Validation of the Polish Version of Knee Outcome Survey Activities of the Daily Living Scale in a Group of Patients after Arthroscopic Anterior Cruciate Ligament Reconstruction.

BACKGROUND: The study aimed to assess the reliability, validity, and responsiveness of the Polish version of Knee Outcome Survey Activities of the Daily Living Scale (KOS-ADLS) in a group of patients after arthroscopic reconstruction of the anterior cruciate ligament (ACL). METHODS: The study was a longitudinal study with repeated measures. One hundred and twelve subjects who qualified for arthroscopic ACL reconstruction (mean age = 31.8 years) were initially enrolled in this study. The Polish version of KOS-ADLS and Short Form-36 v. 2.0 (SF-36) were used. RESULTS: The Polish version of KOS-ADLS in subjects after ACL rupture demonstrated excellent internal consistency (Cronbach's alpha for KOS-ADLS- total = 0.91), and test-retest reliability using the intraclass correlation coefficient (ICC-total = 0.98). The standard error of measurement (SEM) value was 0.81 and the minimal detectable change (MDC) was 2.23 for KOS-ADLS-total. The validity analysis showed a moderate and low correlation between KOS-ADLS and different domains of SF-36 from r = 0.354 between KOS-ADLS activity and the physical component scale (PCS) of SF-36: to r = 0.206 between KOS-ADLS activity and the mental component scale (MCS) of SF-36. CONCLUSIONS: The Polish version of KOS-ADLS turned out to be a reliable, valid and responsive self-reported outcome measure, allowing for the self-assessment of symptoms and function related to the knee joint impairment after ACL reconstruction. Therefore, the scale can be applied in clinical practice and research.

Validity of the Gait Deviation Index in children and adolescents with juvenile idiopathic arthritis.

PURPOSE: Effectiveness of the Gait Deviation Index (GDI) in patients with juvenile idiopathic arthritis (JIA) is unknown. The aim of this study was to investigate the validity of the GDI as an outcome measure of gait disturbance children with JIA. METHODS: Fifty children and adolescents with JIA were included into the study. The control group included 50 healthy children without gait disorders, matched for age and gender. The kinematic gait parameters were measured using a 3D movement analysis system. Walking speed, walking distance, cadence, step length and single support time were also evaluated. RESULTS: The findings show a statistically significant difference between the values of GDI for the right leg in the study group and the controls ( p = 0.036). The individuals included in the study group achieved significantly lower values in this parameter (mean 94.92 ± 8.38 vs. mean 100.00 ± 10.00). The GDI value for right and left leg and the mean GDI value showed low (0.3 ≤ |R| <0.5, p <0.005) to moderate (0.5 ≤ |R| <0.7, p<0.001) correlations with the other gait parameters and measures. CONCLUSIONS: The GDI scores were lower in individuals with JIA compared to controls. This difference in the GDI values was only significant for the right leg. The GDI values showed low to moderate correlations with other gait parameters.

Three-dimensional analysis of gait in children and adolescents with juvenile idiopathic arthritis.

PURPOSE: The paper aimed to assess the gait pattern in children and adolescents with juvenile idiopathic arthritis (JIA) treated at the rehabilitation center and to assess changes in this pattern after the end of treatment and 9 months later. METHODS: 50 children with JIA were enrolled into the study. 35 healthy volunteers were enrolled into the study for a comparison. Spatiotemporal and kinematic gait parameters were obtained using a movement analysis system. The Gait Deviation Index (GDI) was calculated. The assessment was performed three times: on the day of admission to the rehabilitation center, after the end of a 4-week treatment period and 9 months later. RESULTS: With regard to the majority of spatiotemporal and kinematic parameters, differences in their distribution were highly statistically significant between the study group and the control group ( p < 0.001). In two subsequent tests, differences were less significant when compared to the control group ( p < 0.01). In the study group, ranges of motion in the sagittal plane in the hip ( p < 0.01), knee ( p < 0.001) and ankle joints ( p < 0.01) increased significantly between tests 1 and 2, and 1 and 3. A significantly lower value of GDI was observed in the study group (right limb; p = 0.036). CONCLUSIONS: The gait pattern of children with JIA is significantly different from the one observed in healthy children. A rehabilitation program significantly improved gait in children with JIA, but differences compared to healthy children were still observed, and it indicates that the abnormal gait pattern became permanent in this group of subjects.

Translation, cross-cultural adaptation and validation of the polish version of the Oxford Shoulder Score in patients undergoing arthroscopic rotator cuff repair.

BACKGROUND: The Oxford Shoulder Score (OSS) is a simple and reliable, joint-specific, self-reported outcome measure. It can be applied in patients with shoulder disease other than instability. The purpose of this study was to perform a translation, cultural adaptation of the Polish version of the OSS and to evaluate its selected psychometric properties in patients after arthroscopic rotator cuff repair. METHODS: Sixty-nine subjects participated in the study, with a mean age 55.5 (ranging from 40 to 65 years). The OSS has been translated using the widely accepted guidelines. All patients completed the Polish version of OSS (OSS-PL), the short version of the Disabilities of Arm, Shoulder and Hand Questionnaire (QuickDASH), the Short Form-36 v. 2.0 (SF-36) and the 7-point Global Rating of Change Scale (GRC). RESULTS: High internal consistency of 0.96 was found using Cronbach's alpha coefficient. Reliability of the OSS resulted in Intraclass Correlation Coefficient (ICC) = 0.99, Standard Error of Measurement (SEM) = 1.14 and Minimal Detectable Change (MDC) = 3.15. The validity analysis showed a moderate (General health r = 0.34) to high (Physical role functioning r = 0.82) correlation between the OSS-PL and SF-36 and a high correlation between the OSS-PL and the QuickDASH (r = - 0.92). CONCLUSIONS: The Polish version of OSS is a reliable and valid, self-reported questionnaire, which can be applied in patients with a rotator cuff tear undergoing reconstruction surgery. The very good psychometric properties of the Polish version of the OSS indicate that it can be used in clinical practice and scientific research.

Validity of the gait variability index for individuals after a stroke in a chronic stage of recovery.

BACKGROUND: Increased variability in spatiotemporal variables has been demonstrated in individuals after stroke. Gait Variability Index (GVI) has recently been proposed, potentially to be used as a standardized tool for quantifying gait impairment due to spatiotemporal variables. The experience with the GVI in patients after stroke is unknown. RESEARCH QUESTION: The aim of this study was to investigate the validity of the GVI as an outcome measure of gait disturbance after stroke. METHODS: 50 individuals (mean age 60.9 ± 11.2 years) after stroke at a chronic phase of recovery were included. The control group comprised 50 healthy subjects without gait disorders, matched for age and gender. Data on functional mobility and spatiotemporal gait parameters (BTS Smart system) was collected. RESULTS: The results showed lower mean GVI (mGVI) scores (mean 78.53 ± 6.12), lower GVI for the affected leg (mean 76.32 ± 7.98) and for the unaffected leg (mean 80.74 ± 4.68) in the individuals after stroke compared to the healthy subjects (mean 98.00 ± 6.32). This was significantly different from the control group mean for both mGVI, affected and unaffected leg - p < 0.001. The GVI for the affected leg and unaffected leg as well as the mGVI were significantly correlated with all clinical measures of functional mobility (0.7≤R|<0.9, 0.5≤|R|<0.7, p < 0.001). SIGNIFICANCE: The validity of the GVI appears to be confirmed for individuals after stroke at a chronic stage of recovery. The GVI is lower in individuals after stroke compared to healthy controls. The GVI showed moderate to strong correlations with validated clinical measures of functional mobility. Application of the GVI in the clinical practice will significantly facilitate assessment of gait in individuals after stroke, in comparison to the necessity to interpret a large number of data from 3-dimensional gait analysis. CLINICAL TRIAL REGISTRATION: Data are parts of the following clinical trial: ACTRN12617000436370 (anzctr.org.au).

The use of the Gait Variability Index for the evaluation of individuals after a stroke.

PURPOSE: The Gait Variability Index (GVI) summarizes overall gait quality, taking into account spatiotemporal parameters from a 3-dimensional gait analysis. However, there are no studies evaluating changes in gait patterns after stroke, based on the GVI. The study was designed to assess usefulness of the GVI for evaluation of gait pathology in subjects with stroke, compared to healthy individuals. METHODS: Spatiotemporal gait parameters were examined in a group of 50 subjects at a chronic stage post-stroke and in 50 healthy controls. The GVI was calculated based on the 9 spatiotemporal data. RESULTS: The findings show statistically significant differences between the values of the GVI for paretic and non-paretic limbs ( p < 0.001). Higher values of the index were identified in the case of non-paretic limb: 80.74 vs. 76.32. The GVI scores were decreased for both paretic and non-paretic limbs, compared to the controls - p < 0.001. CONCLUSIONS: The GDI score seems to be a viable tool for quantifying changes in gait pattern during evaluation of subjects with chronic post-stroke hemiparesis. Further studies should be conducted to validate the use of GVI in the post-stroke population.

The paediatric version of Wisconsin gait scale, adaptation for children with hemiplegic cerebral palsy: a prospective observational study.

BACKGROUND: In clinical practice there is a need for a specific scale enabling detailed and multifactorial assessment of gait in children with spastic hemiplegic cerebral palsy. The practical value of the present study is linked with the attempts to find a new, affordable, easy-to-use tool for gait assessment in children with spastic hemiplegic cerebral palsy. The objective of the study is to evaluate the Wisconsin Gait Scale (WGS) in terms of its inter- and intra-rater reliability in observational assessment of walking in children with hemiplegic cerebral palsy. METHODS: The study was conducted in a group of 34 patients with hemiplegic cerebral palsy. At the first stage, the original version of the ordinal WGS was used. The WGS, consisting of four subscales, evaluates fourteen gait parameters which can be observed during consecutive gait phases. At the second stage, a modification was introduced in the kinematics description of the knee and weight shift, in relation to the original scale. The same video recordings were rescored using the new, paediatric version of the WGS. Three independent examiners performed the assessment twice. Inter and intra-observer reliability of the modified WGS were determined. RESULTS: The findings show very high inter- and intra-observer reliability of the modified WGS. This was reflected by a lack of systematically oriented differences between the repeated measurements, very high value of Spearman's rank correlation coefficient 0.9 ≤ |R| < 1, very high value of ICC > 0.9, and low value of CV < 2.5% for the specific physical therapists. CONCLUSIONS: The new, ordinal, paediatric version of WGS, proposed by the authors, seems to be useful as an additional tool that can be used in qualitative observational gait assessment of children with spastic hemiplegic cerebral palsy. Practical dimension of the study lies in the fact that it proposes a simple, easy-to-use tool for a global gait assessment in children with spastic hemiplegic cerebral palsy. However, further research is needed to validate the modified WGS by comparing it to other observational scales and objective 3-dimensional spatiotemporal and kinematic gait parameters. TRIAL REGISTRATION: anzctr.org.au , ID: ACTRN12617000436370 . Registered 24 March 2017.

Polish Cross-Cultural Adaptation and Validation of the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS) in Patients Undergoing Total Knee Arthroplasty.

BACKGROUND The Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS) is a self-reported questionnaire used for the evaluation of the overall health of patients with knee dysfunctions. The purpose of this study was to perform a cross-cultural adaptation of the Polish version of KOS-ADLS and to evaluate its psychometric properties in patients at the end-stage of knee osteoarthritis who were qualified for a total knee replacement (TKR). MATERIAL AND METHODS Seventy patients consecutively qualified for surgical TKR procedure participated in this study. To adapt the KOS-ADLS, the following scales and reference tests were used: Knee injury and Osteoarthritis Outcome Score (KOOS), Visual Analogue Scale (VAS), Time Up and Go test (TUG), and Five Times Sit to Stand test (5×STS). The studies were conducted 3 times: 2 weeks before surgery (first study), 6 to 13 days later (retest), and 6 months after surgery. RESULTS The Polish version of KOS-ADLS showed excellent reliability (ICC=0.89 SEM=2.68, MDC=7.43) and high responsiveness (ES=4.76, SRM=3.18). The internal consistency was poor in the first assessment (Cronbach's alpha=0.68), but acceptable in the post-surgery evaluation (Cronbach's alpha=0.86). There were fair and moderate correlations found between KOS-ADLS and VAS scales in the first examination, TUG, and 5×STS. Stronger correlations were observed between the results obtained in KOS-ADLS and KOOS. CONCLUSIONS The Polish version of the KOS-ADLS demonstrated good reliability, validity, and responsiveness for use in patients who have undergone TKR surgery.

Evaluation of Selected Gait Parameters in Patients Prior to and at 6 Months Following Early Anterior Cruciate Ligament Reconstruction.

[b]Background. [/b]ACL rupture and reconstruction may lead to impairment of spatiotemporal and kinematic gait parameters. The purpose of this study was to evaluate patient's gait following a complete tear of the ACL and its endoscopic reconstruction.[b]Material and methods.[/b] 3D gait analysis was performed using the BTS Smart optoelectronic system (6 IR cameras, 120 Hz). The study group included 40 patients with complete unilateral ACL rupture and 37 healthy matched subjects. In the study group gait analysis was performed twice, within one to two weeks prior to the ACL reconstruction and the follow-up study six months after surgery. In the control group single gait analysis was performed.[b]Results. [/b]Six months after the ACL reconstruction the duration of the stance phase for the non-operated limb (p&amp;amp;lt;0,0000) and the initial double stance phase for the operated limb (p&amp;amp;lt;0,0000) were reduced. A statistically significant increase in the step length for both lower limbs was observed. Additionally patients gait cadence (p=0,0003) and mean gait speed (p=0,0006) have also increased. Nevertheless, in the second study, these parameters were still significantly different comparing to the control group. Analysing the kinematic parameters of patients" gait after surgery it was demonstrated, that the hip and knee joints range of motion in both limbs has increased in a statistically significant way. The range of motion of the ankle joint of the operated limb has also improved.[b]Conclusions.[/b] 1. Within six months after the ACL reconstruction there was significant improvement and normalization of the patient's gait pattern, though we may still observe significant differences when compared to the control group, which indicates the need for further rehabilitation focused on the re-education of patients gait pattern. 2. Results of our study indicates a need of long-term observation in the group of patients after ACL reconstruction to determine, whether the gait pattern impairment demonstrate further tendency to improve in time.

Functional effects of robotic-assisted locomotor treadmill thearapy in children with cerebral palsy.

OBJECTIVE: The aim of this study was to assess gait in children with spastic diplegic cerebral palsy rehabilitated with the use of Lokomat active orthosis. DESIGN: A randomized controlled trial. SUBJECTS: Fifty-two children with spastic diplegic cerebral palsy. METHODS: Temporospatial parameters of gait and selected kinematic parameters were assessed. Children from the study group used active orthosis in addition to following a programme of individual exercises. Children in the control group participated only in individual exercises. RESULTS: The difference between the initial and control examinations was statistically insignificant. After the programme was finished, there was a slight improvement in walking speed in both groups. Improvement in the mean walking speed was not significantly different between the groups (p = 0.5905). Range of motion decreased slightly in both groups, and the difference between mean amounts of change was not significant (p = 0.8676). There was significant improvement in maximal range of flexion in the hip joint (p = 0.0065) in the study. It was shown that with a decrease in the mean value of adduction in hip joint, the mean walking speed increased (r = -0.53, p = 0.0011). CONCLUSION: There are several limitations to this study, therefore these results should be regarded as preliminary. Further research consistent with the above indications is needed to investigate the impact of this new treatment option in patients with cerebral palsy.

Changes in the hip migration percentage and motor function in patients with cerebral palsy treated surgically by multilevel soft tissue release--preliminary report.

BACKGROUND: Disturbed muscle balance secondary to upper motor neuron damage in the course of infantile cerebral palsy (ICP) leads to the development of progressive morphological changes in joints, especially the hip. We analysed changes in Reimers' index (hip migration percentage - MP), and functional ability in CP children after multilevel soft tissue release. MATERIAL AND METHODS: We studied 22 patients with cerebral palsy following one-stage multilevel soft tissue release. The children were examined twice: one day before the surgery and at least 6 months (a mean of 9 months) after the procedure. Hip stability was evaluated radiographically using Reimers' index. Post-operative functional changes were analysed with the Gross Motor Function Measure-88 scale (GMFM-88). RESULTS: Reimers' index decreased post-operatively in 20 right and 18 left hips and increased in 2 right and 4 left hips. Functional ability according to the GMFM scale increased in 17 children (by a mean of 7.1%), did not change in 3 patients with near-maximum pre-operative scores, and worsened in 2 patients. CONCLUSIONS: Our study showed that, when performed for appropriate indications, multilevel soft tissue release surgery can improve hip stability and functional ability in CP children.

[Is prediction of the allergic march possible on the basis of nasal cytology?]. / Czy na podstawie badania cytologicznego blony sluzowej nosa mozna przewidziec, u kogo wystapi marsz alergiczny?

INTRODUCTION: The term allergic march has been used to describe natural evolution of the atopic disease in children, accompanied by the change in organ manifestation with time. The aim of the study was to analyze the role of the cellular components of the nasal cytology as a tool for prediction of atopic diseases and clinical symptoms preceding allergic march. MATERIAL AND METHODS: In a retrospective manner out of a group of 1620 children, 146 symptomatic children (60 girls and 86 boys) meeting inclusion criteria (age below 4 years at first visit, symptoms suggesting allergy, nasal cytology performed at the beginning of observation, observation of at least 4 years) were included in analysis. RESULTS: Mean age of children at time of enrollment was 27 months (SD 10 months). After 4 years allergic rhinitis (AR) was diagnosed in 85 children (58.2%), atopic eczema/dermatitis syndrome (AEDS) in 51 (34.9%) and asthma in 48 (32.9%). Nonallergic etiology was identified in 36 patients (22.5%). All patients with asthma suffered from AR. Significant differences between groups were found in number of eosinophils (p < 0.001), neutrophils (p < 0.001), and lymphocytes (p = 0.028) in cytological examination of nasal mucosa. In children with AR (alone or combined with other comorbidities) nasal eosinophilia was higher than in children with AEDS (18% v. 3%; p = 0.004) or non-allergic disease (18% v. 4%; p < 0.001). Nasal eosinophilia of at least 8% was predictive for development of AR (sensitivity 80%, specificity 95%). CONCLUSIONS: In children below 4 years nasal eosinophilia >or= 8% was predictive for AR development. Allergic march was observed in children with AEDS or/and gastrointestinal allergy symptoms present at the beginning of observation. Nasal eosinophilia in small children might be predictive for the risk of allergic march.

Assessment of the impact of orthotic gait training on balance in children with cerebral palsy.

The cerebral palsy symptoms are, among others, balance and gait disorders. The goal of this study was to assess balance capabilities in children with spastic diplegic cerebral palsy rehabilitated using Lokomat active orthosis. The experimental group included children with cerebral palsy, aged 6-14 years, independent standing, level II-III according to GMFCS classification. The cohort was randomly divided into two groups. The balance was assessed on a stabilometric platform. The experimental group was administered a rehabilitation program with the use of Lokomat active orthosis. Statistically significant improvement of balance was found in the experimental group; however, in the control group the improvement was also visible, but not on the statistically significant level. While comparing the results of both groups, significantly bigger improvement was achieved by the children from the experimental group. Lokomat active orthosis is one of the newest devices applied in the rehabilitation. The study shows that training with active orthosis can have positive influence on the balance improvement in children with CP and that further analysis of the impact of such training on locomotive functions is needed.