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To determine, in patients undergoing total knee arthroplasty (TKA), whether increasing context specificity of selected items of the shortened version of the Western Ontario and McMaster Universities Osteoarthritis Index function (WOMAC-F) scale (ShortMAC-F) (1) enhanced the convergent validity of the ShortMAC-F with performance-based mobility measures (ii) affected mean scale score, structural validity, reliability, and interpretability. Secondary analysis of randomized clinical trial data. A tertiary teaching hospital. Patients undergoing TKA (N=114). Not applicable. The ShortMAC-F was modified by specifying the "ascending stairs" and "rising from sitting" items to enquire about difficulty in performing the tasks without reliance on compensatory strategies, whereas the modified "level walking" item enquired about difficulty in walking 400 m. Before and 12 weeks after TKA, patients completed the WOMAC-F questionnaire, modified ShortMAC-F questionnaire, knee pain scale questionnaire, sit-to-stand test, fast gait speed test, and stair climb test. Interpretability was evaluated by calculating anchor-based substantial clinical benefit estimates. The modified ShortMAC-F correlated significantly more strongly than ShortMAC-F or WOMAC-F with pooled performance measures (differences in correlation values, 0.12-0.14). Increasing item context specificity of the ShortMAC-F did not influence its psychometric properties of unidimensionality (comparative fit and Tucker–Lewis indices, >0.95; root mean square error of approximation, 0.05-0.08), reliability (Cronbach's α, 0.75-0.83), correlation with pain intensity (correlation values, 0.48-0.52), and substantial clinical benefit estimates (16 percentage points); however, it resulted in lower mean score (4.5-4.8 points lower). The modified ShortMAC-F showed sufficient measurement properties for clinical application, and it seemed more adept than WOMAC-F at correlating with performance-based measures in TKA. [ABSTRACT FROM AUTHOR]

To evaluate the clinical efficacy and cost-effectiveness of telemonitored self-directed rehabilitation (TR) compared with hospital-based rehabilitation (HBR) for patients with total knee arthroplasty (TKA). In this randomized, non-inferiority clinical trial, 114 patients with primary TKA who were able to walk independently preoperatively were randomized to receive HBR (n = 58) or TR (n = 56). HBR comprised at least five physical therapy sessions over 10 weeks. TR comprised a therapist-led onboarding session, followed by a 10-week unsupervised home-based exercise program, with asynchronous monitoring of rehabilitation outcomes using a telemonitoring system. The primary outcome was fast-paced gait speed at 12 weeks, with a non-inferiority margin of 0.10 m/s. For economic analysis, quality-adjusted-life-years (QALY) was the primary economic outcome (non-inferiority margin, 0.027 points). In Bayesian analyses, TR had >95% posterior probability of being non-inferior to HBR in gait speed (week-12 adjusted TR-HBR difference, 0.02 m/s; 95%CrI, −0.05 to 0.10 m/s; week-24 difference, 0.01 m/s; 95%CrI, −0.07 to 0.10 m/s) and QALY (0.006 points; 95%CrI, −0.006 to 0.018 points). When evaluated from a societal perspective, TR was associated with lower mean intervention cost (adjusted TR-HBR difference, −S$227; 95%CrI, −112 to −330) after 24 weeks, with 82% probability of being cost-effective compared with HBR at a willingness to pay of S$0/unit of effect for the QALYs. In patients with uncomplicated TKAs and relatively good preoperative physical function, home-based, self-directed TR was non-inferior to and more cost-effective than HBR over a 24-week follow-up period. TR should be considered for this patient subgroup. [ABSTRACT FROM AUTHOR]

* OBJECTIVE: To determine if adding lumbar neuromuscular control retraining exercises to a 12-week program of strengthening exercises had greater effect for improving disability than 12 weeks of strengthening exercises alone in people with chronic low back pain (LBP). * DESIGN: Single-center, participant- and assessor-blinded, comparative effectiveness randomized controlled trial. tMETHODS: Sixty-nine participants (31 females; 29 males; mean age: 46.5 years) with nonspecific chronic LBP were recruited for a 12-week program involving lumbar extension neuromuscular retraining in addition to resistance exercises (intervention) or 12 weeks of resistance exercises alone (control). The primary outcome measure was the Oswestry Disability Index. Secondary outcome measures included the Numeric Rating Scale, Tampa Scale for Kinesiophobia, Pain Self-Efficacy Questionnaire, and the International Physical Activity Questionnaire. Outcomes were measured at baseline, 6 weeks, and 12 weeks. * RESULTS: Forty-three participants (22 control, 21 intervention) completed all outcome measures at 6 and 12 weeks. Fourteen participants were lost to follow-up, and 12 participants discontinued due to COVID-19 restrictions. Both groups demonstrated clinically important changes in disability, pain intensity, and kinesiophobia. The difference between groups with respect to disability was imprecise and not clinically meaningful (mean difference, -4.4; 95% CI: -10.2, 1.4) at 12 weeks. Differences in secondary outcomes at 6 or 12 weeks were also small with wide confidence intervals. * CONCLUSIONS: Adding lumbar neuromuscular control retraining to a series of resistance exercises offered no additional benefit over resistance exercises alone over a 12-week period. [ABSTRACT FROM AUTHOR]

• We 3D printed a fine motor gripping and manipulating dexterity assessment tool • Both methods had good to excellent test-retest reliability • It was sensitive to handedness and gripping vs manipulating dexterity • A freely available model is available online and costs little to print. Hand dexterity assessments related to fine motor movements are routinely administered in clinical settings to ascertain an individual's hand function. However, to perform a detailed assessment multiple devices are needed which can be time-consuming and costly to administer. We designed and assessed the test-retest reliability of a 3D printed dexterity device in a cohort of healthy young adults and community-dwelling older adults. This study examines the reliability of the device, association between perceived fine motor gripping and manipulation dexterity components, and dominant hand outperformance during both tasks. Test-retest study of a clinical measurement tool. A convenience sample of thirty-six healthy community-dwelling older and young adults was included in our study. The device was used to collect data at two testing sessions to establish test-retest reliability. Fine motor manipulation dexterity was assessed by lifting notched pegs over a vertical barrier and inserting them into randomly oriented holes sequentially. Fine motor gripping dexterity was assessed by taking these notched pegs out of the holes, lifting them over the barrier and dropping them into a large container. Intraclass correlation coefficient (ICC) 2,1 showed good to excellent test-retest reliability on the dominant and nondominant hands when using the device. Only modest association was found within-hand for the gripping versus manipulation dexterity tests. The between-hand motor gripping dexterity test demonstrated a strong association; however, between-hand the motor manipulation dexterity test was only moderately associated. The device was reliable, discriminated between the motor gripping and motor manipulating dexterity tasks, and was sensitive to handedness during the motor manipulating dexterity task. It shows promise as a hand dexterity assessment device which may provide efficiency and cost advantages. It is freely available via http://www.rehabtools.org/dexterity.html. [ABSTRACT FROM AUTHOR]

In people recovering from traumatic brain injury, is a 3-month ballistic resistance training program targeting three lower limb muscle groups more effective than non-ballistic exercise rehabilitation for improving mobility, strength and balance? Does improved mobility translate to better health-related quality of life? A prospective, multicentre, randomised trial with concealed allocation, intention-to-treat analysis and blinded measurement. A total of 144 people with a neurological movement disorder affecting mobility as a result of traumatic brain injury. For 3 months, the experimental group had three 60-minute sessions of non-ballistic exercise rehabilitation per week replaced by ballistic resistance training. The control group had non-ballistic exercise rehabilitation of equivalent time. The non-ballistic exercise rehabilitation consisted of balance exercises, lower limb stretching, conventional strengthening exercises, cardiovascular fitness training and gait training. The primary outcome was mobility measured using the High-Level Mobility Assessment Tool (HiMAT). Secondary outcomes were walking speed, strength, balance and quality of life. They were measured at baseline (0 months), after completion of the 3-month intervention (3 months) and 3 months after cessation of intervention (6 months). After 3 months of ballistic resistance training, the experimental group scored 3 points (95% CI 0 to 6) higher on the 54-point HiMAT than the control group and remained 3 points (95% CI –1 to 6) higher at 6 months. Although there was a transient decrement in balance at 3 months in the experimental group, the interventions had similar effects on all secondary outcomes by 6 months. Participants with a baseline HiMAT < 27 gained greater benefit from ballistic training: 6 points (1 to 10) on the HiMAT. This randomised trial shows that ballistic resistance training has a similar or better effect on mobility than non-ballistic training in people with traumatic brain injury. It may be better targeted towards those with more severe mobility limitations. ACTRN12611001098921. [ABSTRACT FROM AUTHOR]

Ruptured abdominal aortic aneurysm (AAA) is a medical emergency that requires immediate surgical intervention. The aim of this analysis was to identify the sex- and race-specific disparities that exist in outcomes of patients hospitalized with this condition in the United States using the National Inpatient Sample (NIS) to identify targets for improvement and support of specific patient populations. In this descriptive, retrospective study, we analyzed the patients admitted with a primary diagnosis of ruptured AAA between January 1, 2016, and December 31, 2020, using the NIS database. We compared demographics, comorbidities, and in-hospital outcomes in AAA patients, and compared these results between different racial groups and sexes. A total of 22,395 patients with ruptured AAA were included for analysis. Of these, 16,125 patients (72.0%) were male, and 6270 were female (28.0%). The majority of patients (18,655 [83.3%]) identified as Caucasian, with the remaining patients identifying as African American (1555 [6.9%]), Hispanic (1095 [4.9%]), Asian or Pacific Islander (470 [2.1%]), or Native American (80 [0.5%]). Females had a higher risk of mortality than males (OR, 1.7; 95% confidence interval [CI], 1.45-1.96; P <.001) and were less likely to undergo endovascular aortic repair (OR, 0.70; 95% CI, 0.61-0.81; P <.001) or fenestrated endovascular aortic repair (OR, 0.71; 95% CI, 0.55-0.91; P =.007). Relative to Caucasian race, patients who identified as African American had a lower risk of inpatient mortality (OR, 0.50; 95% CI, 0.37-0.68; P <.001). In this retrospective study of the NIS database from 2016 to 2020, females were less likely to undergo endovascular intervention and more likely to die during their initial hospitalization. African American patients had lower rates in-hospital mortality than Caucasian patients, despite a higher burden of comorbidities. Future studies are needed to elucidate the potential factors affecting racial and sex disparities in ruptured AAA outcomes, including screening practices, rupture risk stratification, and more personalized guidelines for both elective and emergent intervention. [ABSTRACT FROM AUTHOR]

To examine knee flexion range-of-motion, quadriceps strength, and knee self-efficacy trajectory curves over 6 months after anterior cruciate ligament reconstruction (ACLR), stratified by patients' Month-6 sports activity level. Prospective longitudinal study. Hospital outpatient physiotherapy department. 595 individuals after unilateral ACLR (mean age, 27 years). At 2-, 3-, and 6-months post-surgery, knee flexion range-of-motion, quadriceps strength, and self-efficacy were quantified. Flexion range-of-motion was additionally measured at 2- and 4-weeks post-surgery. Sports activity levels were assessed using the Tegner Activity Score at 6-months post ACLR. The various measures improved nonlinearly over time, with substantial improvements observed in the first 2–4 months post-surgery. In multivariable generalized least squares models, greater knee flexion range-of-motion, quadriceps strength, and self-efficacy over time were significantly associated with higher Month-6 Tegner levels (all P values < 0.01). Additionally, receiving a bone-patellar-tendon-bone graft or meniscal repair was associated with lower quadriceps strength trajectories (P -values<0.001) while female sex was associated with lower knee self-efficacy trajectories (P = 0.02). Greater knee flexion range-of-motion, quadriceps strength, and self-efficacy were associated with higher Month-6 Tegner levels. The derived trajectory curves may be useful for effective management decision making and adequate results interpretation during the rehabilitation process. • Higher knee flexion ROM, knee strength, and self-efficacy trajectories were associated with higher Month-6 Tegner levels. • Receiving a bone-patellar-tendon-bone graft or meniscal repair was associated with lower quadriceps strength trajectories. • Female sex was associated with lower knee self-efficacy trajectories. • An interactive website was created (https://sghpt.shinyapps.io/alpha/) where the trajectory curves can be explored in detail. [ABSTRACT FROM AUTHOR]

Lateropulsion is a common problem following stroke. Whilst the Burke Lateropulsion Scale (BLS) is recommended in the literature as the outcome measure of choice for measuring lateropulsion, the internal validity of the BLS has not been investigated. To evaluate the internal validity of the BLS for use in evaluating the effectiveness of therapies aimed at reducing lateropulsion. Rasch analysis procedures were undertaken including assessment of overall model fit, item, and person fit, threshold ordering, differential item functioning, internal consistency, targeting, and dimensionality. Data from 132 participants were utilized to perform Rasch analysis of the BLS. In this preliminary study, overall model fit and individual item and person fit were found to be good using fit residual statistics and chi-square probability values. The BLS was found to be unidimensional and have good internal consistency (Person Separation Index 0.867). Thresholds for four of the five items were found to be only marginally disordered and were subsequently not modified. Non-uniform differential item functioning was detected for age for the transfers item; however, this item did not display item misfit and was therefore not removed. This study identified good psychometric properties of the BLS using Rasch analysis and supports the use of the BLS as a measure of lateropulsion following stroke. Further use of Rasch analysis on the BLS using a larger sample is recommended to confirm these preliminary findings and allow transformation into an interval-level scale. [ABSTRACT FROM AUTHOR]

To develop a prediction model for postoperative day 3 mobility limitations in patients undergoing total knee arthroplasty (TKA). Prospective cohort study. Inpatients in a tertiary care hospital. A sample of patients (N=2300) who underwent primary TKA in 2016-2017. Not applicable. Candidate predictors included demographic variables and preoperative clinical and psychosocial measures. The outcome of interest was mobility limitations on post-TKA day 3, and this was determined a priori by an ordinal mobility outcome hierarchy based on the type of the gait aids prescribed and the level of physiotherapist assistance provided. To develop the model, we fitted a multivariable proportional odds regression model with bootstrap internal validation. We used a model approximation approach to create a simplified model that approximated predictions from the full model with 95% accuracy. On post-TKA day 3, 11% of patients required both walkers and therapist assistance to ambulate safely. Our prediction model had a concordance index of 0.72 (95% confidence interval, 0.68-0.75) when evaluating these patients. In the simplified model, predictors of greater mobility limitations included older age, greater walking aid support required preoperatively, less preoperative knee flexion range of movement, low-volume surgeon, contralateral knee pain, higher body mass index, non-Chinese race, and greater self-reported walking limitations preoperatively. We have developed a prediction model to identify patients who are at risk for mobility limitations in the inpatient setting. When used preoperatively as part of a shared-decision making process, it can potentially influence rehabilitation strategies and facilitate discharge planning. [ABSTRACT FROM AUTHOR]

To investigate whether a three-dimensional (3-D) camera (Microsoft Kinect) and a smartphone can be used to accurately quantify the joint angular velocity and range of motion (ROM) compared to a criterion-standard 3-D motion analysis system during a lower limb spasticity assessment. Observational, criterion-standard comparison study. Large rehabilitation center. A convenience sample of 35 controls, 35 patients with a neurologic condition, and 34 rehabilitation professionals (physiotherapists and rehabilitation doctors) participated (N=104). Not applicable. The Modified Tardieu Scale was used to assess spasticity of the quadriceps, hamstrings, soleus, and gastrocnemius. Data for each trial were collected concurrently using the criterion-standard Optitrack 3-D motion analysis (3DMA) system, Microsoft Kinect, and a smartphone. Each healthy control participant was assessed by 1 health professional and each patient with a neurological condition was assessed by 3 health professionals. Spearman correlation coefficient and intraclass correlation coefficient with 95% confidence intervals were used to report the strength of the relationships investigated. The smartphone and Microsoft Kinect demonstrated excellent concurrent validity with the 3DMA system. Overall, 74.8% of the relationships investigated demonstrated a very strong (≥0.80) correlation across all of the testing parameters. The Microsoft Kinect was superior to the smartphone for measuring joint start and end angle, the smartphone was superior for measuring joint angular velocity, and the 2 systems were comparable for measuring total joint ROM. These findings provide preliminary evidence that user-friendly, low-cost technologies can be used to facilitate accurate measurements of joint angular velocity and angles during a lower limb spasticity assessment in a clinical setting. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to discuss how knowledge of the biomechanics of walking can be used to inform the prescription of resistance exercises for people with mobility limitations. Muscle weakness is a key physical impairment that limits walking in commonly occurring neurologic conditions such as cerebral palsy, traumatic brain injury, and stroke. Few randomized trials to date have shown conclusively that strength training improves walking in people living with these conditions. This appears to be because (1) the most important muscle groups for forward propulsion when walking have not been targeted for strengthening, and (2) strength training protocols have focused on slow and heavy resistance exercises, which do not improve the fast muscle contractions required for walking. We propose a theoretical framework to improve exercise prescription by integrating the biomechanics of walking with the principles of strength training outlined by the American College of Sports Medicine to prescribe exercises that are specific to improving the task of walking. The high angular velocities that occur in the lower limb joints during walking indicate that resistance exercises targeting power generation would be most appropriate. Therefore, we propose the prescription of plyometric and ballistic resistance exercise, applied using the American College of Sports Medicine guidelines for task specificity, once people with neurologic conditions are ambulating, to improve walking outcomes. This new theoretical framework for resistance training ensures that exercise prescription matches how the muscles work during walking. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to describe how the use of digital rectal exam to triage patients to standard transrectal ultrasound (TRUS) biopsies or magnetic resonance imaging (MRI) then MRI fusion biopsies impacts cancer detection rates, departmental resources and the diagnostic journey. Patients and methods: A retrospective analysis of all patients undergoing prostate biopsies in a 15-month period following the introduction of triage digital rectal exam (DRE) and MRI at Ayr University Hospital was conducted. MRI usage and patient journeys were also examined. Results: A total of 95.5% of patients proceeding directly to TRUS had malignant histology and less than 1% required further investigation. Forty-nine per cent of patients who underwent triage MRI avoided biopsy and over one-third of patients with previously benign TRUS biopsies had clinically significant malignancy on MRI fusion biopsies. The pathway eliminated repeat TRUS biopsy and the number of biopsies a month decreased. MRI usage doubled and waiting times to diagnostic biopsy increased when compared to a one-stop diagnostic clinic. Conclusion: Triaging according to DRE avoided delays in cases of overt malignancy and increased the detection rate of standard TRUS. For those patients with a benign DRE, MRI enabled half to avoid biopsy. The increase in demand on MRI was mitigated, in part, by using a shorter detection protocol but institutions must be aware of the potential for delays to diagnosis. Level of evidence: 4 [ABSTRACT FROM AUTHOR]

Objectives: Accurately measuring speed and acceleration during walking, running and sprinting has important implications for rehabilitation, planning training and talent identification in sporting and clinical populations. Light detection and ranging laser technology provides a continuous stream of distance data. It has the potential to allow rapid and precise measurement and may be advantageous compared with discrete methods of assessment, such as stopwatches and timing gates, which may be inaccurate over short distances. Therefore, the aim of this study was to assess the validity of a novel, low-cost and easy to implement laser-based system during walking and running trials.Design: Cross-sectional study.Methods: Thirty-two healthy adults performed walking and running trials from flying and static starts while monitored concurrently with reference standard three-dimensional motion analysis and laser systems. Velocity was calculated over short (0.5m) and longer (3m) intervals using both systems. Validity was assessed using absolute agreement intraclass correlation coefficients (ICC2,1), mean absolute errors, Pearson's correlations and regressions and Bland-Altman plots.Results: All intraclass correlation coefficients and correlations were excellent (ICC>0.88, R>0.89). For the longer interval, all mean absolute errors were <0.03m/s (0.24-1.31%). Slightly higher mean absolute error values were reported for the shorter interval (3.16-5.10%), with the highest error of 0.184m/s evident for the flying start running trial.Conclusions: These results indicate that a low-cost and accessible laser system can be used to accurately assess walking and running speed. To aid implementation and further research, freely available hardware design descriptions and downloadable software can be accessed at www.rehabtools.org/LIDAR. [ABSTRACT FROM AUTHOR]

Abstract Objective To establish the feasibility and effectiveness of a 6-week ballistic strength training protocol in people with stroke. Design Randomized, controlled, assessor-blinded study. Setting Subacute inpatient rehabilitation. Participants Consecutively admitted inpatients with a primary diagnosis of first-ever stroke with lower limb weakness, functional ambulation category score of ≥3, and ability to walk ≥14 m were screened for eligibility to recruit 30 participants for randomization. Interventions Participants were randomized to standard therapy or ballistic strength training 3 times per week for 6 weeks. Main Outcome Measures The primary aim was to evaluate feasibility and outcomes included recruitment rate, participant retention and attrition, feasibility of the exercise protocol, therapist burden, and participant safety. Secondary outcomes included measures of mobility, lower limb muscle strength, muscle power, and quality of life. Results A total of 30 participants (11% of those screened) with mean age of 50 years (SD 18) were randomized. The median number of sessions attended was 15 of 18 and 17 of 18 for the ballistic and control groups, respectively. Earlier than expected discharge to home (n=4) and illness (n=7) were the most common reasons for nonattendance. Participants performed the exercises safely, with no study-related adverse events. There were significant (P <.05) between-group changes favoring the ballistic group for comfortable gait velocity (mean difference [MD] 0.31m/s, 95% confidence interval [CI]: 0.08-0.52), muscle power, as measured by peak jump height (MD 8cm, 95% CI: 3-13), and peak propulsive velocity (MD 64cm/s, 95% CI: 17-112). Conclusions Ballistic training was safe and feasible in select ambulant people with stroke. Similar rates of retention and attrition suggest that ballistic training was acceptable to patients. Secondary outcomes provide promising results that warrant further investigation in a larger trial. [ABSTRACT FROM AUTHOR]

Although self-reported measures of physical disability are strong indication criterion for total knee arthroplasty (TKA) in painful knee osteoarthritis (OA), some patients may report greater-than-observed disability. Contributing factors to this discordance are relatively unexplored. We aimed to examine whether pain and negative affect, including anxiety and depression, were associated with the discordance of self-reported measures with performance-based measures (PPM) of physical function. We used cross-sectional data (n = 212) from two randomized rehabilitation trials in knee OA. All patients were assessed for knee pain intensity and symptoms of anxiety and depression. Self-reported function was assessed by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) physical-function subscale. Objective performance-based measures (PPMs) of physical function were assessed by timed gait and stair tests. Continuous discordance scores were quantified by the difference in percentiles between WOMAC and PPMs (WOMAC-PPM), where a positive discordance, WOMAC-PPM >0, implied greater perceived than observed disability. Around 1 in 4 patients had >20 percentile units in WOMAC-PPM discordance. In Bayesian regression analyses, knee pain intensity had >99% posterior probability of positive associations with WOMAC-PPM discordance. Among patients awaiting TKA, anxiety intensity had approximately 99% probability of positive associations with discordance, and these associations had >65% probability of exceeding 10 percentile units. In contrast, depression had low (79% to 88%) probability of any association with discordance. In patients who have knee OA, a sizable proportion reported substantially greater physical disability than actually observed. Pain and anxiety intensity, but not depression, were meaningful predictors of this discordance. If validated, our findings may help in refining patient selection criteria for TKA. [ABSTRACT FROM AUTHOR]

Objectives: Determine whether clinically feasible tests of isometric lower limb strength and range of motion (ROM) in Australian Football (AF) athletes are useful in Periodic Health Examinations to identify persistent deficits following hamstring strain injury (HSI).Design: Case-control.Methods: Thirty-seven male, semi-professional AF athletes (mean±SD; age, 20.2±2.9years; height, 1.7±0.5m; mass, 81±9.2kg) participated, ten athletes (37%) reported HSI within the previous three seasons of competition. Comparisons of pre-season isometric knee flexion and hip extension strength variables (peak force, torque and torque normalised to body mass) and hip, knee and ankle ROM measures were made between athletes with and without past-history of HSI using linear mixed-effect models. A logistic regression evaluated whether any of the outcome measures could differentiate athletes with a past-history of HSI.Results: Knee flexion peak force, torque and torque normalised to body mass were significantly reduced in athletes with a past-history of HSI (coefficient, 95% CI) (-44.8N, -86.3 to -3.3), (-22.2Nm, -40.5 to -3.7) and (-0.2Nmkg-1, -0.4 to 0.0) respectively. Knee flexion peak torque normalised to body mass (Nmkg-1) approached significance as a test was able to differentiate athletes with history of HSI (p=0.068). There were no differences between groups for any hip extension strength or lower limb ROM outcome measures.Conclusions: Deficits in isometric peak knee flexion strength persist for up to three seasons following HSI in AF athletes. Isometric knee flexion strength testing may be a clinically feasible option for Periodic Health Examinations and inform tertiary injury prevention strategies. [ABSTRACT FROM AUTHOR]

Objective To integrate the literature investigating factors associated with post-stroke physical activity. Data Sources A search was conducted from database inception to June 2016 across 9 databases: Cochrane, MEDLINE, ProQuest, Web of Science, PsycINFO, Scopus, Embase, CINAHL, and Allied and Complementary Medicine Database. The reference lists of included articles were screened for secondary literature. Study Selection Cohort and cross-sectional studies were included if they recruited community-dwelling stroke survivors and measured factors associated with physical activity. Data Extraction Risk of bias was evaluated using the Quality in Prognosis Studies checklist. A meta-analysis was conducted for correlates where there were at least 2 studies that reported a correlation value. Correlation values were used in an effect size measure and converted to a standardized unit with Fisher r to z transformation and conversion back to r method. Results were described qualitatively for studies that could not be pooled. Data Synthesis There were 2161 studies screened and 26 studies included. Age (meta r =−.17; P ≤.001) and sex (meta r =−.01; P =.02) were the nonmodifiable factors that were found to be associated with post-stroke physical activity. The modifiable factors were physical function (meta r =.68–.73; P <.001), cardiorespiratory fitness (meta r =.35; P ≤.001), fatigue (meta r =−.22; P =.01), falls self-efficacy (meta r =−.33; P <.001), balance self-efficacy (meta r =.37; P <.001), depression (meta r =−.58 to .48; P <.001), and health-related quality of life (meta r =.38–.43; P <.001). The effect of side of infarct, neglect, and cognition on post-stroke physical activity was inconclusive. Conclusions Age, sex, physical function, depression, fatigue, self-efficacy, and quality of life were factors associated with post-stroke physical activity. The cause and effect of these relations are unclear, and the possibility of reverse causality needs to be addressed. [ABSTRACT FROM AUTHOR]

Objectives To evaluate strength and flexibility measures pre- and post- Australian Football (AF) competition to determine their potential utility as secondary prevention measures. Design Cohort study. Setting Semi-professional AF club. Participants Ten male AF athletes (mean ± SD; age, 21.3 ± 2.2 years; height, 186.1 ± 6.3 cm; weight, 83.5 ± 8.6 kg). Main Outcome Measures Maximal unilateral isometric knee flexion strength performed in 45 degrees of hip flexion and 30 degrees of knee flexion, flexibility measures of hip and knee extension and ankle dorsiflexion. All outcome measures were evaluated pre-match to determine baseline measurements and repeated acutely post-match and at 26, 50 and 74 h following. Comparisons were made between baseline measures and all other time points. Results Knee flexion strength was significantly reduced at a group level acutely (−122.8N, 95%CI −156.2 to −89.4, p  = 0.000) and at 26 h (−89.6N, 95%CI −122.9 to −56.2, p  = 0.000) following competition. Hamstring flexibility was significantly reduced at all time periods following competition (all p  < 0.05), however these values were not clinically meaningful. Conclusions Knowledge that unilateral isometric knee flexion strength returns to pre-competition levels by 50 h following match-play in AF athletes is valuable for planning recovery time frames and may inform implementation of secondary prevention strategies. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Prospective cohort. BACKGROUND: Quadriceps strength is associated with hop distance and jump height in persons who have undergone anterior cruciate ligament (ACL) reconstruction. However, it is unknown whether the ability to rapidly generate quadriceps torque in the early phase of recovery is associated with future hopping and jumping performance in this population. OBJECTIVE: To evaluate the prospective associations among quadriceps strength and rate of torque development (RTD) and single-leg hop for distance, vertical jump height, vertical ground reaction force (vGRF), and vertical force loading rate during a landing task in persons who have undergone ACL reconstruction. METHODS: Seventy patients with unilateral ACL reconstruction participated. At 6 weeks post ACL reconstruction, isometric quadriceps strength and RTD were measured using a dynamometer. At 6 months following ACL reconstruction, patients performed the single-leg hop for distance test. Patients also performed the single-leg vertical jump test on a force plate that measured maximum jump height, vGRF, and average loading rate during landing. RESULTS: Both quadriceps strength and RTD at 6 weeks post ACL reconstruction were associated with all hopping and jumping measures at 6 months post ACL reconstruction (P≤.04). Single-leg hop distance was associated more closely with quadriceps strength than with quadriceps RTD (P = .05), and vertical jump height and vGRF measures were associated more closely with quadriceps RTD than with quadriceps strength (P = .05 and P<.01, respectively). Both quadriceps measures were associated with loading rate. CONCLUSION: Quadriceps strength and RTD are complementary but distinct predictors of future hopping and jumping performance in persons who have undergone ACL reconstruction. These findings may contribute to improved rehabilitation of patients who are at risk for poor jumping/ hopping performance and abnormal knee loading. [ABSTRACT FROM AUTHOR]

Objectives Gait speed limitations can remain significant issues after a total knee arthroplasty (TKA) but their associated factors are not well understood. This study aimed to identify the factors associated with acute gait speed recovery post-TKA. Methods We performed a prospective longitudinal study of 1765 patients who underwent primary TKA between July 2013 and July 2015. At 4, 8, 12, and 16 weeks postsurgery, fast gait speed was measured. The factors associated with gait speed over time since TKA were identified using multivariable generalized least squares modeling. Results Lower postoperative quadriceps strength and knee flexion range of motion were closely associated with lower gait speed over time (0.084 m/s, 0.064 m/s, and 0.055 m/s change in gait speed per interquartile range change in ipsilateral quadriceps strength, contralateral quadriceps strength, and knee flexion range of motion, respectively). Additional strong predictors of lower gait speed included older age (0.11 m/s), lower levels of preoperative Short Form 36 physical function (0.066 m/s), greater body mass (0.046 m/s), and the preoperative use of a walking aid (overall P < 0.001). Patients who reported that they limited their daily activities due to a fear of falling also had poorer gait speed (0.033 m/s and 0.054 m/s slower gait speed for “Occasional” and “Often” categories, respectively, vs. “None”). Conclusions Gait speed recovery post-TKA is driven by both physical and psychological factors, suggesting that identifying and treating the underlying physical and cognitive causes of gait speed limitations may be crucial to optimize functional recovery. [ABSTRACT FROM AUTHOR]

Objectives: Firstly to describe the reliability of assessing maximal isometric strength of the hip abductor and adductor musculature using a hand held dynamometry (HHD) protocol with simultaneous wireless surface electromyographic (sEMG) evaluation of the gluteus medius (GM) and adductor longus (AL). Secondly, to describe the correlation between isometric strength recorded with the HHD protocol and a laboratory standard isokinetic device.Design: Reliability and correlational study.Methods: A sample of 24 elite, male, junior, rugby league athletes, age 16-20 years participated in repeated HHD and isometric Kin-Com (KC) strength testing with simultaneous sEMG assessment, on average (range) 6 (5-7) days apart by a single assessor. Strength tests included; unilateral hip abduction (ABD) and adduction (ADD) and bilateral ADD assessed with squeeze (SQ) tests in 0 and 45° of hip flexion.Results: HHD demonstrated good to excellent inter-session reliability for all outcome measures (ICC(2,1)=0.76-0.91) and good to excellent association with the laboratory reference KC (ICC(2,1)=0.80-0.88). Whilst intra-session, inter-trial reliability of EMG activation and co-activation outcome measures ranged from moderate to excellent (ICC(2,1)=0.70-0.94), inter-session reliability was poor (all ICC(2,1)<0.50).Conclusions: Isometric strength testing of the hip ABD and ADD musculature using HHD may be measured reliably in elite, junior rugby league athletes. Due to the poor inter-session reliability of sEMG measures, it is not recommended for athlete screening purposes if using the techniques implemented in this study. [ABSTRACT FROM AUTHOR]

Objective To investigate the effectiveness of aquatic exercise in improving lower limb strength in people with musculoskeletal conditions. Data Sources A systematic search used 5 databases, including MEDLINE, CINAHL, Embase, SPORTDiscus, and The Cochrane Library. Study Selection Randomized controlled trials evaluating aquatic exercise with a resistance training component for adults with musculoskeletal conditions compared with no intervention or land-based exercise were identified. Fifteen studies from the initial yield of 1214 met these criteria. Data Extraction Data related to participant demographics, study design, and methods, interventions, and outcomes, including numerical means and SDs, were extracted independently by 2 reviewers. Data Synthesis Nine of the 15 studies were of high quality, scoring at least 6 on the Physiotherapy Evidence Database Scale. Limited consideration of the prescription of resistance in the aquatic exercise and application of resistance training principles existed. Low- or very low–quality evidence indicates there was no difference in average effect between aquatic exercise and no exercise in improving hip abductor strength (standardized mean difference [SMD], .28; 95% confidence interval [CI], −.04 to .59), knee extensor strength (SMD, .18; 95% CI, −.03 to .40), knee flexor strength (SMD, .13; 95% CI, −.20 to .45), or lower limb endurance (SMD, .35; 95% CI, −.06 to .77). Low-quality evidence indicates no difference in average effect between aquatic and land exercise for knee extensor (SMD, −.24; 95% CI, −.49 to .02) or flexor strength (SMD, −.15; 95% CI, −.53 to .22). Conclusions It is likely that the inadequate application of resistance in water is a significant contributor to the limited effectiveness of aquatic exercise interventions in improving hip and knee muscle strength in people with musculoskeletal conditions. Future research is needed to quantify resistance with aquatic exercises and to determine if using opportunities for greater resistance in aquatic rehabilitation and appropriate resistance training principles can be more effective in improving muscle strength. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Cross-sectional, controlled laboratory study. BACKGROUND: Postural control following anterior cruciate ligament reconstruction (ACLR) primarily has been investigated during static single-leg balance tasks. Little is known about dynamic postural control deficits post-ACLR. OBJECTIVES: To compare dynamic postural control (bilaterally) in individuals who have undergone ACLR and in healthy controls, and to evaluate the relationship between dynamic postural control and self-reported and objective function. METHODS: Ninety-seven participants (66 male; median age, 28 years) 12 months post-ACLR and 48 healthy controls (20 male; median age, 30 years) underwent balance assessment using a Nintendo Wii Balance Board during a single-leg squat. Center-of-pressure (CoP) path velocity, as well as CoP amplitude and standard deviation, in both mediolateral (ML) and anteroposterior (AP) directions were recorded. Self-reported function was assessed with the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), while hop for distance was used to evaluate functional status. RESULTS: Compared to healthy controls, the ACLR group had greater mean CoP path velocity (16% higher, P = .004), ML range (23%, P<.001), ML SD (28%, P<.001), AP range (14%, P = .009), and AP SD (15%, P = .013), indicating worse dynamic balance post-ACLR. Dynamic balance performance was similar between the ACLR limb and the uninjured contralateral limb. The AP SD was weakly associated with hop performance (β = -.2, P = .046); no balance measures were associated with IKDC score. CONCLUSION: Individuals who have undergone ACLR demonstrate impaired dynamic balance bilaterally when performing a single-leg squat, which may have implications for physical function and future injury risk. Routine dynamic balance assessment may help identify patients who could benefit from targeted neuromuscular training programs to improve objective function and potentially lower reinjury risk. [ABSTRACT FROM AUTHOR]

Objective: To evaluate single-leg squat performance 1-2 years after arthroscopy for intra-articular hip pathology compared with control subjects and the nonsurgical limb, and to investigate whether single-leg squat performance on the operated limb was associated with hip muscle strength.Design: Cross-sectional study.Setting: Private physiotherapy clinic and university laboratory.Participants: Thirty-four participants (17 women, 36.7 ± 12.6 years) 1-2 years after hip arthroscopy and 34 gender-matched control subjects (17 women, 33.1 ± 11.9 years).Methods: Participants performed single-leg squats using a standardized testing procedure. Squat performance was captured using video. Video footage was uploaded and reformatted for analyses. Hip muscle strength was measured with handheld dynamometry using reliable methods.Outcome Measures: Frontal plane pelvic obliquity, hip adduction, and knee valgus were measured. Repeated measures analysis of variance evaluated between-group differences, with limb as a within-subjects factor (surgical versus nonsurgical) and gender as a between-subjects factor (P < .05).Results: The hip arthroscopy group demonstrated significantly greater apparent hip adduction (mean difference 2.7°, 95% confidence interval [CI] 0.7°-4.8°) and apparent knee valgus (4.0°, 95% CI 1.0°-7.1°) at peak squat depth compared with control subjects. The operated limb also demonstrated significantly greater pelvic obliquity during single-leg stance compared with the nonsurgical limb (1.2°, 95% CI 0.1°-2.3°). Women had significantly greater apparent hip adduction (standing 1.6°, 95% CI 0.5°-2.6°; peak squat depth 2.4°, 95% CI 0.3°-4.4°) and apparent knee valgus (standing 3.3°, 95% CI 1.8°-4.7°; peak squat depth 3.1°, 95% CI 0°-6.1°). Significant positive correlations were found between frontal plane angles and hip flexor and extensor peak torque (P > .05).Conclusion: One to 2 years after hip arthroscopy, deficits in single-leg squat performance exist that have the potential to increase hip joint impingement and perpetuate postoperative symptoms. Rehabilitation after hip arthroscopy should target retraining in functional single-leg positions. [ABSTRACT FROM AUTHOR]

To investigate the accuracy of subjective rating of upper limb associated reactions (ARs) during walking using the International Classification of Functioning, Disability and Health Framework's (ICF) Qualifiers Scale compared to criterion-reference three-dimensional motion analysis (3DMA). Cross-sectional observational study. A major brain injury rehabilitation centre in Australia. Forty-one participants with an ABI and hemiplegic upper limb AR during walking. N/A. Participants underwent 3DMA at their self-selected walking speed to generate an AR outcome measure, quantifying upper limb kinematic deviation compared to healthy controls at each joint axis and whole upper limb. Three experienced neurological physiotherapists viewed video recordings of the participants' walking trials and applied the ICF Qualifiers Scale to subjectively rate the global AR severity and severity at each upper limb joint on a 5-point scale. The comparative accuracy was calculated via quantifying relationships (Fisher's exact test), percentage agreement, sensitivity, and specificity. The ICF Qualifiers Scale had limited accuracy compared to 3DMA hemiplegic upper limb assessment. The wrist severity score was the only outcome demonstrating a significant relationship to the corresponding 3DMA outcome (p < 0.05). Four out of seven outcomes had ≤ 58% agreement in abnormality classification. None of the outcomes had high sensitivity and specificity. The sensitivity was relatively low for all outcomes (0.32-0.73) and specificity relatively high (>0.80) for four of the seven outcomes. Given that the ICF Qualifiers scale tended to under classify abnormality with false negatives likely, it cannot be confidently implemented in clinical practice. There appears to be a disconnect between 3DMA and subjective rating of ARs. Evaluation of ARs during walking may require objective assessment. There are no disclosures to report. [ABSTRACT FROM AUTHOR]