoarthritis Outcome Score, and Psychosocial Impact of Assistive Devices Scale data in the intervention group in contrast to the control group. However, further research with a larger sample size is required to provide tangible evidence on the significance of the effect of the purposeful walk compared to step count.

Validity and reliability of innovative field measurements of tibial accelerations and spinal kinematics during cricket fast bowling.

The use of inertial sensors in fast bowling analysis may offer a cheaper and portable alternative to current methodologies. However, no previous studies have assessed the validity and reliability of such methods. Therefore, this study aimed to assess the validity and reliability of collecting tibial accelerations and spinal kinematics using inertial sensors during in vivo fast bowling. Thirty-five elite male fast bowlers volunteered for this study. An accelerometer attached to the skin over the tibia was used to determine impacts and inertial sensors over the S1, L1 and T1 spinous processes used to derive the relative kinematics. These measurements were compared to optoelectronic and force plate data for validity analysis. Most acceleration and kinematics variables measured report significant correlations > 0.8 with the corresponding gold standard measurement, with intraclass correlation coefficients greater than 0.7. Low standard error of measurement and consequently small minimum detectable change (MDC) values were also observed. This study demonstrates that inertial sensors are as valid and reliable as current methods of fast bowling analysis and may provide some advantages over traditional methods. The novel metrics and methods described in this study may aid coaches and practitioners in the design and monitoring of fast bowling technique. Graphical abstract illustrating the synopsis of the findings from this paper.

Lower limb kinematic, kinetic and spatial-temporal gait data for healthy adults using a self-paced treadmill.

Through gait analysis, gait phases can be identified, the kinematic and kinetic parameters of human gait events can be determined, and quantitative evaluation can be undertaken. This data article is the first to report a comprehensive data set on a large cohort of healthy participants. Individual strides were determined from vertical force data and all kinematics and kinetic data separated into strides. Local minima and maxima were determined respectively for each anatomical region and the mean calculated for twenty of the 25 strides. When twenty strides were not available the mean of ten strides was used. Stride data were time normalised so one stride was represented by 100%. In addition to the local maxima and minima, the kinematic- and kinetic-time curves were explored and used to determine the mean kinematic-time and kinetic-time curves across all trials and participants (∼1800 gait cycles) to provide mean±sd kinematic- and kinetic-time curves for each of the anatomical regions.

A review of current use of commercial wearable technology and smartphone apps with application in monitoring individuals following total hip replacement surgery.

The advent of commercially available wearable activity monitors and smartphone apps allows objective digital monitoring of daily activities of patients before and after THR surgery. A wide variety of wearable activity monitors and smartphone apps are being marketed to assist with enhancing physical activity following surgery. A systematic review of commercial wearable technology and smartphone apps was undertaken to assess the evidence supporting their efficacy in assisting rehabilitation and patient monitoring following THR. A search was conducted using the electronic databases including Medline, CINAHL, Cochrane, PsycARTICLES and PubMed of studies from January 2000 to January 2019. Five studies met the eligibility criteria. A review of the studies found very little evidence to support long term efficacy of the technology in enhancing rehabilitation and patient monitoring post THR. Future work is required to establish which commercially available monitoring technology is most valuable to patients, which ones improve clinical outcomes post THR, and what are the best economical models for their deployment.

Why Do People Undergo THR and What Do They Expect to Gain-A Comparison of the Views of Patients and Health Care Professionals.

Little concerted effort has been made to understand why individuals undergo total hip replacement (THR) surgery and their rehabilitation goals. Similarly, insight of views and perspective of health care professionals' (HCPs) regarding surgery and what objective measures help them with decision-making is lacking. This patient and public involvement report aimed to explore both patients' and HCPs' perspectives of THR surgery. Twenty patients, 10 pre-THR, 10 post-THR, 9 physiotherapists, and 6 surgeons took part. Results suggest a consensus among patients and HCPs on pain reduction being the main reason for undergoing THR. The inability to carry out simple daily activities such as dog walking and sleep deprivation had a significant effect on patients' mental and physical well-being. This article is the first to explore the views of THR patients and HCPs on reasons behind THR surgery amalgamated into a single report. As walking is important, wearable activity monitors are suggested as a possible motivator to enhance patient compliance to self-care rehabilitation and increase quality of life. A future research project on the use of such wearable activity monitors in enhancing mobility post-THR is therefore planned.

Ground reaction force, spinal kinematics and their relationship to lower back pain and injury in cricket fast bowling: A review.

BACKGROUND: Fast bowlers display a high risk of lower back injury and pain. Studies report factors that may increase this risk, however exact mechanisms remain unclear. OBJECTIVE: To provide a contemporary analysis of literature, up to April 2016, regarding fast bowling, spinal kinematics, ground reaction force (GRF), lower back pain (LBP) and pathology. METHOD: Key terms including biomechanics, bowling, spine and injury were searched within MEDLINE, Google Scholar, SPORTDiscuss, Science Citation Index, OAIster, CINAHL, Academic Search Complete, Science Direct and Scopus. Following application of inclusion criteria, 56 studies (reduced from 140) were appraised for quality and pooled for further analysis. RESULTS: Twelve times greater risk of lumbar injury was reported in bowlers displaying excessive shoulder counter-rotation (SCR), however SCR is a surrogate measure which may not describe actual spinal movement. Little is known about LBP specifically. Weighted averages of 5.8 ± 1.3 times body weight (BW) vertically and 3.2 ± 1.1 BW horizontally were calculated for peak GRF during fast bowling. No quantitative synthesis of kinematic data was possible due to heterogeneity of reported results. CONCLUSIONS: Fast bowling is highly injurious especially with excessive SCR. Studies adopted similar methodologies, constrained to laboratory settings. Future studies should focus on methods to determine biomechanics during live play.

Are shoulder counter rotation and hip shoulder separation angle representative metrics of three-dimensional spinal kinematics in cricket fast bowling?

This study aimed to investigate the relationship between shoulder counter-rotation (SCR), hip shoulder separation (HSS) and three-dimensional spinal kinematics during fast bowling in cricket. Thirty five elite male fast bowlers were analysed using three-dimensional inertial sensors on the spine. Lumbar, thoracic and thoracolumbar kinematics were determined during the delivery stride. Spearman's pairwise correlations displayed significant associations between SCR, thoracic and thoracolumbar lateral flexion between the back foot impact and max contralateral rotation phase of the delivery stride (rs = -.462 and -.460). HSS and thoracolumbar lateral flexion displayed a significant correlation between back foot impact and max contralateral rotation (rs = -.552). No other significant correlations were observed. These results suggest SCR and HSS are modestly related to lateral flexion, leaving a large component of SCR and HSS unrelated to specific three-dimensional spinal kinematics. It is possible that this represents changes in whole spinal orientation and not resultant spinal motion. Despite this, SCR remains the only metric currently related to injury and therefore is important; however it is only a very modest proxy for more traditional descriptions of spinal motion.

Quantification of prone thoracic manipulation using inertial sensor-derived accelerations.

OBJECTIVE: The aim of this study was to determine the linear acceleration, time-to-peak acceleration, and effect of hand position comparing 2 clinicians completing a thoracic manipulation. METHODS: Thirteen volunteers received a right- and left-"handed" prone thoracic manipulation while accelerations were recorded by an inertial sensor. Peak thrust acceleration and time-to-peak thrust were measured. RESULTS: There were differences in thrust acceleration between right- and left-handed techniques for one therapist. The mean peak thrust acceleration was different between therapists, with the more practiced therapist demonstrating greater peak thrust accelerations. Time-to-peak acceleration also revealed between therapist differences, with the more practiced therapist demonstrating shorter time-to-peak acceleration. Cavitation data suggested that manipulations with greater accelerations were more likely to result in cavitation. CONCLUSION: The results of this study suggest that with greater frequency of use, therapists are likely to achieve greater accelerations and shorter time-to-peak accelerations. Furthermore, this study showed that an inertial sensor can be used to quantify important variables during thoracic manipulation and are able to detect intertherapist differences in technique.

A novel approach to the clinical evaluation of differential kinematics of the lumbar spine.

Clinical measurement of lumbar motion has traditionally been limited to range of motion (ROM). Despite this, deficits in angular velocities and accelerations are more pronounced compared to ROM in low back pain (LBP) sufferers. There is increasing interest in movement quality among manual therapists and therefore the ability to measure angular velocities and accelerations within the clinical environment is becoming increasingly important. The aims of this study were to (1) investigate the reliability of a clinic based inertial sensor system to measure ROM along with angular velocities and accelerations in low back pain sufferers; (2) introduce the feasibility and reliability of using the relationship between ROM and velocity to investigate movement trajectory and irregularity. Forty LBP sufferers completed three trials of spinal movements and lifting. The ROM curve was differentiated and double differentiated to yield angular velocities and accelerations. Repeated measures reliabilities were determined by comparisons of kinematic curves as well as peak values. ROM and angular velocity relationships were investigated for their use in describing the movement trajectory and irregularity. Results show excellent similarities of ROM and angular velocity curves and moderate-to-good similarities for angular acceleration curves. Peak value similarities were excellent with small error measurements for all variables. The quantification of ROM-angular velocity plots was reliable with small mean absolute differences in motion irregularity scores. Such a method was able to demonstrate differences in movement irregularity. This method provides clinicians with the ability to yield important additional movement related information including angular velocity, acceleration and movement irregularity.

Dynamic lumbar curvature measurement in acute and chronic low back pain sufferers.

OBJECTIVES: (1) To determine the reliability of a novel fiber-optic method to dynamically measure lumbar curvature in low back pain (LBP) sufferers, and (2) to investigate the dynamic lumbar curvature in acute and chronic LBP sufferers. DESIGN: Cross-sectional study. SETTING: Physiotherapy clinic. PARTICIPANTS: Acute (n=20) and chronic (n=20) LBP sufferers recruited from general practitioner and therapist referrals. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A fiber-optic device was used to measure curvature through time during flexion, lifting, and extension movements. Repeated-measures reliability for curvature-time curves was tested using coefficients of multiple correlation (CMCs) and root mean square error, and for peak curvature values intraclass correlation coefficients (ICCs) and mean absolute errors were used. Acute and chronic LBP groups were compared using peak curvatures and sequencing of curvature change. RESULTS: The fiber-optic method was shown to be highly reliable in measuring both whole lumbar and lower lumbar curvature with CMC values >.81 and ICC values >.99. Chronic LBP sufferers displayed greater peak curvatures during flexion and lifting for the whole lumbar spine and lifting for the lower lumbar spine. The sequencing behavior demonstrated that the quartile of movement associated with the greatest curvature change was the second for flexion and lifting and first and second for extension across both groups. No significant differences in sequencing were demonstrated between the 2 groups. CONCLUSIONS: This method is reliable for dynamic lumbar curvature measurement in back pain sufferers and is a viable option for clinicians. Acute LBP sufferers display less kyphosis during flexion and lifting. Sequencing of curvature change is similar across the 2 groups.