Feasibility and Preliminary Outcomes of a Physical Therapist-Administered Physical Activity Intervention After Total Knee Replacement.

OBJECTIVE: To explore the feasibility, fidelity, safety, and preliminary outcomes of a physical therapist-administered physical activity (PA) intervention after total knee replacement (TKR). METHODS: People who had undergone a unilateral TKR and were receiving outpatient physical therapy (PT) were randomized to a control or intervention group. Both groups received standard PT for TKR. The intervention included being provided with a Fitbit Zip, step goals, and 1 phone call a month for 6 months after discharge from PT. Feasibility was measured by rates of recruitment and retention, safety was measured by the frequency of adverse events, and fidelity was measured by adherence to the weekly steps/day goal created by the physical therapist and participant monitoring of steps/day. An Actigraph GT3X measured PA, which was quantified as steps/day and minutes/week of engaging in moderate-to-vigorous PA. Our preliminary outcome was the difference in PA 6 months after discharge from PT between the control and intervention groups. RESULTS: Of the 43 individuals who were enrolled, 53.4% were women, the mean ± SD age was 67.0 ± 7.0 years, and the mean ± SD body mass index was 31.5 ± 5.9 kg/m2 . For both the control and intervention groups, the recruitment and retention rates were 64% and 83.7%, respectively, and adherence to the intervention ranged from 45% to 60%. No study-related adverse events occurred. The patients in the intervention group accumulated a mean 1,798 more steps/day (95% confidence interval [95% CI] 240, 3,355) and spent 73.4 more minutes/week (95% CI -14.1, 160.9) engaging in moderate-to-vigorous PA at 6 months than those in the control group. CONCLUSION: A physical therapist-administered PA intervention is feasible and safe, demonstrates treatment fidelity, and may increase PA after TKR. Future research is needed to establish the effectiveness of the intervention.

The effect of stride length on lower extremity joint kinetics at various gait speeds.

Robot-assisted training is a promising tool under development for improving walking function based on repetitive goal-oriented task practice. The challenges in developing the controllers for gait training devices that promote desired changes in gait is complicated by the limited understanding of the human response to robotic input. A possible method of controller formulation can be based on the principle of bio-inspiration, where a robot is controlled to apply the change in joint moment applied by human subjects when they achieve a gait feature of interest. However, it is currently unclear how lower extremity joint moments are modulated by even basic gait spatio-temporal parameters. In this study, we investigated how sagittal plane joint moments are affected by a factorial modulation of two important gait parameters: gait speed and stride length. We present the findings obtained from 20 healthy control subjects walking at various treadmill-imposed speeds and instructed to modulate stride length utilizing real-time visual feedback. Implementing a continuum analysis of inverse-dynamics derived joint moment profiles, we extracted the effects of gait speed and stride length on joint moment throughout the gait cycle. Moreover, we utilized a torque pulse approximation analysis to determine the timing and amplitude of torque pulses that approximate the difference in joint moment profiles between stride length conditions, at all gait speed conditions. Our results show that gait speed has a significant effect on the moment profiles in all joints considered, while stride length has more localized effects, with the main effect observed on the knee moment during stance, and smaller effects observed for the hip joint moment during swing and ankle moment during the loading response. Moreover, our study demonstrated that trailing limb angle, a parameter of interest in programs targeting propulsion at push-off, was significantly correlated with stride length. As such, our study has generated assistance strategies based on pulses of torque suitable for implementation via a wearable exoskeleton with the objective of modulating stride length, and other correlated variables such as trailing limb angle.

Changes in diet quality and home food environment in preschool children following weight management.

BACKGROUND: Family-based obesity treatment interventions can successfully reduce energy intake in preschoolers. An implicit goal of obesity treatment interventions is to improve diet quality, but diet quality has been less examined as a treatment outcome in studies of preschoolers. The purpose of this study was to conduct a secondary analysis comparing the change in diet quality and home food environment in preschoolers assigned to a behavioral family-based obesity intervention (LAUNCH), motivational interviewing (MI) condition, or standard care (STC) condition. METHODS: Three 24-h dietary recalls were completed at baseline and 6-months and were analyzed using NDS-R software; diet quality was assessed using the Healthy Eating Index-2010 (HEI-2010). Availability of foods and beverages in the home was assessed through direct observation using the Home Health Environment tool that classifies foods and beverages as 'red' or 'green' based upon fat and sugar content. Repeated measures linear mixed effects models were used to examine changes in diet quality and home food environment between conditions (LAUNCH, MI, STC). RESULTS: At 6-months, preschoolers in the LAUNCH condition had a higher HEI-2010 total score (62.8 ± 13.7) compared to preschoolers in the MI (54.7 ± 13.4, P = 0.022) and STC (55.8 ± 11.6, P = 0.046) conditions. Regarding the home food environment, families in LAUNCH had significantly less 'red' foods in their home at 6-months (12.5 ± 3.4 'red' foods) compared to families in MI (14.0 ± 3.7 'red' foods, P = 0.030), and STC (14.3 ± 3.4 'red' foods, P = 0.006). There were no statistically significant differences across home food environments for number of 'green' foods. CONCLUSION: Family-based obesity treatment interventions for preschoolers can improve overall diet quality and alter the home food environment through reductions in 'red' foods. TRIAL REGISTRATION: Clinicaltrials.gov, NCT01546727 . Registered March 7, 2012.

Change in Pain Score after Administration of Analgesics for Lower Extremity Fracture Pain during Hospitalization.

BACKGROUND: Effective acute pain management following injury is critical to improve short-and long-term patient outcomes. Analgesics can effectively reduce pain intensity, yet half of injury patients report moderate to severe pain during hospitalization. PURPOSE: The primary aim of this study was to identify the analgesic, different analgesic combinations, or analgesic and adjuvant analgesic combination that generated the largest percent change from pre- to post-analgesic pain score. DESIGN: This was a descriptive retrospective cohort study of 129 adults admitted with lower extremity fractures to a trauma center. METHODS: Name, dose, and frequency of analgesics and adjuvant analgesics administered from admission to discharge were collected from medical records. Percent change was calculated from pain scores documented on the 0-10 numeric rating scale. RESULTS: The analgesic with largest percent change from pre- to post-administration pain score was hydromorphone 2 mg IV (53%) for the emergency department and morphine 4 mg IV (54%) for the in-patient unit. All analgesics administered in the emergency department and ∼50% administered on the in-patient unit produced a minimal (15%) decrease in pain score. CONCLUSIONS: This study revealed that few analgesics administered in the emergency department and the in-patient unit to patients with lower extremity fractures provide adequate pain relief. In the emergency department, all analgesics administered resulted in at least minimal improvement of pain. On the in-patient unit 13 analgesic doses resulted at least minimal improvement in pain while nine doses did not even reach 20% change in pain. Findings from this study can be used guide the treatment of fracture pain in the hospital.

Gait mechanics and tibiofemoral loading in men of the ACL-SPORTS randomized control trial.

The risk for post-traumatic osteoarthritis is elevated after anterior cruciate ligament reconstruction (ACLR), and may be especially high among individuals with aberrant walking mechanics, such as medial tibiofemoral joint underloading 6 months postoperatively. Rehabilitation training programs have been proposed as one strategy to address aberrant gait mechanics. We developed the anterior cruciate ligament specialized post-operative return-to-sports (ACL-SPORTS) randomized control trial to test the effect of 10 post-operative training sessions consisting of strength, agility, plyometric, and secondary prevention exercises (SAPP) or SAPP plus perturbation (SAPP + PERT) training on gait mechanics after ACLR. A total of 40 male athletes (age 23 ± 7 years) after primary ACLR were randomized to SAPP or SAPP + PERT training and tested at three distinct, post-operative time points: 1) after impairment resolution (Pre-training); 2) following 10 training sessions (Post-training); and 3) 2 years after ACLR. Knee kinematic and kinetic variables as well as muscle and joint contact forces were calculated via inverse dynamics and a validated electromyography-informed musculoskeletal model. There were no significant improvements from Pre-training to Post-training in either intervention group. Smaller peak knee flexion angles, extension moments, extensor muscle forces, medial compartment contact forces, and tibiofemoral contact forces were present across group and time, however the magnitude of interlimb differences were generally smaller and likely not meaningful 2 years postoperatively. Neither SAPP nor SAPP + PERT training appears effective at altering gait mechanics in men in the short-term; however, meaningful gait asymmetries mostly resolved between post-training and 2 years after ACLR regardless of intervention group. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2364-2372, 2018.

Expressed emotion in mothers of currently depressed, remitted, high-risk, and low-risk youth: links to child depression status and longitudinal course.

This study examined expressed emotion in the families of children and adolescents who were (a) in a current episode of Major Depressive Disorder (MDD), (b) in remission from a past episode of MDD, (c) at high familial risk for developing MDD, and (d) low-risk controls. Participants were 109 mother-child dyads (children ages 8-19). Expressed emotion was assessed using the Five Minute Speech Sample, and psychiatric follow-ups were conducted annually. Mothers of children with a current or remitted episode of MDD and at high risk for MDD were more likely to be rated high on criticism than mothers of controls. There were no differences in critical expressed emotion among mothers of children in the current, remitted, or high-risk for depression groups. Higher initial critical expressed emotion was associated with a greater likelihood of having a future onset of a depressive episode in high-risk and depressed participants. Diagnostic groups did not differ in Emotional Overinvolvement.