Search

Objective: To determine the point prevalence of chronic musculoskeletal ankle disorders in the community., Design: Cross-sectional stratified (metropolitan vs regional) random sample., Setting: General community., Participants: Population-based computer-aided telephone survey of people (N=2078) aged 18 to 65 years in New South Wales, Australia. Of those contacted, 751 participants provided data., Interventions: Not applicable., Main Outcome Measures: Point prevalence for no history of ankle injury or chronic ankle problems (no ankle problems), history of ankle injury without residual problems, and chronic ankle disorders. Chronic musculoskeletal ankle disorders due to ankle sprain, fracture, arthritis, or other disorder compared by chi-square test for the presence of pain, weakness, giving way, swelling and instability, activity limitation, and health care use in the past year., Results: There were 231 (30.8%) participants with no ankle problems, 342 (45.5%) with a history of ankle injury but no chronic problems, and 178 (23.7%) with chronic ankle disorders. The major component of chronic ankle disorders was musculoskeletal disorders (n=147, 19.6% of the total sample), most of which were due to ankle injury (n=117, 15.6% of the total). There was no difference among the arthritis, fracture, sprain, and other groups in the prevalence of the specific complaints, or health care use. Significantly more participants with arthritis had to limit activity than in the sprain group (Chi-square test, P=.035)., Conclusions: Chronic musculoskeletal ankle disorders affected almost 20% of the Australian community. The majority were due to a previous ankle injury, and most people had to limit or change their physical activity because of the ankle disorder., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To propose standardized, patient-centered measures of recovery from nonspecific low back pain (LBP) in research, underpinned by an empirically derived concept of recovery and informed by expert opinion., Design: Synthesis of literature reviews and expert panel opinion., Setting: Primary care centers for the management of nonspecific LBP., Participants: Persons with nonspecific LBP., Interventions: Conservative treatments for nonspecific LBP., Main Outcome Measures: Three phases of research were conducted. First, qualitative research that explored patients' perspectives of recovery from nonspecific LBP was reviewed. Second, measures of recovery used in LBP clinical trials during the past decade were investigated in a systematic review. Third, opinion was sought from an expert panel of clinicians and researchers about how to measure recovery from nonspecific LBP, in a workshop at the 10th International Forum for Primary Care Research in Low Back Pain., Results: An empirically derived and patient-centered concept of recovery from nonspecific LBP was developed from the qualitative research phase. The systematic review conducted in the second study phase revealed that researchers have used vastly heterogeneous measures of LBP recovery in clinical trials during the past decade. Finally, the key conclusions of the LBP Forum workshop were (1) that appropriate patient-centered instruments to measure recovery include global measures and patient-specific measures; and (2) that the benefits of implementing the same recovery measures for acute and chronic LBP outweigh the disadvantages of using different measures., Conclusions: The results were synthesized to inform our recommendation that researchers consider adopting 2 instruments as standardized measures of recovery from nonspecific LBP, as an adjunct to the existing core set of LBP outcome measures. These instruments are an 11-point Global Back Recovery Scale, for a simple measure of global recovery, and the Patient-Generated Index of Quality of Life-Back Pain, to evaluate specific relevant dimensions of recovery. This recommendation has majority endorsement by members of the Australian National Health and Medical Research Council Acute Low Back Pain Review Group., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To conduct a systematic review and meta-analysis on the prognosis of acute idiopathic neck pain and disability., Data Sources: EMBASE, CINAHL, Medline, AMED, PEDro, and CENTRAL were searched from inception to July 2009, limited to human studies. Reference lists of relevant systematic reviews were searched by hand. Search terms included: neck pain, prognosis, inception, cohort, longitudinal, observational, or prospective study and randomized controlled trial., Study Selection: Eligible studies were longitudinal cohort studies and randomized controlled trials with a no treatment or minimal treatment arm that recruited an inception cohort of acute idiopathic neck pain and reported pain or disability outcomes. Eligibility was determined by 2 authors independently. Seven of 20,085 references were included., Data Extraction: Pain and disability data were extracted independently by 2 authors. Risk of bias was assessed independently by 2 authors., Data Synthesis: Statistical pooling showed a weighted mean pain score (0-100) of 64 (95% confidence interval [CI], 61-67) at onset and 35 (95% CI, 32-38) at 6.5 weeks. At 12 months, neck pain severity remained high at 42 (95% CI, 39-45). Disability reduced from a pooled weighted mean score (0-100) at onset of 30 (95% CI, 28-32) to 17 (95% CI, 15-19) by 6.5 weeks, without further improvement at 12 months. Studies varied in length of follow-up, design, and sample size., Conclusions: This review provides Level I evidence that the prognosis of acute idiopathic neck pain is worse than currently recognized. This evidence can guide primary care clinicians when providing prognostic information to patients. Further research to identify prognostic factors and long-term outcomes from inception cohorts would be valuable., (Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Unlabelled: A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain., Objective: To determine whether neck manipulation is more effective for neck pain than mobilization., Design: Randomized controlled trial with blind assessment of outcome., Setting: Primary care physiotherapy, chiropractic, and osteopathy clinics in Sydney, Australia., Participants: Patients (N=182) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner., Interventions: Participants were randomly assigned to receive treatment with neck manipulation (n=91) or mobilization (n=91). Patients in both groups received 4 treatments over 2 weeks., Main Outcome Measure: The number of days taken to recover from the episode of neck pain., Results: The median number of days to recovery of pain was 47 in the manipulation group and 43 in the mobilization group. Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilization (hazard ratio=.98; 95% confidence interval, .66-1.46)., Conclusions: Neck manipulation is not appreciably more effective than mobilization. The use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.

Objectives: To investigate the ability of asymptomatic participants to discriminate between active knee rotation movements of different magnitude and to determine whether proprioceptive acuity of active knee rotation differs between limbs (dominant and nondominant and right and left)., Design: Cross-sectional study., Setting: Laboratory in an Australian university., Participants: Healthy volunteers (N=30) without previous cruciate ligament injury or surgery, previous fracture of the lower limbs, or other lower-limb disorders in the last 3 months., Interventions: Not applicable., Main Outcome Measures: Knee rotation proprioceptive acuity was determined by using our custom-designed device. The measure of proprioceptive acuity used in this study was the just-noticeable difference (JND). Participants actively rotated the knee (internal or external rotation) to 1 of 4 movement blocks and judged the magnitude of the permitted motion. Proprioceptive acuity scores, representing a participant's ability to detect small differences in magnitude of active knee rotation movements, were then calculated., Results: The means of the JND for proprioceptive acuity of internal rotation (1.37 degrees +/-.11 degrees ) were significantly (P=.04) lower than for external rotation (1.6 degrees +/-.14 degrees ) regardless of side (right, left) or dominance. No significant difference was found between the mean JND for left and right knee rotations (P=.84) or between the mean JND for dominant and nondominant knee rotation (P=.69)., Conclusions: Participants perceived smaller differences between active internal rotation movements than external rotation. No significant difference was found between the dominant and nondominant leg or between the left and right leg; therefore, clinicians can establish whether a proprioceptive deficit exists after unilateral injury and can use acuity of the uninjured knee as a normal status for rehabilitation.

Objective: To test the Cumberland Ankle Instability Tool (CAIT), a 9-item 30-point scale, for measuring severity of functional ankle instability., Design: Cross-sectional study., Setting: General community., Participants: Volunteer sample of 236 subjects., Interventions: Not applicable., Main Outcome Measures: Concurrent validity by comparison with the Lower Extremity Functional Scale (LEFS) and a visual analog scale (VAS) of global perception of ankle instability by using the Spearman rho. Construct validity and internal reliability with Rasch analysis using goodness-of-fit statistics for items and subjects, separation of subjects, correlation of items to the total scale, and a Cronbach alpha equivalent. Discrimination score for functional ankle instability by maximizing the Youden index and tested for sensitivity and specificity. Test-retest reliability by intraclass correlation coefficient, model 2,1 (ICC(2,1))., Results: There were significant correlations between the CAIT and LEFS (rho=.50, P<.01) and VAS (rho=.76, P<.01). Construct validity and internal reliability were acceptable (alpha=.83; point measure correlation for all items, >0.5; item reliability index, .99). The threshold CAIT score was 27.5 (Youden index, 68.1); sensitivity was 82.9% and specificity was 74.7%. Test-retest reliability was excellent (ICC(2,1)=.96)., Conclusions: CAIT is a simple, valid, and reliable tool to measure severity of functional ankle instability.

Objective: To determine the relation between 2 proprioceptive tests, movement detection and movement discrimination, at the ankle., Design: A cross-sectional descriptive study., Setting: Research laboratory., Participants: Eighteen subjects with recurrent ankle inversion sprain., Interventions: Not applicable., Main Outcome Measures: Threshold to detection of movement was tested for inversion and eversion movements at 3 velocities (0.1 degrees , 0.5 degrees , 2.5 degrees /s). Movement discrimination was tested for plantarflexion and inversion movements. The tests were performed in random order, and the velocity and movements were randomized within each test paradigm. Correlations (Pearson r) were calculated between movement detection and movement discrimination., Results: Correlation within each proprioceptive paradigm was poor to moderate: for movement detection, correlations among movement directions at each velocity ranged from r equal to .53 to r equal to .54; for movement discrimination correlation was r equal to .49. There was poor correlation between the scores for the 2 tasks in 10 of the 12 comparisons (r range, -.02 to -.36)., Conclusions: These findings show that performance in different proprioceptive tests is not well correlated and, therefore, that general proprioceptive status cannot be inferred from assessment of a single proprioceptive test.

Objectives: To review the experimental evidence and development of concepts in knee kinematics and to present a synthesis of current theories., Data Sources: Historical literature from private collections and published journals, from Galen in 160 AD, and Weber and Weber in 1860, through to current research in knee kinematics, sourced through MEDLINE and CINAHL., Study Selection: Studies of the healthy human knee in vivo and in vitro were included. Other studies were included when relevant, for example, when knee surgery methods have led to a change in kinematic concepts. Of 285 items, 94 were included based on their contribution to original research. When relevant, authors were contacted to resolve issues., Data Extraction: Sources included were descriptive studies, anatomic dissections, controlled experimental designs, editorials, and review articles., Data Synthesis: The axes of rotation of the knee are fundamental to kinematic models. The hinge model is contradicted by the ellipsoid shape of the femoral condyles, which results in a moving instant center of motion. However, the "instant center of motion" model was based on analysis of sagittal sections, oblique to the plane of movement and neglecting rotation. The four-bar linkage theory linked cruciate ligament isometry with the roll and glide pattern of knee motion. Recently, however, studies of the biomechanics and histology of the knee ligaments have enabled more accurate kinematic modeling. Three-dimensional imaging and computer modeling have made possible analysis of kinematics parallel to the planes of motion and incorporation of conjoint rotation. Femoral roll back is now described as the manifestation of longitudinal rotation during knee flexion., Conclusions: Current research concludes that the knee has 4 independent axes: patella, posterior condylar, distal condylar, and longitudinal axes. The axes combine to produce the characteristic helical motion of the knee.