Patient and Staff Insights on Digital Care Pathways for Patients With Low Back Pain in the Emergency Department: A Qualitative Study.

BACKGROUND: Back pain is a huge global problem. For some people, the pain is so severe that they feel the need to present to an emergency department (ED). Our aim was to explore patient and staff perspectives for the development of a digital care pathway (DCP) for people with back pain who have presented to ED, including acceptability, barriers and facilitators. METHODS: We used a descriptive phenomenology approach using semi-structured interviews with patient and staff participants at a tertiary hospital. Interviews were transcribed and data codes were developed using inductive thematic analysis. Themes were discussed between researchers until consensus was achieved. RESULTS: A total of 16 interviews were carried out, half of which involved patient participants. We identified three major themes: (i) expectations and experiences of staff and patients with low back pain in ED; (ii) a digital care pathway can empower patients and support clinicians in providing care; and (iii) acceptability, barriers, facilitators and recommendations of engaging with a DCP to track the trajectory of back pain. Each theme was further categorised into subthemes. CONCLUSION: Introducing a DCP was perceived as acceptable and beneficial by patients and staff. Both groups were aware of the potential participant burden if surveys were too long. Introducing a DCP could be a valuable adjunct to current management care models, providing a standardised source of education with the potential for individualised tracking and monitoring. The design and development of a DCP will need to consider reported facilitators and address perceived barriers for engagement. PATIENT OR PUBLIC CONTRIBUTION: This project sought insights from patients and staff about a digital care pathway. This forms the first step of patient and consumer consultation before implementing a digital care pathway. All consumers were offered the opportunity to review their responses and our interpretation.

Prefabricated contoured foot orthoses to reduce pain and increase physical activity in people with hip osteoarthritis: A randomised feasibility trial.

BACKGROUND: Hip osteoarthritis (OA) is a prevalent and burdensome condition that leads to impaired quality of life and a substantial economic burden. Encouraging physical activity, particularly walking, is crucial for OA management, but many individuals with hip OA fail to meet recommended activity levels. Prefabricated contoured foot orthoses have shown promise in improving hip muscle efficiency during walking in laboratory settings, but their real-world feasibility and efficacy remain uncertain. OBJECTIVE: The aim of this study was to assess the feasibility of conducting a fully powered randomised controlled trial (RCT) to evaluate the effectiveness of prefabricated contoured foot orthoses, prescribed via telehealth, in people with hip OA. METHODS: This feasibility trial randomised 27 participants with hip OA into two groups: prefabricated contoured foot orthoses or flat shoe inserts. Feasibility outcomes were assessed, including recruitment rate, adherence, logbook completion, and dropout rate. Patient-reported outcomes and accelerometer-measured physical activity were collected as secondary outcomes. RESULTS: While the recruitment rate was low (0.88 people/week), adherence to the intervention (59%), logbook completion (93%), and dropout rates (7%) met or exceeded our predefined feasibility parameters. Participants found the intervention acceptable, and practicality was demonstrated with minor adverse events. Preliminary efficacy testing indicated that prefabricated contoured foot orthoses positively affected physical activity (adjusted mean difference = 2590 [260 to 4920] steps/day), with comparable outcomes for hip-related quality of life and pain. CONCLUSION: This trial supports proceeding to a fully powered RCT to assess the effect of teleheath prescribed prefabricated contoured foot orthoses on physical activity in people with hip OA. STUDY REGISTRATION NUMBER: National Institutes of Health Trial Registry (NCT05138380).

From concept to reality: A comprehensive exploration into the development and evolution of a virtual emergency department.

Emergency department (ED) overcrowding remains a persistent challenge in global public health, leading to detrimental outcomes for patients and healthcare professionals. Traditional approaches to improve this issue have been insufficient, prompting exploration of novel strategies such as virtual care interventions. Our team developed the first comprehensive statewide virtual ED in Australia, the Victorian Virtual Emergency Department, offering an alternative to in-person care for non-life-threatening emergencies. Here, we present the development and ongoing refinement of this pioneering virtual care service, aiming to provide insights for hospital administrators and policymakers seeking to implement patient-centric care solutions worldwide. By sharing our model of care, we hope to guide further work toward addressing the global problem of over crowded EDs.

BackTrAC: A Digital Care Pathway for People Presenting to Emergency with Lower Back Pain. A Development and Feasibility Study Protocol.

OBJECTIVES: Back pain is a prevalent condition that affects 1 in 6 Australians at any time, with high associated health care costs. To date, there is limited information relating to symptom severity and recovery trajectory in people with back pain who present to the emergency department for care. A digital care pathway (DCP) can track patient outcomes following presentation with back pain. The primary aim of this protocol is to outline the co-development, implementation, and evaluation of a DCP for back pain patients who present to the emergency department. METHODS: The primary aim will be addressed in 3 overlapping phases: Phase 1 (co-design) will include interviews with back pain patients and health care professionals from the Northern Hospital Emergency Department. Interview findings will inform education resources featured on the DCP and establish questionnaire content and frequency acceptability. Phase 2 (implementation) will include the rollout of the DCP and tracking of patient-reported outcome measures, which will be collected over 12 weeks. Phase 3 (evaluation) will include interviews with a subset of back pain patients who have participated in Phase 2 to evaluate the acceptability of the DCP and the barriers and facilitators of using the DCP. ETHICS AND DISSEMINATION: This project has been approved via the National Health and Medical Research Council of Australia's National Mutual Acceptance Scheme by St Vincent's Hospital Human Ethics Committee (2022/PID06476), La Trobe University Research Governance (HEC#206/22), and Northern Health Research Governance (NH-2023-372687). We plan to publish the findings in a peer-reviewed journal and present them at conferences.

Pain, function and quality of life are impaired in adults undergoing periacetabular osteotomy (PAO) for hip dysplasia: a systematic review and meta-analysis.

BACKGROUND: Hip dysplasia is a common condition in active adults with hip pain that can lead to joint degeneration. Periacetabular osteotomy (PAO) is a common surgical treatment for hip dysplasia. The effect of this surgery on pain, function and quality of life (QOL) has not been systematically analysed. PURPOSE: In adults with hip dysplasia: (1) evaluate differences in pain, function and QOL in those undergoing PAO and healthy controls; (2) evaluate pre- to post-PAO changes in pain, function and QOL; (3) evaluate differences in pain, function and QOL in those with mild versus severe dysplasia, undergoing PAO; and (4) evaluate differences in pain, function and QOL in those having primary PAO versus those with previous hip arthroscopy. METHODS: A comprehensive, reproducible search strategy was performed on 5 different databases. We included studies that assessed pain, function and QOL in adults undergoing PAO for hip dysplasia, using hip-specific patient reported outcomes measures. RESULTS: From 5017 titles and abstracts screened, 62 studies were included. Meta-analysis showed PAO patients had worse outcomes pre- and post-PAO compared to healthy participants. Specifically, pain (standardised mean difference [SMD] 95% confidence interval [CI]): -4.05; -4.78 to -3.32), function (-2.81; -3.89 to -1.74), and QOL (-4.10; -4.43 to -3.77) were significantly poorer preoperatively.Meta-analysis found patients experienced improvements following PAO. Pain improved from pre-surgery to 1-year (standardised paired difference [SPD] 1.35; 95% CI, 1.02-1.67) and 2 years postoperatively (1.35; 1.16-1.54). For function, the activities of daily living scores at 1 year (1.22; 1.09-1.35) and 2 years (1.06; 0.9-1.22) and QOL at 1 year (1.36; 1.22-1.5) and 2 years (1.3; 1.1-1.5) all improved. No difference was found between patients undergoing PAO with mild versus severe dysplasia. CONCLUSIONS: Before undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, function and QOL compared to healthy participants. These levels improve following PAO, but do not reach the same level as their healthy participants. REGISTRATION: PROSPERO (CRD42020144748).

How effective are exercises delivered digitally (requiring internet), amongst patients with hip or knee osteoarthritis? A systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review and meta-analysis is to describe the effect of digitally delivered exercise on pain, physical function and quality of life (QoL) for people with knee or hip osteoarthritis (OA). METHODS: Articles were eligible for inclusion if they were of a randomized control trial that evaluated the prescription of digitally delivered exercise (requiring the internet) in people with symptomatic primary hip and/or knee OA. Risk of bias was assessed using the Physiotherapy Evidence Database scale, and levels of evidence were assessed according to Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Digitally delivered exercise was delivered via synchronous and asynchronous methods (or a combination of both). Digitally delivered exercise was superior to education only for pain and physical function, with high-quality evidence for quality-of-life outcomes in the long-term (standardized mean difference -0.35, 95% confidence interval -0.59 to -0.12, P = 0.003) in people with knee OA. Furthermore, there was very low to low-quality evidence that digitally delivered exercise was comparable to face-to-face delivery in the short and long-term for people with hip or knee OA and comparable in the medium-term for people with knee OA only. DISCUSSION: The review demonstrated very low to low-quality evidence that digitally delivered exercise was comparable to face-to-face delivery for pain, function and QoL. In the absence of higher-level evidence, we would provisionally recommend that healthcare providers offer the choice of face-to-face or digitally delivered exercise intervention for people with hip or knee OA. Further work is required to understand these programs' reach, access, uptake and implementation across diverse population groups.

Diagnostic Accuracy of Clinical Tests for Assessing Greater Trochanteric Pain Syndrome: A Systematic Review With Meta-analysis.

OBJECTIVE: We aimed to evaluate the accuracy of clinical tests that are used to diagnose greater trochanteric pain syndrome (GTPS) in clinical practice. DESIGN: Diagnostic test accuracy systematic review with meta-analysis. LITERATURE SEARCH: MEDLINE, Embase, CINAHL, AMED, and SPORTDiscus were searched using key words mapped to diagnostic test accuracy for GTPS. STUDY SELECTION CRITERIA: Studies with published or derivable diagnostic accuracy data were included. DATA SYNTHESIS: Risk of bias was assessed using the QUADAS-2 tool, and certainty of evidence, via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. MetaDTA "R" random-effects models were used to summarize individual and pooled data including sensitivity, specificity, likelihood ratios, and pretest/posttest probabilities. RESULTS: From a database yield of 858 studies, 23 full texts were assessed. We included 6 studies for review, involving 15 tests and 272 participants (314 hips). Overall certainty of evidence ranged from very low to moderate. Meta-analysis of 6 tests revealed sequenced test clusters able to significantly shift pretest-posttest probability for or against a GTPS diagnosis. In people reporting lateral hip pain, a negative gluteal tendon (GT) palpation test followed by a negative resisted hip abduction test significantly reduced the posttest probability of GTPS from 59% to 14%. In those with a positive GT palpation test followed by a positive resisted hip abduction test, the posttest probability of GTPS significantly shifted from 59% to 96%. CONCLUSION: The value of magnetic resonance imaging for diagnosing GTPS is debated. We have identified a straightforward, clinically useful diagnostic test cluster to help confirm or refute the presence of GTPS in people reporting lateral hip pain. J Orthop Sports Phys Ther 2024;54(1):1-24. Epub 10 August 2023. doi:10.2519/jospt.2023.11890.

The association between lateral hip muscle size/intramuscular fat infiltration and hip strength in active young adults with long standing hip/groin pain.

OBJECTIVES: To investigate associations between lateral hip muscle size/intramuscular fat infiltration (MFI) and hip strength in active young adults with longstanding hip/groin pain. DESIGN: Cross-sectional study. SETTING: University/Clinical. PARTICIPANTS: Sub-elite soccer and Australian Football players (n = 180; 37 female) with long standing hip/groin pain. MAIN OUTCOME MEASURES: Muscle size (volume) and MFI of gluteus maximus, medius, and minimis, and tensor fascia latae (TFL) were assessed using magnetic resonance imaging. Isometric hip strength was measured with handheld dynamometry. Associations between muscle size/MFI were assessed using linear regression models, adjusted for body mass index and age, with sex-specific interactions. RESULTS: Positive associations were identified between lateral hip muscle volume and hip muscle strength, particularly for gluteus maximus and gluteus minimus volume. For all muscles, hip abduction was associated with an increase in strength by up to 0.69 N (R2 ranging from 0.29 to 0.39). These relationships were consistent across sexes with no sex interactions observed. No associations were found between MFI and strength measures. CONCLUSION: Greater lateral hip muscle volumes are associated with greater hip strength in active young adults with long standing hip/groin pain, irrespective of sex. Gluteus maximus and minimus volume showed the most consistent relationships with hip strength across multiple directions.

Response to letter to editor: The association between hip strength, physical function and dynamic balance in people with unilateral knee osteoarthritis: A cross-sectional study.

We thank the reader for their interest and response to our study investigating the association between clinical measures of hip strength in multiple directions and physical function (including dynamic balance) in people with knee osteoarthritis. Below, we provide a response to their questions, in turn.

Association of baseline physical activity participation with participant characteristics and outcomes following education and exercise-therapy in people with knee osteoarthritis: A GLA:D® Australia prospective cohort study.

OBJECTIVES: To investigate whether participants with knee osteoarthritis classified as 'more' or 'less' physically active at baseline differ in characteristics and/or outcomes at baseline and at 3 and 12 months following the commencement of an education and exercise-therapy program. METHODS: Prospective cohort study using the GLA:D® Australia registry. The University of California, Los Angeles Physical Activity Scale (UCLA) participant data dichotomised as 'more' (≥7) or 'less' active (≤6). Groups were compared using chi-square (obesity [baseline only], comorbidity prevalence, medication consumption, fear of damage from physical activity); and linear mixed model regression (12-item Injury Osteoarthritis Outcome Score [KOOS-12], pain [visual analogue scale], health-related quality of life [QoL] [EQ-5D-5L]) statistics, adjusted for age, sex and baseline physical activity at 3 and 12 months. RESULTS: We included 1059 participants (70% female). At baseline, 267 (25%) were classified as 'more' active, increasing to 29% and 30% at 3 and 12 months, respectively. At baseline, compared to the 'less' active group, the 'more' active group had a lower proportion of participants who were obese ('more' = 21% vs. 'less' = 44%), had comorbidities (58% vs. 74%) and consumed medications (71% vs. 85%); lower pain intensity (37 vs. 47); and higher KOOS-12 (59 vs. 50), and health-related QoL (0.738 vs. 0.665) scores. When accounting for age, sex and baseline physical activity, improvements seen in knee-related burden and health-related QoL were not different between groups at 3 or 12 months. Compared to the 'less' active group, the proportion of participants not consuming medication remained higher in the 'more' active group at 3 ('more' 45% vs. 'less' 28%) and 12 months (43% vs. 32%). CONCLUSION: 'More' active people with knee osteoarthritis were less likely to be obese, had fewer comorbidities, lower medication consumption, knee-related burden and pain intensity, and higher health-related QoL than 'less' active participants at all timepoints.

Effects of foot orthoses and footwear interventions on impairments and quality of life in people with hip pain: A systematic review.

BACKGROUND: Foot orthoses and footwear interventions are advocated for the management of lower limb musculoskeletal conditions including the hip, but much of the research is focused on knee disorders. The aim of this systematic review was to synthesise the literature that investigates the use of foot orthoses or footwear in people with hip-related pain. METHODS: MEDLINE, EMBASE, CINAHL, AMED and SPORTDiscus were searched from inception to March 2023. Randomised controlled trials (RCT), cohort and pre-post studies reporting on footwear and foot orthoses interventions, in participants with hip-related pain, were eligible for inclusion. Outcomes included pain, physical function, and quality of life (QoL). Effect sizes were calculated where sufficient data were available. Reporting quality was assessed using the Cochrane Risk of Bias Tool (Rob-2) and the Joanna Briggs Institute Checklist. The overall quality of evidence was rated according to the Grading of Recommendations, Assessment, Development, and Evaluations framework. RESULTS: Of the seven included studies (n = 266 participants), there was one RCT, one cohort and five single-group pre-post designs. Interventions included customised and non-customised arch supports, heel lifts, and footwear modifications, used in the following hip conditions: trochanteric pain, non-specific hip pain, hip osteoarthritis, and leg length dysfunction following total hip arthroplasty. Meta-analysis was possible for outcomes in two studies, demonstrating moderate improvement in pain following foot orthoses use. Overall certainty of evidence ranged from very low to low. CONCLUSION: Single-group pre-post study designs describe positive relationships between foot orthoses and footwear use and improvements in hip pain, function, and QoL. However, these results were not supported by the only available RCT. Given this is a relatively inexpensive and non-invasive treatment approach, further rigorous studies are warranted.

Are hip biomechanics during running associated with symptom severity or cam morphology size in male football players with FAI syndrome?

BACKGROUND: Femoroacetabular impingement (FAI) syndrome is considered a motion-related condition. Little is known about the influence of symptom severity and cam morphology on hip biomechanics for individuals with FAI syndrome. RESEARCH QUESTION: Are hip biomechanics during running associated with symptom severity or cam morphology size in male football players with FAI syndrome? METHODS: Forty-nine male, sub-elite football (soccer or Australian football) players (mean age= 26 years) with FAI syndrome completed the International Hip Outcome Tool-33 (iHOT-33) and Copenhagen Hip and Groin Outcome Score (HAGOS) and underwent radiographic evaluation. Biomechanical data were collected during overground running (3-3.5 m∙s-1) using three-dimensional motion capture technology and an embedded force plate. Various discrete hip angles and impulses of joint moments were analysed during the stance phase. Linear regression models investigated associations between running biomechanics data (dependent variables) and iHOT-33 and HAGOS scores and cam morphology size (independent variables). RESULTS: Hip joint angles during running were not associated with symptom severity in football players with FAI syndrome. A positive association was found between the impulse of the hip external rotation moment and HAGOS-Sport scores, such that a smaller impulse magnitude occurred with a lower HAGOS-Sport score (0.026 *10-2 [95%CI <0.001 *10-2 to 0.051 *10-2], P = 0.048). Larger cam morphology was associated with a greater peak hip adduction angle at midstance (0.073 [95%CI 0.002-0.145], P = 0.045). SIGNIFICANCE: Hip biomechanics during running did not display strong associations with symptom severity or cam morphology size in male football players with FAI syndrome who were still participating in training and match play. Future studies might consider investigating associations during tasks that utilise end range hip joint motion or require greater muscle forces.

Frequent hospital presenters' use of health information during COVID-19: results of a cross-sectional survey.

BACKGROUND: High-frequency hospital users often present with chronic and complex health conditions and are at increased risk of serious morbidity and mortality if they contract COVID-19. Understanding where high-frequency hospital users are sourcing their information, whether they understand what they find, and how they apply the information to prevent the spread of COVID-19 is essential for health authorities to be able to target communication approaches. METHODS: Cross-sectional survey of 200 frequent hospital users (115 with limited English proficiency) informed by the WHO's "Rapid, simple, flexible behavioral insights on COVID-19". Outcome measures were source of, and trust in information, and knowledge of symptoms, preventive strategies, restrictions, and identification of misinformation. RESULTS: The most frequently cited source of information was television (n = 144, 72%) followed by the internet (n = 84, 42%). One in four television users sought their information from overseas news outlets from their country of origin, while for those using the internet, 56% relied on Facebook and other forms of social media including YouTube and WeChat. Overall, 41.2% of those surveyed had inadequate knowledge about symptoms, 35.8% had inadequate knowledge about preventative strategies, 30.2% had inadequate knowledge about government-imposed restrictions, and 69% believed in misinformation. Half of the respondents (50%) trusted all information, and only one in five (20%) were uncertain or untrusting. English-speaking participants were almost three times more likely to have adequate knowledge about symptoms (OR 2.69, 95%CI 1.47;4.91) and imposed restrictions (OR 2.10 95%CI 1.06; 4.19), and 11 times more likely to recognize misinformation (OR 11.52 95%CI 5.39; 24.60) than those with limited English. CONCLUSION: Within this population of high-frequency hospital users with complex and chronic conditions, many were sourcing their information from less trustworthy or locally relevant sources, including social media and overseas news outlets. Despite this, at least half were trusting all the information that they found. Speaking a language other than English was a much greater risk factor for having inadequate knowledge about COVID-19 and believing in misinformation. Health authorities must look for methods to engage diverse communities, and tailor health messaging and education in order to reduce disparities in health outcomes.

Hip muscle activity in people with hip-related pain compared to asymptomatic controls: A systematic review.

BACKGROUND: Altered hip and thigh muscle activity have been observed across a spectrum of articular hip pathologies, including hip osteoarthritis, femoroacetabular impingement syndrome, and labral pathology. No systematic reviews have examined muscle activity associated with hip pathology and hip-related pain across the life span. A greater understanding of impairments in hip and thigh muscle activity during functional tasks may assist in the development of targeted treatment strategies. METHODS: We conducted a systematic review using the PRISMA guidelines. A literature search was performed in five databases (MEDLINE, CINAHL, EMBASE, Sports Discuss, and PsychINFO). Studies were included that (i) investigated people with hip-related pain (femoroacetabular impingement syndrome, labral tears) or hip osteoarthritis; and (ii) reported on muscle activity using electromyography of hip and thigh muscles during functional tasks such as walking, stepping, squatting, or lunging. Two independent reviewers performed data extraction and assessed risk of bias using a modified version of the Downs and Black checklist. RESULTS: Non-pooled data demonstrated a limited level of evidence. Overall, differences in muscle activity appeared to be more prevalent in people with more advanced hip pathology. CONCLUSIONS: We found that impairments in muscle activity in those with intra-articular hip pathology measured using electromyography were variable but appeared to be greater in severe hip pathology (e.g., hip OA).

The Widening Gap between the Digital Capability of the Care Workforce and Technology-Enabled Healthcare Delivery: A Nursing and Allied Health Analysis.

There is a need to ensure that healthcare organisations enable their workforces to use digital methods in service delivery. This study aimed to evaluate the current level of digital understanding and ability in nursing, midwifery, and allied health workforces and identify some of the training requirements to improve digital literacy in these health professionals. Representatives from eight healthcare organizations in Victoria, Australia participated in focus groups. Three digital frameworks informed the focus group topic guide that sought to examine the barriers and enablers to adopting digital healthcare along with training requirements to improve digital literacy. Twenty-three participants self-rated digital knowledge and skills using Likert scales and attended the focus groups. Mid-range scores were given for digital ability in nursing, midwifery, and allied health professionals. Focus group participants expressed concern over the gap between their organizations' adoption of digital methods relative to their digital ability, and there were concerns about cyber security. Participants also saw a need for the inclusion of consumers in digital design. Given the widening gap between digital innovation and health workforce digital capability, there is a need to accelerate digital literacy by rapidly deploying education and training and policies and procedures for digital service delivery.

Trajectory of knee health in runners with and without heightened osteoarthritis risk: the TRAIL prospective cohort study protocol.

INTRODUCTION: Running is one of the most popular recreational activities worldwide, due to its low cost and accessibility. However, little is known about the impact of running on knee joint health in runners with and without a history of knee surgery. The primary aim of this longitudinal cohort study is to compare knee joint structural features on MRI and knee symptoms at baseline and 4-year follow-up in runners with and without a history of knee surgery. Secondary aims are to explore the relationships between training load exposures (volume and/or intensity) and changes in knee joint structure and symptoms over 4 years; explore the relationship between baseline running biomechanics, and changes in knee joint structure and symptoms over 4 years. In addition, we will explore whether additional variables confound, modify or mediate these associations, including sex, baseline lower-limb functional performance, knee muscle strength, psychological and sociodemographic factors. METHODS AND ANALYSIS: A convenience sample of at least 200 runners (sex/gender balanced) with (n=100) and without (n=100) a history of knee surgery will be recruited. Primary outcomes will be knee joint health (MRI) and knee symptoms (baseline; 4 years). Exposure variables for secondary outcomes include training load exposure, obtained daily throughout the study from wearable devices and three-dimensional running biomechanics (baseline). Additional variables include lower limb functional performance, knee extensor and flexor muscle strength, biomarkers, psychological and sociodemographic factors (baseline). Knowledge and beliefs about osteoarthritis will be obtained through predefined questions and semi-structured interviews with a subset of participants. Multivariable logistic and linear regression models, adjusting for potential confounding factors, will explore changes in knee joint structural features and symptoms, and the influence of potential modifiers and mediators. ETHICS AND DISSEMINATION: Approved by the La Trobe University Ethics Committee (HEC-19524). Findings will be disseminated to stakeholders, peer-review journals and conferences.

The association between hip strength, physical function and dynamic balance in people with unilateral knee osteoarthritis: A cross-sectional study.

BACKGROUND: In people with knee osteoarthritis, the association between multidirectional hip strength and physical function or balance is unknown. OBJECTIVE: To determine the relationship between hip flexion, extension, abduction, adduction, external and internal rotation strength and (1) physical function and (2) dynamic balance. DESIGN: Cross-sectional. METHODS: Forty-seven participants (20 men and 27 women, age 66.2 ± 8.2 years) with unilateral knee osteoarthritis were included. Hip strength was assessed with hand-held dynamometry; physical function was assessed with the 40m fast-paced walk test (40mFPWT), 30-s chair-stand test (30sCST), and stair-climb test (SCT); and dynamic balance was assessed in 3 directions using the Star Excursion Balance Test. Multivariable linear regression analysis was used to determine the strength of relationships between measures. RESULTS: Hip strength, in all directions except for internal rotation, was positively associated with better physical function (40mFPWT: R2 = 0.48 to 0.65; SCT: R2 = 0.5 to 0.54; 30sCST: R2 = 0.39 to 0.42), and dynamic balance (anterior: R2 = 0.33 to 0.45; posteromedial: R2 = 0.32 to 0.45; posterolateral: R2 = 0.27 to 0.35). Hip strength, after adjusting for knee extension strength, explained an additional 8%-12% (p < 0.05) and 5%-12% (p < 0.05) reach in the anterior and posteromedial directions of the Star Excursion Balance Test, respectively. CONCLUSIONS: Hip strength in multiple directions is associated with measures of physical function and dynamic balance in people with unilateral knee osteoarthritis. Clinicians are encouraged to consider hip strength in multiple directions in the context of the patients' functional and/or balance goals when developing exercise programs for people with knee osteoarthritis.

Comparison between a targeted exercise program and a sham intervention on gluteal muscle activity in people with hip osteoarthritis: Analysis of secondary outcomes from a randomised clinical trial.

BACKGROUND: People with hip osteoarthritis (OA) typically display altered gluteus minimus (GMin) and gluteus medius (GMed) activity during gait, in addition to reduced walking speed and stride length. It is unknown if current rehabilitation programs address changes in gluteal muscle activity in people with hip OA. RESEARCH QUESTION: Can a targeted gluteal intervention restore normal gluteal muscle segment activity during gait in people with hip OA? METHODS: This study presents secondary outcomes from a multi-site, double-blinded clinical trial in which participants with radiologically confirmed mild-moderate hip OA were randomised into a targeted gluteal or sham intervention for 12-weeks following baseline testing. Electromyography (EMG) outcomes were only conducted at a single site and data were collected from 22 participants. Intramuscular electrodes were inserted into two segments of GMin (anterior, posterior) and three segments of GMed (anterior, middle, posterior) to record average amplitude, peak amplitude and time to peak (TTP) during the first 60 % of the gait cycle (stance phase) at baseline and post-intervention. RESULTS: Following the targeted gluteal intervention, posterior GMin displayed a decrease in average (P = 0.032, ES=1.04) and peak (P = 0.017, ES=1.17) muscle activity during late stance phase with a shift to an earlier TTP (P = 0.034, ES=1.02). There were no further significant changes between groups for other outcome measures. Similar trends for an earlier TTP were observed for the posterior segment of GMed following the targeted intervention (P = 0.095, ES=0.87). The earlier TTP in the posterior segments of both GMin and GMed post-intervention resembled patterns observed in a healthy young population. SIGNIFICANCE: A targeted gluteal intervention can positively impact activity in posterior GMin during gait in people with hip OA when compared to a sham intervention.

Hip strength, quadriceps strength and dynamic balance are lower in people with unilateral knee osteoarthritis compared to their non-affected limb and asymptomatic controls.

BACKGROUND: There is insufficient literature on multi-directional hip strength differences and dynamic balance between people with knee osteoarthritis (KOA) and healthy controls. OBJECTIVE: In people with unilateral KOA, determine if hip/knee strength and dynamic balance differs (i) between sides, and (ii) compared to controls. METHODS: Thirty-six participants (17 women; 65.5 ± 8.9 years) with unilateral KOA and 36 age- and sex-matched controls were included in a cross-sectional study. Outcomes included hip strength, quadriceps strength, and dynamic balance (three directions) during the Star Excursion Balance Test. Mixed ANOVA analysis was completed to investigate differences between Limbs and Groups. Mean differences (MD) and 95% confidence intervals (CI) were calculated. RESULTS: Quadriceps and hip adduction strength were 16% (95%CI:10, 22) and 9% [95%CI: 3, 16) lower on the affected compared to non-affected side. Quadriceps and hip abduction, adduction, flexion, and extension strength (MD varying from 16%, 95%CI: 8, 25; to 34%, 95%CI: 17, 50) were weaker bilaterally in individuals with KOA compared to control. Posteromedial balance was 4% (95%CI: 2, 6) lower for affected compared to non-affected limbs in those with KOA and 13% (95%CI: 6, 21) lower in the affected limb compared to controls. Individuals with KOA had lower balance bilaterally in the anterior 11% (95%CI: 7, 15) and posterolateral 21% (95%CI: 13, 30) directions. CONCLUSION: Hip/knee strength (especially in the sagittal and frontal planes) and dynamic balance are lower bilaterally in people with KOA compared to controls. Hip adduction strength is lower on the affected than non-affected limbs of people with KOA. Clinicians should consider that knee extension strength, hip strength, and dynamic balance are lower bilaterally in people with unilateral KOA.