Trends in Australian knee injury rates: An epidemiological analysis of 228,344 knee injuries over 20 years.

Background: Acute knee injuries are a key predisposing risk factor for knee osteoarthritis. Public health interventions require in-depth epidemiological evidence to determine which knee injuries are problematic in critical age and sex demographics. Methods: Descriptive epidemiological analysis of longitudinal data on knee injuries (July 1998 - June 2018) from the National Hospital Morbidity Database in Australia were studied. The main outcomes where the population-related knee injury frequency, incidence per 100,000 and annual growth rate (%) over the 20-year observation period. Age-group and sex differences were also studied to determine demographic-specific trends. Findings: 228,344 knee injuries were diagnosed over the 20-year analysis period. Significantly rising annual incidences were observed for total knee injuries, anterior cruciate ligament (ACL) injuries and knee contusions in males and females. Posterior cruciate ligament (PCL) injuries and knee dislocations were also rising in females, but not males. Greater annual growth rates were observed for females compared to males for total knee injuries, knee contusions, PCL injuries and knee dislocations. Demographic analysis revealed that the highest annual growth rate in injury incidence (10.4%) was observed for ACL injuries in females aged 5-14 years old. Interpretation: Increasing annual incidence of knee injuries was observed over the 20-year period. Males have a higher incidence of knee injury per capita than females, but the gap appears to have narrowed over the 20-year analysis period. Younger Australians show a precipitous rise in the annual number of ACL injuries, particularly for females aged 5-14 years. These trends warrant urgent intervention. Funding: None.

Therapy influences goal attainment following botulinum neurotoxin injection for focal spasticity in adults with neurological conditions.

OBJECTIVE: To determine whether therapy influenced goal attainment following botulinum toxin (BoNT-A) injection for focal spasticity in adults with neurological conditions. METHODS: A prospective observational cohort study conducted in a large metropolitan spasticity clinic on adults with focal spasticity of any origin. Participants were provided with a therapy programme, designed to maximise therapeutic outcome. The primary outcome measure was Goal Attainment Scaling. To measure adherence, participants completed a therapy-recording tool each day. Goal attainment, and the rate of adherence to the therapy programme, was evaluated after 10 weeks. RESULTS: Active indications for BoNT-A treatment made up the majority of the goals (80.30%). Goals were achieved in 43/76 cases (56.60%; 95% CI = 42.40 to 69.80%). Therapy adherence was associated with significantly greater goal attainment (OR = 1.02, p = 0.03, 95% CI = 1.00 to 1.04). Greater adherence to therapy increased the odds of goal achievement for active indications but not for passive indications, suggesting a possible statistical interaction between the indication for injection and adherence to therapy (p < 0.01). CONCLUSION: Therapy adherence was associated with greater goal attainment. Active indications for BoNT-A were more reliant on adherence to prescribed therapy programmes than passive indications, although further investigation is required.

The effectiveness of therapy on outcome following (BoNT-A) injection for focal spasticity in adults with neurological conditions: A systematic review.

OBJECTIVE: To determine the independent effectiveness of adjunctive therapies when provided in conjunction with botulinum neurotoxin (BoNT-A) injection for focal spasticity in adults with neurological conditions. DATA SOURCES: Nine electronic databases. STUDY SELECTION: A systematic search was performed to identify randomized, controlled trials (RCTs) evaluating the benefit of adjunctive therapies following BoNT-A injection. DATA EXTRACTION/SYNTHESIS: Two authors extracted the data independently. Each trial was assessed for internal validity and rated for quality using the PEDro scale. Articles were further appraised using the American Academy of Neurology (AAN) evidence classification to construct concise clinical recommendations. RESULTS: The search identified 12 studies that reported on the effects of eight different adjunctive therapies following BoNT-A injection in adults with focal spasticity. No high level evidence was identified. The mean PEDro score for the 12 studies was 5.6 (SD = 1.6) and the clinical recommendations provided were Grade U, indicating the effectiveness of the adjunctive therapies was unknown or unproven. CONCLUSION: There was insufficient evidence to support or refute the effectiveness of any of the commonly prescribed adjunctive therapies following BoNT-A injection for focal spasticity in adults.

Coordination of dynamic balance during gait training in people with acquired brain injury.

OBJECTIVE: To investigate movement of the center of mass (COM) during different gait training methods in people with neurologic conditions. DESIGN: Coordination of the gait cycle, represented by mediolateral COM displacement amplitude, timing, and stability, was assessed during a variety of gait training methods performed in a single session. SETTING: Gait laboratory. PARTICIPANTS: People who were unable to walk unassisted due to an acquired brain injury (n=17) and healthy control subjects (n=25). INTERVENTIONS: The participants performed 7 alternative gait training methods in a randomized order. These were therapist manual facilitation, the use of a gait assistive device, treadmill walking with handrail support, and 4 variations of body weight-support treadmill training with combinations of handrail and/or therapist support. MAIN OUTCOME MEASURES: Mediolateral COM movement was analyzed in terms of displacement amplitude (overall range of motion), timing (relative to stride time), and stability (steadiness of the movement). Normative values for these measures were acquired from 25 healthy participants walking at a self-selected comfortable pace. RESULTS: Body weight-support treadmill training without any additional support resulted in significantly (P<.05) greater amplitude, altered timing, and reduced movement stability compared with nonpathologic gait. Allowing handrail support or therapist facilitation reduced this effect and resulted in treadmill training (± body weight support) having lower movement amplitudes when compared with the other training methods. Therapist manual facilitation most closely matched nonpathologic gait for timing and stability. CONCLUSIONS: In the context of overall dynamic gait coordination, no single method of training provides the optimal stimulus. A training program that uses a variety of techniques may provide a beneficial rehabilitation response.