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Osteoarthritis (OA) is a common degenerative disease affecting joints with an increasing prevalence around the world and in the Middle East region. Research about the prevalence/incidence of OA in the Gulf Cooperation Council (GCC) countries was limited with inconsistent findings. Therefore, the aim of this study was to conduct a systematic review and meta-analysis for studies reporting the prevalence/incidence of OA among people living in the GCC countries. A comprehensive search was performed using MEDLINE, PubMed, CINAHL, Web of Science, and Google Scholar from inception to December 2020 to identify eligible studies examining the prevalence/incidence of OA in the GCC countries. Meta-analysis was conducted, and the Newcastle Ottawa Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was utilized to evaluate methodological quality. Thirteen studies were included (12 studies reported prevalence and one study reported incidence), with a total of 24,625 participants with an estimated overall prevalence of 16.13% and incidence of 3.5% of OA in the GCC countries. The quality of the included studies was unsatisfactory (six studies), satisfactory (six studies), and good quality (one study). Common risk factors were being older adult, female, obese, and having lower scores for quality of life. This study shows a high prevalence of OA among individuals living in the GCC countries at approximately 16.13%. Only one study reported incidence of 3.5% of OA in this population. This prevalence rate needs to be confirmed in future research with a similar population and at the site of joint OA levels. Common risk factors should be interpreted with caution since only a few studies reported risk factors. Key Points • The pooled prevalence of Osteoarthritis in the Gulf Cooperation Council countries was 16.13% based on 12 included studies.

Background: To investigate how changes in sedentary behavior relate to health outcomes, it is important to establish the test–retest reliability of activity monitors in measuring habitual sedentary behavior in people with type 2 diabetes (T2D) as a prerequisite for interpreting this information. Thus, the authors’ objective was to examine the test–retest reliability of a common activity monitor (activPAL™) in measuring sedentary behavior and physical activity in people with T2D. Methods: Sedentary-time, standing-time, stepping-time, step-count, and sit-to-stand transitions were obtained from two 7-day assessment periods separated by at least 1 week. Test–retest reliability was determined with the intraclass correlation coefficient (ICC) to compare sedentary and activity measures between the 2 time points. Results: A total of 30 participants with self-reported T2D completed the study (age 65 [6] y, 63% women, body mass index 33.3 [5] kg/m2). High test–retest reliability was found for sedentary-time (ICC = .79; 95% confidence interval [CI], .61–.89) and standing-time (ICC = .74; 95% CI, .53–.87). Very high test–retest reliability was found for stepping-time (ICC = .90; 95% CI, .81–.95), step-count (ICC = .91; 95% CI, .83–.96), and sit-to-stand transitions (ICC = .90; 95% CI, .79–.95). Conclusion: The activPAL™ device showed high to very high test–retest reliability in measuring all tested activity categories in people with T2D.

The primary aim of this study was to examine the effect of Cognitive Behavioral Therapy for Insomnia (CBT-I) on the severity of insomnia in people with Type 2 diabetes (T2D) compared to a health education (HE) control group. The secondary aim was to explore the effect of CBT-I on other sleep outcomes and concomitant symptoms.Twenty-eight participants with T2D were randomly assigned to CBT-I (Validated assessments were used at baseline and post intervention to assess sleep outcomes and concomitant symptoms. In addition, actigraph and sleep diaries were used to measure sleep parameters. Independent sampleParticipants in the CBT-I group showed higher improvements in the following mean change scores compared to the HE group: insomnia symptoms (This study identified a clinically meaningful effect of CBT-I on sleep outcomes and concomitant symptoms in people with T2D and insomnia symptoms. Further work is needed to investigate the long-term effects of CBT-I in people with T2D and insomnia symptoms.

Background Previous studies have shown the negative impact of sleep disturbances, specifically insomnia symptoms, on glucose metabolism for people with type 2 diabetes (T2D). People with insomnia symptoms are at risk of poor glycemic control and suboptimal diabetes self-care behavior (DSCB). Investigating the impact of a safe and effective intervention for individuals with T2D and insomnia symptoms on diabetes’ health outcomes is needed. Therefore, the aim of this exploratory study is to examine the effects of Cognitive Behavioral Therapy for Insomnia (CBT-I) on glycemic control, DSCB, and fatigue. Methods Twenty-eight participants with T2D and insomnia symptoms, after passing an eligibility criteria at a medical research center, were randomly assigned to CBT-I (n = 14) or Health Education (HE; n = 14). The CBT-I and HE groups received 6 weekly one-hour sessions. This Randomized Controlled Trial (RCT) used a non-inferiority framework to test the effectiveness of CBT-I. Validated assessments were administered at baseline and post-intervention to assess glycemic control, DSCB, and fatigue. A Wilcoxon signed-rank test was utilized to compare within-group changes from baseline to post-intervention. A Mann-Whitney test was utilized to measure the between-group differences. Linear regression was used to assess the association between the blood glucose level and the number of days in the CBT-I group. Results The recruitment duration was from October 2018 to May 2019. A total of 13 participants completed the interventions in each group and are included in the final analysis. No adverse events, because of being a part of this RCT, were reported. CBT-I participants showed significantly greater improvement in glycemic control, DSCB, and fatigue. There was a significant association between the number of days in the CBT-I intervention with the blood glucose level before bedtime (B = -0.56, p = .009) and after awakening in the morning (B = -0.57, p = .007). Conclusions This study demonstrated a clinically meaningful effect of CBT-I on glycemic control in people with T2D and insomnia symptoms. Also, CBT-I positively impacted daytime functioning, including DSCB and fatigue. Future research is needed to investigate the long-term effects of CBT-I on laboratory tests of glycemic control and to understand the underlying mechanisms of any improvements. Trial registration Clinical Trials Registry (NCT03713996). Retrospectively registered on 22 October 2018

This study investigated the association of combined arthritis and diabetes, diabetes only, and arthritis only compared with neither with gait speed in the general population. This cross-sectional study included data from the second wave of Midlife in the United States-2 (MIDUS 2) project 4: Biomarker Project, 2004–2009. The MIDUS 2 biomarker project included 1255 individuals aged between 34 and 84 years. Participants were categorized into four groups: combined arthritis and diabetes, diabetes only, arthritis only, or neither. The main outcome measure was gait speed measured by the 50-ft walk test. Covariates included age, gender, body mass index (BMI), depression symptoms, and number of chronic conditions/symptoms. A total of 1255 participants were included with mean age 54.52 ± 11.71, of those 713 (56.8%) participants were females. The results showed that combined arthritis and diabetes was significantly associated with a greater decline in gait speed (B = − 0.11, 95% confidence interval (CI) [− 0.17 to − 0.6], p

Background Forward and retro locomotion on a treadmill is a common tool for lower extremity rehabilitation in the clinical setting. The purpose of this study was to evaluate effect on anthropometrical body composition adaptations and aerobic performance during forward and retro locomotion training on a treadmill at 10-degree inclinations. Methods A convenience sample of 30 healthy male subjects with mean age of 20.93±2.54 years, participated in the study. Subjects were divided into 2 groups, Forward Locomotion Group (FLG) and Retro Locomotion Group (RLG) (n=15) and performed forward and retro locomotion training on a treadmill at 10-degree inclination respectively for duration of 6 weeks. Study outcomes such as aerobic performance and anthropometrical body composition were measured at pre and post intervention phases. Results Although both FLG and RLG training improved aerobic performance significantly. However, RLG reported a significant improvement as compared to FLG in the above parameters. Whereas, anthropometrical body composition changes are not found to be significant even after 6 weeks of intervention in both groups. Conclusion Both the forward and retro locomotion training improved aerobic performance but not the body composition variables, also retro locomotion training was more effective than forward locomotion in improving aerobic performance.

Background Some studies investigated the relationship between musculoskeletal conditions and chronic diseases. However, no study examined the association between social determinants and chronic diseases among people at high risk for knee osteoarthritis. Thus, the current study was aimed to address this gap. Methods A secondary data analysis was conducted on a total of 3280 men and women aged 45 to 79 who were recruited in the Osteoarthritis Initiative. Results Multivariable logistic regression analyses show that age ≥ 65 years was associated with 1.98, 1.96, and 1.46 times odds of the presence of diabetes, heart attack, and multi-morbidity, respectively than age ≤ 64 years. Men were associated with 1.39, 1.41, 1.76, and 2.24 times odds of the presence of arthritis, cancer, diabetes, and heart attack, respectively than women. African American/Asian/ non-Caucasian was associated with 2.71, 2.56, and 1.93 times odds of the presence of arthritis, diabetes, and heart attack, respectively than Caucasian. Primary school/less education was associated with twice or more times the odds of arthritis and chronic obstructive pulmonary disease (COPD) than ≥high school education. Unemployment was associated with 1.41-, 1.73-, 1.58-, and 1.70-time odds of the presence of arthritis, cancer, COPD, and heart attack, respectively, then employed. Unmarried/widowed/separated was associated with 1.41, 1.75, 2.77, 2.76, 1.86, and 3.34 times odds of the presence of arthritis, asthma, cancer, COPD, diabetes, and heart attack, respectively than married. Annual income Conclusions Social determinants are associated with the presence of chronic diseases. Some of the social determinants are modifiable or treatable. Thus, these findings can inform public health strategies in the United States.

The purpose of this study was to evaluate landing biomechanics in soccer players following ACLR during two landing tasks. Eighteen soccer players with an ACLR and 18 sex-matched healthy control soccer players participated in the study. Planned landing included jumping forward and landing on the force-plates, whereas unplanned landing included jumping forward to head a soccer ball and landing on the force-plates. A significant landing×group interaction was found only for knee flexion angles (p=0.002). Follow-up comparisons showed that the ACL group landed with greater knee flexion during planned landing compared with unplanned landing (p

There is increasing awareness of the high prevalence of insomnia symptoms in individuals with type 2 diabetes (T2D). Past studies have established the importance of measuring sleep parameters using measures of central tendency and variability. Additionally, subjective and objective methods involve different constructs due to the discrepancies between the two approaches. Therefore, this study is aimed at comparing the averages of sleep parameters in individuals with T2D with and without insomnia symptoms and comparing the variability of sleep parameters in these individuals. This study assessed the between-group differences in the averages and variability of sleep efficiency (SE) and total sleep time (TST) of 59 participants with T2D with and without insomnia symptoms. Actigraph measurements and sleep diaries were used to assess sleep parameter averages and variabilities calculated by the coefficient of variation across 7 nights. Mann–Whitney U tests were utilized to compare group differences in the outcomes. Validated instruments were used to assess the symptoms of depression, anxiety, and pain as covariates. Objective SE was found to be statistically lower on average (85.98±4.29) and highly variable (5.88±2.57) for patients with T2D and insomnia symptoms than in those with T2D only (90.23±6.44 and 3.82±2.05, respectively). The subjective average and variability of SE were also worse in patients with T2D and insomnia symptoms, with symptoms of depression, anxiety, and pain potentially playing a role in this difference. TST did not significantly differ between the groups on averages or in variability even after controlling for age and symptoms of depression, anxiety, and pain. Future studies are needed to investigate the underlying mechanisms of worse averages and variability of SE in individuals with T2D and insomnia symptoms. Additionally, prompting the associated risk factors of insomnia symptoms in individuals with T2D might be warranted.

Stroke is a leading cause of death and disability worldwide. However, our knowledge of the incidence of stroke for Saudi Arabian population is not known. Thus, we aimed to determine the pooled annual incidence of stroke in Saudi Arabia. We conducted a comprehensive literature search of PubMed, Web of Science, and SCOPUS, without language or publication year limits. Outcomes of interest were stroke incidence rate for both first and recurrent. A total of five studies met the inclusion criteria for this review. The pooled annual incidence of stroke in Saudi Arabia was 0.029% (95% CI: 0.015 to 0.047) equivalent of 29 strokes per 100,000 people annually (95% CI: 15 to 47). The findings indicate that there are 29 stroke cases for every 100,000 people annually for individuals residing Saudi Arabia. Our values were lower than those of other high-income countries. Establishing a nationwide stroke registry is warranted for monitoring and improving healthcare services provided to stroke survivors.

BackgroundOver recent decades, there has been a dramatic transformation in mechanization reaching all aspects of people's lives in Saudi Arabia. In the light of this, there was a significant change in physical behavior in the community. The aim of the current study was to investigate the national and regional distribution of physical activity practice among adults aged ≥15 y across Saudi Arabia.MethodsData from the Bulletin of Household Sports Practice National Survey were used to determine the physical activity practice distribution. A total of 26 000 families from 13 administrative regions across Saudi Arabia were surveyed.ResultsThe proportion of the total Saudi population who were practitioners of physical activity (i.e. ≥150 min per week) among Saudi adults aged ≥15 y was 17.40%, while the proportion of non-practitioners was 82.60%.ConclusionThis study found a low level of physical activity among Saudi adults who meet physical activity guidelines. These findings suggest that interventions and promotional programs should be developed to increase physical activity among the Saudi population.

Individuals with type 2 diabetes (T2DM) are advised to undertake diabetes self-care behavior (DSCB) in order to avoid complications of T2DM. However, comorbidities, such as insomnia symptoms which are commonly reported in people with T2DM, may limit the ability to engage in DSCB. Insomnia and the common sequelae accompanying insomnia such as pain, depression, and anxiety may negatively influence the performance of DSCB. Therefore, this study aimed to compare the DSCB of people with T2DM with and without insomnia symptoms. Sixty participants with T2DM were divided into two groups based on the presence of insomnia symptoms: T2DM-only group and T2DM+ insomnia group. Insomnia symptoms were identified using the Insomnia Severity Index (ISI). DSCB was assessed using the Diabetic Care Profile (DCP). A standardized composite score was established to account for all of the DCP domains. Chi-square and independent sample t tests were used to assess between-group differences in categorical and continuous variables, respectively. Stepwise linear regression analysis used the ISI score to predict standardized DCP composite score, while controlling for covariates. Significant between-group differences were found in age, symptoms of pain, depression, and anxiety. The total DCP composite score was significantly lower in the T2DM+ insomnia group compared to the T2DM-only group (− 0.30 ± 0.46 vs. 0.36 ± 0.48, respectively, p

Introduction: Rehabilitation approaches have been used for people with stroke to decrease spasticity and improve functions, but little is known about the effect of neuromuscular electrical stimulation (NMES) in this population. Therefore, the primary purpose of this study was to establish a protocol for a double-blinded randomized clinical trial to examine using NMES on plantarflexors spasticity, dorsiflexor muscle strength, physical functions, and self-reported health outcomes in people with chronic stroke in Saudi Arabia.Material and Methods: This randomized clinical trial with two arms and double-blinded registered in ClinicalTrials (NCT04673045) will enroll 44 participants with chronic stroke and randomized them into either the experimental group (EG), including electrical stimulation (ES) with conventional therapy or the control sham group (NMESsham) including placebo electrical stimulation with conventional therapy. The frequency will be set at 80 Hz for 30 min. The intervention will be three times a week for 4 weeks for both groups. Data collection for pre- and post-intervention outcomes will include measurements for the primary outcomes including paretic limb (plantarflexor spasticity, ankle range of motion, and dorsiflexor muscles strength), and gait speed using 10-m walk test (10-MWT). The secondary outcomes including mobility function using Timed Up and Go (TUG), walking endurance using 6 Minutes Walk Test (6-MWT), activity of daily living using the Arabic version of Barthel Index (BI), and self-reported health measures such as quality of life using the Medical Outcomes Survey (Short Form 36, SF-36), physical activity using Rapid Assessment of Physical Activity (RAPA), depression symptoms using Patient Health Questionnaire-9 (PHQ-9), fatigue level using Fatigue Severity Scale (FSS), and risk of fall using Fall Efficacy Scale International (FES-I). An independent t-test will be utilized to examine the effect of the intervention on the outcome measures.Results: The recruitment has started and is ongoing.Conclusions: Using 4 weeks of NMES will provide information about its effect in improving plantarflexor spasticity, dorsiflexor muscles strength, gait speed, mobility functions, and other self-reported health outcomes in people with chronic stroke when compared to NMESsham.

This study examined the feasibility and effect of sedentary behavior (SB) counseling on total sitting time (TST) and glycemic control in people with type 2 diabetes (T2D). Community-dwelling sedentary adults with T2D (n = 10; 8 women; age 65.6 ± 7.31) completed SB counseling (motivational interviewing-informed education about SB) aided by an activity monitor with a vibrotactile feature (activPAL3TM). The monitor was worn for 7 days, on weeks 1 and 13 (without the vibrotactile feature) and during weeks 5 and 9 (with the vibrotactile feature). Intervention feasibility was determined by study retention rates and activity monitor tolerability, and differences between pre- and post-intervention average daily TST. Paired t-test were performed. The effect size (ES) was calculated using Cohen d. All participants attended all study sessions with only 20% reporting moderate issues tolerating the activity monitor. TST time decreased from 11.8 hours ± 1.76 at baseline to 10.29 hours ± 1.84 at 3 months’ assessment ( P

Objective To examine the association between type 2 diabetes (T2D) and pain severity in people with localized osteoarthritis (OA) and to explore the association between glycemic control, measured by hemoglobin A1c (HbA1c) level, and pain severity in people with localized OA and T2D. Design Retrospective study. Setting A tertiary medical center. Subjects Data from 819 patients (mean age = 65.08±9.77 years, 54.3% women) were used. Methods Patients were grouped to localized OA only (N = 671) and localized OA+T2D (N = 148) based on diagnosis codes. An index date was set as the first diagnosis date of localized OA and linked to pain severity, measured by numeric rating scale from 0 to 10. HbA1c values were obtained for patients with T2D within six months of the index date. Multiple linear regression was used. Results After controlling for age, gender, body mass index (BMI); diagnoses of depression, hypertension, dyslipidemia; OA locations; and medication list (+/- 90 days of the index date), T2D was significantly associated with increased pain severity (B = 1.07, 95% confidence interval [CI] = 0.25 to 1.88, P = 0.014). For patients with T2D and localized OA with available data for HbA1c (N = 87), the results showed that an increased HbA1c value was significantly associated with higher pain severity (B = 0.36, 95% CI = 0.036 to 0.67, P = 0.029) after controlling for age, gender, BMI, medications, and OA locations. Conclusion T2D was associated with higher pain severity in people with localized OA, and poor glycemic control was associated with higher pain severity in people with localized OA+T2D. Clinicians should emphasize that better HbA1c control might help with pain management in people with T2D and OA.

Background Hand grip strength (HGS) is an important function of upper extremities for older adults. Several studies have shown the importance of measuring HGS in different settings. Current established normative values of HGS are applicable for Western countries. However, there is limited information of normative values of HGS after considering demographics in Saudi population. Therefore, this study aimed to establish normative values of HGS stratified by age and gender, and to determine the association of anthropometric measurements with the HGS in Saudi population. Methods A cross-sectional study included a total of 1048 participants (mean age 73 ± 5 years). Grip strength was calculated by the average peak force of three trials for the dominant hand using a dynamometer. Sociodemographic data on age, gender, marital status, educational levels were collected. Anthropometric measurements including height, body mass index, arm circumference, and upper arm length were obtained. The sample was categorized into three age groups: 65–69 years, 70–74 years, and 75–80 years. Linear regression analysis was used to assess the association between the sociodemographic and anthropometric data and HGS. Results The mean values of HGS (kg) for men for each age group were 36.9 ± 8.3 for the younger group, 35.7 ± 7.4 for the 70–74 years group and 30.5 ± 7.1 for the older group. The mean values of HGS for women for each group were 23.2 ± 4.7 for the younger group, 21.1 ± 4.6 for the 70–74 years group and 18.8 ± 4.9 for the older group. The HGS was negatively associated with the age for men (B = -.40, 95% confidence interval (CI) [−.52, −.29], p p = .02), but negatively associated in women (B = -.42, 95% CI [− 0.75, − 0.08], p = .01). Conclusion This study is the first that established normative values of HGS for older adults in Saudi Arabia. Future research may benefit from the current normative value of HGS in Saudi population for geriatric rehabilitation programs.

Type 2 diabetes mellitus (T2DM) has been associated with osteoarthritis (OA). T2DM may be associated with generalized OA (GOA ≥ 3 joints) rather than localized OA (LOA 3 joints). The purpose of this study was to examine the prevalence of T2DM in people with GOA compared with LOA and to investigate the association between demographic risk factors and chronic diseases (i.e., T2DM, hypertension, dyslipidemia, neuropathy, and body mass index (BMI)) with GOA compared with LOA.A retrospective review of data was performed, and patients with diagnostic codes for OA were selected. Identified codes included primary GOA, primary LOA, T2DM, hypertension, dyslipidemia, neuropathy, depression, anxiety, and sleep disorders. Information about BMI and medication list was obtained. Chi-square and logistic regression were performed to examine the prevalence and risk factors, respectively.Data from 3855 patients (mean age = 66.43 ± 11.02, 60.9% women) included patients with GOA (n = 1265) and LOA (n = 2590). The prevalence of T2DM was significantly greater among patients with GOA (25.8%) compared with those with LOA (12.0%); however, the GOA group were older. Based on age groups, T2DM was prevalent in 17.8% of GOA compared with 7.2% in LOA for younger adults (aged 45-64 years) and was prevalent in 28.8% of GOA compared with 15.7% in LOA for older adults (aged 65 years or older). The odds ratio of GOA increased in people with chronic diseases compared with those without including T2DM (odds ratio (OR) 1.37, 95% confidence interval (CI) 1.05-1.78, p = 0.02), hypertension (OR 1.99, CI 1.63-2.43, p 0.001), and dyslipidemia (OR 3.46, CI 2.86-4.19, p 0.001), adjusting for covariates.Higher prevalence of T2DM was found in people with GOA when compared with LOA across both age groups. T2DM, hypertension, and dyslipidemia were associated with GOA. Future research with longitudinal designs is needed to test the causality of this association.Key Points• The prevalence of type 2 diabetes in people with generalized osteoarthritis was almost double compared with localized osteoarthritis, although generalized osteoarthritis group were older.• Among people with osteoarthritis, the risk of generalized osteoarthritis is increased by 37% when people had type 2 diabetes, by 99% when people had hypertension, and by 246% when people had dyslipidemia.

Aim: The aim of this study was to conduct a systematic review and meta -analysisforstudiesthat have examined the prevalence and risk factors of falls in older adults living in the Gulf Cooper ation Council countries(GCC). Methods: A liter ature search was performed using PubMed, Web of Science, Physiotherapy Ev idence Database; and SCOPUS up to Octo ? ber 2018 to identify studies that have examined prevalence, risk fac ? tors, or consequences of fallsin older adultsliving in the GCC. Results: A total of 6 studies met the inclusion criteria. The pooled prevalence of falls among older adults residing in GCC countries was 46.9%. Falls among included studies were associated with older age, female gender, low ed ucational level, and number of medications. Conclusions: The study shows a high prevalence of fallsin older adults living in the GCC countries. The risk factorsin the currentstudy must be interpreted with caution, since some of the included studies did not report any risk factors. Due to the limited number of ev idence eval uating risk factors and consequences of fallsin the GCC countries pop ulation, a furtherlongitudinalresearch is needed.

Background We aimed to examine the effect of a high-intensity exercise bout on landing biomechanics in soccer players who underwent anterior cruciate ligament reconstruction (ACLR) and non-injured soccer players during a soccer-specific landing maneuver. Methods Eighteen soccer players who underwent ACLR and 18 normal soccer players were enrolled in this investigation (ACLR group; age, 26.11 ± 3.95 years; body mass index, 23.52 ± 2.69 kg/m2; surgery time, 5 ± 3.30 years: control group; age, 25.83 ± 3.51 years; body mass index, 24.09 ± 3.73 kg/m2, respectively). Participants were evaluated during the landing maneuver before and after carrying out the high-intensity exercise bout using the Wingate test. The intensity of the exercise was defined as a blood lactate accumulation of at least 4 mmol/L. The dependent variables included sagittal-plane kinematics and kinetics of the ankle, knee and hip joints, and electromyography activity of the gastrocnemius, hamstrings, quadriceps, and gluteus maximus. Results On 2 × 2 analysis of variance, none of the dependent variable showed significant exercise×group interactions. Regardless of group, significant main effects of exercise were found. Post-exercise landing was characterized by increased flexion of hip (p = 0.01), knee (p = 0.001), and ankle joints (p = 0.002); increased extension moments of hip (p = 0.009), knee (p = 0.012), and ankle joints (p = 0.003), as well as decreased quadriceps activity (p = 0.007). Conclusion At 1 year or more post-ACLR, the effect of the high-intensity exercise bout on landing biomechanics is not expected to differ from that experienced by healthy soccer players.

Background: This study examined the association between baseline gait speed with incident diabetes mellitus (DM) among people with or at elevated risk for knee OA. Materials and Methods: Participants from the Osteoarthritis Initiative, aged 45 to 79 years, where included. Participants with or at risk of knee OA from baseline to the 96-month visit were included. Participants with self-reported DM at baseline were excluded. DM incidence was followed over the 4-time points. Gait speed was measured at baseline using a 20-m walk test. Generalized estimating equations with logistic regression were utilized for analyses. Receiver operator characteristic curves and area under the curve were used to determine the cutoff score for baseline speed. Results: Of the 4313 participants included in the analyses (58.7% females), 301 participants had a cumulative incidence of DM of 7.0% during follow-up. Decreased gait speed was a significant predictor of incident DM (RR 0.44, p = 0.018). The threshold for baseline gait speed that predicted incident DM was 1.32 m/s with an area under the curve of 0.59 (p &lt, 0.001). Conclusions: Baseline gait speed could be an important screening tool for identifying people at risk of incident diabetes, and the determined cutoff value for gait speed should be examined in future research.

Background Prevalence of frailty has been previously established in different Western countries; however, the prevalence and the burden of in the aging populations of Saudi Arabia has not been examined. Therefore, the aim of this study was to examine the prevalence of frailty, and associated factors among Saudi older population. Methods The study included a total of 486 community-dwelling elderly adults aged 60 years and over living in the Riyadh area. This study took place from August 2019 to June 2020. The prevalence of frailty was determined using the Fried’s frailty phenotype. Association between sociodemographic features and clinical factors and frailty was estimated by Odds Ratio and confidence intervals (OR, IC 95%) using a multinomial logistic regression model. Results The overall prevalence of pre-frailty and frailty were 47.3 and 21.4%, respectively. The following factors were associated with being frail: age (OR: 6.92; 95%CI 3.11–15.41); living alone (OR: 2.50; 95%CI: 1.12–5.59); had more chronic conditions (OR: 1.96; 95%CI: 1.16–3.30); and cognitive impairment (OR: 7.07; 95%CI: 3.92–12.74). Conclusions The Compared with other populations, the prevalence of frailty and pre-frailty in the Riyadh region of Saudi Arabia was high. The implications of frailty in this population should be discussed in future study.

Background. Although several studies investigated the relationship between obesity, osteoarthritis, and pain, no study examined the association between obesity and multijoint pain in the lower limbs. The purpose of this study was to address this gap. Method. This cross-sectional study was performed in Riyadh, Saudi Arabia, between March and April 2019. In this study, a total of 4,661 adults aged 45–79 years with or at high risk for knee osteoarthritis were included from the Osteoarthritis Initiative. The persons who had an elevated risk of developing symptoms of knee osteoarthritis during the study were defined as high risk for knee osteoarthritis. According to the body mass index, participants were categorized into three groups: normal weight (n = 1,068), overweight (n = 1,832), and obese (n = 1,761). Logistic regression was used to examine the association between obesity and multisite pain. Results. The odds of multisite pain was associated significantly (p<0.001) by 1.36 times higher with obesity than normal weight, no, or sigle-site pain, even after adjusting for sociodemographic and health variables Conclusion. Obesity is associated with an increased likelihood of multisite pain in the lower limbs. The results enable clinicians to adopt better standards of practice for the prevention and screening of multisite pain in this community.

Introduction: The coexistence of Knee osteoarthritis (OA) and diabetes mellitus (DM) can be explained by shared risk factors such as age and obesity. Both conditions adversely affect gait speed, however, longitudinal studies investigating the relationship between gait speed and DM incidence in people with or at elevated risk for knee OA are lacking. Therefore, the aim was to investigate the association between baseline gait speed and risk of DM incidence among people with or at risk for knee OA. Methods: Participants from the osteoarthritis initiative, aged 45 to 79 years, who were at risk or had knee OA and followed up from baseline to 96-month visit were included. Self-reported diabetes was used over a 4-time points to identify DM incidence. Gait speed was measured at baseline using 20 meter walk test. Body mass index (BMI) was measured and included as a time-dependent covariate. Generalized estimating equations with logistic regression were utilized to examine the association between baseline gait speed and DM incidence. Results: Increased baseline gait speed was significantly associated with decreased odds of incident DM after adjustments for covariates (OR 0.52). The risk of DM incidence decreased 48% for each 0.1 m/s increase in gait speed at baseline for individuals with established or at risk of knee OA. Sensitivity analysis showed that the significant results were maintained with those at risk of OA (OR 0.45) but not in those with established knee OA. Conclusion: Increasing baseline gait speed in general was significantly associated with a lower risk of DM incidence over time. However, the association disappeared after adjustments for BMI in people with established knee OA, suggesting that the majority of this association might be explained by higher weight. Therefore, future research should examine closely the link between gait speed and well-defined DM risk using objective measures such as glucose level. Disclosure A.M. Alenazi: None. B. Alqahtani: None. M.M. Alshehri: None. A.D. Alanazi: None. K. Khunti: Advisory Panel; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Board Member; Self; AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. Consultant; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier. Speaker’s Bureau; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. V. Vennu: None. N.A. Segal: None. S.M. Bindawas: None.

Background Sleep disturbances showed negative impact on self-care and diabetes outcomes for people with type 2 diabetes. However, there is a need to understand to what extent insomnia symptoms impact daytime functioning in people with type 2 diabetes. This study compared common daytime functioning outcomes including fatigue, daytime sleepiness, and quality of life related to vitality and physical function in people with type 2 diabetes with and without insomnia symptoms. Methods This study was a cross-sectional comparison design which used validated instruments to assess common daytime functioning outcomes (i.e. fatigue severity scale, daytime sleepiness, and quality of life related to vitality and physical function domains) in 60 participants with type 2 diabetes with and without symptoms of insomnia. Insomnia Severity Index was used to stratify participants into an insomnia group and non-insomnia control group. Multivariate linear model and partial correlations tests were utilized to examine the relationships between outcomes in the two groups after controlling for age and depression symptoms. Results Levels of fatigue severity, and quality of life related vitality and physical function were worse in the insomnia group compared to non-insomnia group (P

Background Sleep apnea and diabetes mellitus (DM) negatively impact cardiovascular health. One important indicator of cardiovascular health is the Ankle-Brachial Index (ABI). Either low ABI or high ABI are signs of peripheral vascular impairment. Impaired vascular health and DM, together, might provoke sleep apnea; however, information regarding these relationships is limited. Therefore, this study aimed to investigate the association between ABI, DM status, and severity of obstructive sleep apnea in people of Hispanic/Latino descent who are diverse in culture, environmental exposures, nativity, socioeconomic status, and disease burden. Methods A cross sectional analysis from a multi-center epidemiologic study, Hispanic Community Health Study/Study of Latinos, was utilized and included 3779 participants (mean age 55.32 ± 7.67, females 57.9%). The sample was divided into 4 groups based on the American Diabetes Association diagnostic guidelines (no DM or DM), and the ABI status (normal and abnormal). Multiple linear regression analysis was used to determine the association of the four groups and other independent variables with severity of sleep apnea measured by apnea-hypopnea index. Kruskal-Wallis H test was used for comparisons between groups for the apnea-hypopnea index. The significant level was set at 0.01. Results There were significant differences between groups in the mean of apnea-hypopnea index (P P = 0.001) after controlling for age, sex, BMI, income, education, alcohol use, cigarette use, hypertension or related medication, stroke and statin use. Conclusion These findings suggest that people with DM and abnormal ABI were more likely to have high apnea-hypopnea index compared to the other groups. We observed gradual increasing in the severity of sleep apnea from low abnormality groups to high abnormality groups for Hispanic/Latino. Further work should elucidate the association of DM, abnormal ABI and sleep apnea with longer term outcomes, and replicate this work in different populations.

Limited research has examined the association between diabetes mellitus (DM) and knee pain in people with osteoarthritis (OA). Therefore, this study aimed at examining the association between DM and knee pain severity, and to explore the association between DM and knee pain distribution (unilateral or bilateral versus no pain) in subjects with knee OA. This is a cross-sectional analysis of the baseline visit of individuals who were enrolled in the Osteoarthritis Initiative. Data of participants with knee OA were used for this analysis (n = 1319), and grouped into subjects with both knee OA and DM (n = 148) or knee OA only without DM (n = 1171). Pain severity was measured using a numeric rating scale from 0 to 10 over the past 7 and 30 days for each knee, and the more symptomatic knee with higher pain severity was chosen for analysis. DM was significantly associated with increased knee pain severity over 7 days (B 0.68; 95% CI 0.25–1.11) and over 30 days (B 0.59; 95% CI 0.17–1.01) after adjustments for all covariates, including age, gender, BMI, race, depression symptoms, composite OA score, use of pain medications, and knee injections. Multinomial regression showed that participants with knee OA and DM had 2.45 (95% CI 1.07–5.61) to 2.55 (95% CI 1.12–5.79) times higher likelihood of having unilateral and bilateral knee pain than those without DM and without knee pain. This study found that DM was associated with higher pain severity and unilateral and bilateral knee pain distribution.

Background Frailty is a common geriatric syndrome that can be screened using validated questionnaires. A commonly used assessment is the Tilburg Frailty Indicator (TFI), containing fifteen self-reported questions about components of frailty, with scores ranging from zero to fifteen (higher scores representing increased frailty and a cutoff score of greater than five used to diagnose frailty). Despite its widespread use, the TFI is not commonly used in Arabic-speaking countries, and there is an overall lack of Arabic-translated questionnaires to adequately detect and measure frailty for older adults in Saudi Arabia. Objectives To translate and cross-culturally adapt the Tilburg Frailty Indicator (TFI) specifically for use with the Saudi population, and to examine reliability and construct validity among adults in senior-living facilities in Saudi Arabia. Methods A total of 84 community-dwelling older adults were enrolled (mean age = 72 ± 4.7 years). The translation and cross-cultural adaptation of the TFI from English to Arabic was performed using standardized guidelines. Test–retest reliability and internal consistency were examined in two visits, spaced one-week apart. Construct validity of the TFI against other measurements related to frailty was examined. The physical domain for TFI was validated against the Short Physical Performance Battery (SPPB), the timed Up and Go Test (TUG), and gait speed (as part of the SPPB). The psychological domains were validated against the Patient Health Questionnaire, and the social domains were validated against the social domain scores from the WHOQOL-BREF. Results The internal consistency of the TFI with the overall KR-20 was 0.70. For the domain scores KR-20 was 0.68 for the physical, 0.57 for the psychological, and 0.42 for the social. The KR-20 after deletion of each item correlations ranged from 0.66 to 0.72. For the test-retest reliability with one-week interval, the ICC was 0.86 (95 % CI = 0.67–0.94). The Arabic TFI showed statistically significant association with other measurements related to frailty. Conclusion This study found that the translated Arabic (Saudi) TFI is a valid and reliable instrument in assessing the frailty among Saudi community-dwelling older adults. Our results suggest that the use of this Arabic-translated TFI for clinical screening of frailty in any primary health setting may aid continued understanding for the validity of this instrument and help provide a quantitative diagnostic tool for the prevention and treatment of frailty.

Cardiovascular disease is a common health problem resulting from many factors, including dyslipidemia. T'ai chi is one of the interventions assigned to improve lipid profiles and other physical outcomes. However, conflicting results might be attributed to different study designs and interventional approaches. A systematic review and meta-analysis are needed to evaluate existing evidence.The aim of this systematic review and meta-analysis is to evaluate existing randomized clinical trials (RCTs) regarding the overall effect of t'ai chi exercise on lipid profiles.Electronic databases (MEDLINE and Cumulative Index to Nursing and Allied Health Literature) were searched. The authors included only English peer reviewed published RCTs that used a t'ai chi intervention and high-density lipoprotein cholesterol (HDL-C) as the primary outcome along with low-density lipoprotein cholesterol (LDL-C) and/or total cholesterol (TC) as secondary outcomes.The authors identified 37 potentially eligible studies. Only eight RCTs were eligible for their qualitative review, and seven studies were eligible for meta-analysis. The included studies were rated as having a low risk of bias. Despite the overall low risk of bias, all studies failed to blind participants to group assignment and were generally unclear about whether they were selectively reporting data. A fixed effect model (IT'ai chi may potentially be beneficial on lipid profiles across different age groups and populations. Although there were conflicting results regarding the effect of t'ai chi on lipid profiles, the majority of studies had at least a small positive effect indicating a potential positive effect of t'ai chi on HDL-C, LDL-C, and/or TC. Therefore, further research is needed to confirm the small positive effect of t'ai chi on lipid profiles found in this review.

Introduction There is an increasing awareness of the high prevalence of insomnia symptoms in people with type 2 diabetes (T2D). Past studies have demonstrated the importance of measuring sleep parameters in both averages and variabilities using subjective and objective methods. Thus, we aimed to compare the averages and variability of sleep parameters in people with T2D with and without insomnia symptoms. Methods Actigraph measurements and sleep diaries were used in 59 participants to assess sleep parameters, including sleep efficiency (SE), sleep latency, total sleep time, and wake after sleep onset over seven nights. Validated instruments were used to assess the symptoms of depression, anxiety, and pain. Circular data were used to describe the distribution of bed distribution with SE as a magnitude for both groups. Mann Whitney U test was utilized to compare averages and variability of sleep parameters between the two groups. Multivariable general linear model to control for demographic and clinical variables. For the secondary aim, multiple linear regression tests were utilized to assess the association between averages and variability values for both groups. Results SE was found to be lower in average and higher in variability for participants with T2D and insomnia symptoms, than those with T2D only subjectively and objectively. SE variability was also the only sleep parameter higher in people with T2D and insomnia symptoms, with psychological symptoms potentially playing a role in this difference. We observed that people in T2D+Insomnia tend to go to bed earlier compared to the T2D only group based on objective measures, but no difference was observed between groups in subjective measures. The only significant relationship in both objective and subjective measures was between the averages and variability of SE. Conclusion Our findings suggest a discrepancy between subjective and objective measures in only average of total sleep time, as well as agreement in measures of variability in sleep parameters. Also, the relationship between averages and variabilities suggested the importance of improving SE to minimize its variability. Further research is warranted to investigate the complex relationship between sleep parameters and psychological factors in people with T2D and insomnia symptoms. Support None

Background Lateral epicondylitis (i.e., tennis elbow) is a condition caused by overuse of the arm, which can result in elbow pain. Recent evidence has shown wrist joint splinting as an effective intervention for people with lateral epicondylitis. Aim The purpose of this study was to compare the effect of a 3 week wrist joint splinting and physical therapy intervention versus a standard physical therapy intervention on pain, wrist range of motion (ROM), and grip strength in people with lateral epicondylitis. Design Randomized clinical trial. Setting University hospital outpatient clinics. Population Forty participants diagnosed with lateral epicondylitis. Methods The participants were randomized into 2 groups. The standard care group followed a treatment program consisting of stretching exercises for the wrist extensors, ultrasonic therapy, and deep friction massage on the proximal attachment of the wrist extensor muscles. The intervention group followed a standard wrist joint splinting program in addition to the physical therapy program that the standard care group received. Participants in both groups received treatment 3 times per week for 3 weeks. The outcome measures were pain intensity, wrist extension ROM, wrist flexion ROM, and grip strength. Each outcome measure was assessed at baseline and after completion of the intervention. Results There were no significant between-group differences at baseline. After the treatment period, the intervention group showed statistically significant improvement in pain intensity. Other outcomes also improved including wrist flexion ROM, wrist extension ROM, and grip strength in comparison to the standard care group. Conclusions Using wrist joint splinting in addition to physical therapy for a short duration is effective for improving pain intensity. The evidence from this study indicates that wrist joint splinting and physical therapy may also be effective for improving wrist ROM and grip strength in the treatment of patients with lateral epicondylitis, although more research is need in this area. Clinical rehabilitation impact Wrist joint splinting is an effective intervention that can be applied in clinical rehabilitation practices for people with lateral epicondylitis.

Objective: Type 2 diabetes (T2D) has been associated with osteoarthritis (OA). However, research related to the impact of T2D on pain severity is limited. The purpose of this study was to examine the association between T2D and pain severity in people with localized OA (LOA) (e.g., OA restricted to only one or two joints), and to explore the association between glycosylated hemoglobin (A1c) level and pain severity in people with LOA and T2D. Methods: A retrospective review of data from a tertiary medical center was performed. Records were selected based on diagnoses codes for LOA using international classification of disease 9th and 10threvisions. Index date was set as the first diagnosis date. Pain severity, measured by a 0 to 10 numeric rating scale, was obtained and linked to the index date. T2D was defined as having two diagnostic codes for T2D or using insulin. A1c was obtained for patients with T2D within six months of the index date. Covariates of age, sex, depression, hypertension, dyslipidemia, and medications (+/- 90 days of the index date) were included in linear regression analysis. Alpha level was 0.05. Results: Data from 819 patients (mean age = 65.08±9.77, 54.3% women) included 671 patients with LOA only (n=671) and 148 patients with LOA+T2D. T2D was significantly associated with increased pain severity (B=1.08, 95% CI 0.23 -1.93, p=0.013) after controlling for covariates. For patients with LOA+T2D with data for A1C (n=87), higher A1c was significantly associated with increased pain severity (B=0.33, 95% CI 0.01 -0.64, p=0.045) after controlling for medications. Conclusion: This study found that T2D was associated with higher pain severity in people with LOA, and that poorer glycemic control was associated with higher pain severity in people with LOA+T2D. Only T2D was associated with pain that exceeded the clinically meaningful difference (>1 score). Clinicians should consider T2D as a factor in the management of pain in people with LOA. Disclosure A.M. Alenazi: None. S.M. Obaidat: None. M. Alshehri: None. C.M. Gray: None. S. Alothman: None. J.L. Rucker: None. L.R. Waitman: None. P. Kluding: None.

Introduction: Sudomotor impairment (SI) is common in people with diabetic peripheral neuropathy (DPN) and could potentially influence the effects of exercise. Exercise is known to improve outcomes such as physical fatigue (PF); however, the impact of SI on PF is not clear. Thus, our objective was to examine the impact of sudomotor function on PF change after 16-weeks of moderate intensity aerobic exercise (AEx). Methods: People with DPN (n=17) who participated in 16-weeks of AEx were included in this secondary analysis. Sudomotor function was evaluated at baseline via a quantitative sudomotor axon reflex test and classified as normal (n=6), mild (n=6), moderate (n=3), or severe (n=2). Self-reported PF was assessed at baseline and post-intervention via a fatigue questionnaire. A Kruskal-Wallis test evaluated the impact of baseline sudomotor function on change in PF after exercise. Dunn’s tests were used to evaluate multiple comparisons. Association between sudomotor function and PF change was evaluated via a Spearman’s correlation. Alpha was set at 0.05. Results: Changes in PF are reported as negative (↓in PF) and positive (↑in PF) values. Median PF changes of -29%, -30%, 0%, and 14% were observed for normal, mild, moderate, and severe groups, respectively with a significant between-group difference (p=0.039). Pairwise comparisons revealed significant differences between normal and moderate (p=0.025), normal and severe (p=0.047), and mild and moderate (p=0.04) groups. A moderate correlation between SI and PF change (r=0.630, p=0.007) was observed. Conclusions: Our results indicate that change in PF following 16-weeks of AEx may be influenced by SI. SI can limit the body’s ability to dissipate heat during exercise, potentially exacerbating PF through disruptions in the thermoregulatory negative feedback loop. This could influence response to exercise, and future research should examine the effects of underlying mechanisms of SI on PF in this population. Disclosure C.M. Gray: None. A. Yahya: None. A.M. Alenazi: None. M. Alshehri: None. J.L. Rucker: None. M. Pasnoor: Advisory Panel; Self; Alexion Pharmaceuticals, Inc., Terumo BCT. Consultant; Self; Momenta Pharmaceuticals. P. Kluding: None. Funding National Center for Advancing Translation Sciences (UL1TR000001); Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32HD057850)

Introduction: Sleep apnea and diabetes mellitus (DM) negatively impact cardiovascular health. One important indicator of cardiovascular health is the Ankle-Brachial Index (ABI). Either low (LABI) or high (HABI) are signs of peripheral vascular impairment. Impaired vascular health and DM, together, might provoke sleep apnea; however, information regarding these relationships is limited. Therefore, this study aimed to investigate the association between ABI, DM status, and severity of sleep apnea in people of Hispanic/Latino descent. Methods: A cross sectional analysis from a multi-center epidemiologic study, HCHS/SOL‎, was utilized, including 8,378 participants (mean age 45.92?±?13.96, female = 49%, mean BMI=30.06?±?5.55). The sample was divided into 6 groups based on ADA guidelines (no-DM or DM) and ABI categories (LABI, normal ABI, or HABI). A linear regression was used to determine the strength of association between groups to predict the severity of sleep apnea, measured by the Apnea-Hypopnea Index (AHI). A Kruskal-Wallis H test was used for AHI comparisons between groups. Significance level was set at 0.01. Results: There were significant differences between groups for mean AHI (P Conclusion: ?These data suggest that ?people with DM and HABI were more likely to have severe apnea compared to the other groups. People with DM, HABI, and severe sleep apnea might be at higher risk of cardiovascular complications. Thus, further research is required to elucidate the appropriate intervention to combat the high level of Peripheral artery disease. Disclosure M.M. Alshehri: None. A.S. Alqahtani: None. A.M. Alenazi: None. S. Alothman: None. M. Aldhahi: None. C.M. Gray: None. B. Alqahtani: None. P. Kluding: None.

Background: Shoulder impingement syndrome (SIS) is the second most common musculoskeletal condition that causes shoulder pain in the general population. Shoulder girdle muscle imbalance and...

Hintergrund: Knochelverstauchungen fuhren oft zur Instabilitat des Sprunggelenks, welche hochstwahrscheinlich durch Schaden an passiven Strukturen und durch neuromuskulare Funktionsstorungen verursacht werden. Die meisten Verstauchungen werden nicht-operativ, sondern mit einem Rehabilitationsprogramm behandelt. Methoden: Eine Studiengruppe von 40 Patienten mit einer subakuten lateralen Knochelverstauchung (Grad II) mit einem mittleren Alter von 21,8±2,9 Jahre nahm an dieser Studie teil. Diese 40 Patienten wurden in 2 Gruppen eingeteilt. Die erste Gruppe (n=20) fuhrte Kraftigungsubungen in offener kinematische Kette (OKC) durch, wahrend die zweite Gruppe (n=20) mit geschlossener kinematischer Ketten (CKC) an den Muskelgruppen der Dorsalflexoren, Plantarflexoren, Evertoren und Invertoren beubte. Beide Studiengruppen fuhrten ein Trainingsprogramm bestehend aus 3 Sitzungen pro Woche fur insgesamt 6 Wochen durch. Das Studienergebnis wurde durch eine rein funktionelle Bewertung (ADLs), ein Punkte-System des Japanischen Verbandes der Orthopaden, durch das Messen des Bewegungsumfangs (ROM) der Dorsalflexion und der Plantarflexion mit Hilfe eines universellen Goniometers und durch eine visuelle Analogskala (VAS), die verwendet wird um die Schmerzstarke zu messen, ermittelt. Ergebnisse: Es gab signifikante Unterschiede in den Ergebnissen von VAS, ROM und ADLs in der OKC- bzw. der CKC-Gruppe (p>0,05). Insbesondere gab es einen deutlichen Unterschied bei ADLs zwischen der CKC-Gruppe und der OKC-Gruppe (p>0,05). Fazit: Im Rahmen dieser Studie konnte beobachtet werden, dass die Behandlung von Knochelverstauchungen mit Hilfe von OKC- und CKC-Ubungen wirksam ist. Trotzdem ist festzustellen, dass CKC-Ubungen moglicherweise OKC-Ubungen vorzuziehen sind, wenn wir funktionelle Aktivitaten, vor allem ADLs, betrachten.

Objectives: The purpose of the study was to cross-culturally adapt the Rapid Assessment of Physical Activity (RAPA) for Arabic speaking people and examine the test-retest reliability and the construct validity in Saudi older adults. Methods: Test-retest reliability was assessed over two testing visits occurring one week apart. The construct validity was examined between RAPA and Short Physical Performance Battery (SPPB) and Timed Up and Go (TUG) tests. Results: The original RAPA was translated into Arabic following standardized guidelines. For the test-retest reliability, the weighted kappa was 0.87 (95% confidence interval: 0.76–0.98), which indicates good reliability. There was a significant correlation between the Arabic version of RAPA and the SPPB (Spearman’s correlation coefficients (r) = 0.536, p < 0.001), and the TUG test (r = -0.435, p < 0.010). Conclusions: The Arabic version of the RAPA questionnaire adapted for Saudi older adults provides an easy, valid, and reliable way to measure physical activity.

Background Exercise-related or lower-limb overuse injury characterized by pain located between the knee and the ankle that occurs during activity is commonly referred to as shin splint. Hyperpronation is considered the ultimate culprit in the development of overuse injuries such as shin splint. This study endeavors to compare the functional outcomes of the most commonly used anti-pronation techniques, kinesio taping and standard orthotics. Methods A total of 40 subjects (mean age, 24.16±2.6 years) with symptoms of shin splint participated in the current study. These subjects were randomly allocated to two groups (N.=20) and underwent anti-pronation kinesio taping and standard orthotics, respectively. The functional outcomes were assessed using the navicular drop test, visual analog scale, and hop distance. Results The kinesio taping intervention group showed significant improvements in pain and hop distance compared to the standard orthotics intervention group, whereas an insignificant intergroup difference was observed for the navicular drop test. Patients in both groups benefited, but the response to kinesio taping was better than that to orthotics. Conclusions Kinesio taping played a vital role in improving functional outcomes compared to orthotics by reducing pain and improving functional activity in patients with shin splint; however, navicular drop correction did not occur using either intervention.

Background Insomnia symptoms are a common form of sleep difficulty among people with type 2 diabetes (T2D) affecting sleep quality and health outcomes. Several interventional approaches have been used to improve sleep outcomes in people with T2D. Nonpharmacological approaches, such as cognitive behavioral therapy for insomnia (CBT-I), show promising results regarding safety and sustainability of improvements, although CBT-I has not been examined in people with T2D. Promoting sleep for people with insomnia and T2D could improve insomnia severity and diabetes outcomes. Objective The objective of this study is to establish a protocol for a pilot randomized controlled trial (RCT) to examine the effect of 6 sessions of CBT-I on insomnia severity (primary outcome), sleep variability, and other health-related outcomes in individuals with T2D and insomnia symptoms. Methods This RCT will use random mixed block size randomization with stratification to assign 28 participants with T2D and insomnia symptoms to either a CBT-I group or a health education group. Outcomes including insomnia severity; sleep variability; diabetes self-care behavior (DSCB); glycemic control (A1c); glucose level; sleep quality; daytime sleepiness; and symptoms of depression, anxiety, and pain will be gathered before and after the 6-week intervention. Chi-square and independent t tests will be used to test for between-group differences at baseline. Independent t tests will be used to examine the effect of the CBT-I intervention on change score means for insomnia severity, sleep variability, DSCB, A1c, fatigue, sleep quality, daytime sleepiness, and severity of depression, anxiety, and pain. For all analyses, alpha level will be set at .05. Results This study recruitment began in February 2019 and was completed in September 2019. Conclusions The intervention, including 6 sessions of CBT-I, will provide insight about its effect in improving insomnia symptoms, sleep variability, fatigue, and diabetes-related health outcomes in people with T2D and those with insomnia symptoms when compared with control. Trial Registration ClinicalTrials.gov NCT03713996; https://clinicaltrials.gov/ct2/show/NCT03713996 International Registered Report Identifier (IRRID) DERR1-10.2196/14647

Objective: Sedentary behavior (SB) has been shown to have an acute negative effect on glucose and insulin metabolism in people who are healthy and those with diabetes. It is unknown whether habitual SB will negatively affect long-term glycemic control as measured by HbA1c. Therefore, the purpose of this study is to examine the relationship between habitual SB and HbA1c in people with type 2 diabetes (T2D). Methods: Objective assessment of SB and overall daily physical activity was collected in people with T2D in this cross-sectional analysis by asking the participants to wear an activity monitor with accelerometer and inclinometer measures (ActivPAL) for 7 days. The following variables average were included to examine the relationship with HbA1c (measured via disposable blood finger stick test using (A1cNow+) kit): total sitting time (TST), standing time (ST), walking time (WT). Results: Total of 31 participants (65 ± 7.64 years, 10 males) were included in the analysis. The main outcomes averages were as follow: HbA1c 7.33 ± 1.41, TST 11.43 hr. ± 2.21, ST 3.86 hr. ± 1.65, WT 1.49 hr. ± 0.7. Person correlation coefficients test showed that HbA1c was positively correlated with TST (r= 0.365, p Conclusion: The results of this study indicates that SB level is an important modifiable factor in glycemic control in people with T2D. This effect appears to be independent of daily physical activity level. Future studies should focus on establishing causality between SB and long-term glycemic control. As many people with T2D struggle to meet recommended physical activity levels, targeting SB may be an important step in the process of reaching a healthy lifestyle. Disclosure S. Alothman: None. M. Alshehri: None. A.M. Alenazi: None. P. Kluding: None.

A back pain lasting more than 12 weeks has been defined as a chronic low back pain (LBP) [1]. More than half of people suffer from LBP [1]. The purpose of this study was to examine the effect of gastrocnemius muscle stretching in the treatment of chronic low back pain. Methods: Forty patients with chronic low back pain, ages ranging from 25 to 40 years, were recruited and divided randomly into two groups. The control group followed a physical therapy program that included stretching exercises for back, hamstring and iliopsoas muscles. Strengthening exercises for abdominal muscle and postural instructions for activities of daily living were also performed. The experimental group followed the same control-group exercises with the addition of stretching exercises for gastrocnemius muscles. The interventions for both groups consisted of three sessions per week for six weeks, each session lasting for an hour. The outcome measures were visual analog scale (VAS) for pain severity, modified fingertip to floor (FTF) for range of motion (ROM) of trunk flexion, Oswestry Disability Index (ODI), and loading X-ray to detect lumbosacral angle. Results: There was no significant difference between groups at baseline characteristics. At final follow up, the two groups were significantly different in all outcome measures in terms of pain (p < 0.01), modified FTF (p < 0.01), disability questionnaire (p < 0.01), and lumbosacral angle (p < 0.01). Conclusion: Gastrocnemius manual stretching exercise is more beneficial in reducing pain and improving functions for patients with chronic low back pain when adding to stretching exercises for hamstring, iliopsoas, and back muscles, and strengthening exercise for abdominal muscles.

[Purpose] Forward walking (FW) and backward walking (BW) on a treadmill is a common tool for lower extremity rehabilitation in the clinical setting. The purpose of this study was to evaluate the effects on anaerobic performance and anthropometrical adaptations during FW and BW on a treadmill. [Subjects and Methods] A convenience sample of thirty healthy male subjects with a mean age of 20.93 ± 2.54 years participated in this study. Subjects were divided into 2 groups, a Forward Walking Group (FWG) (n=15) and a Backward Walking Group (BWG) (n=15), which performed FW and BW on a treadmill at 10° inclination, respectively. The training consisted of three sessions per week for 6 weeks. Study outcomes such as anaerobic performance and anthropometrical body composition were measured at pre- and post-intervention. [Results] Both FW and BW improved anaerobic performance significantly, and the BW group showed better performance than FW. However, changes in anthropometrical body composition were found to be not significant after six weeks of intervention in both the FW and BW groups. [Conclusions] BW training in rehabilitation can be considered more effective than FW at improving anaerobic performance. We also conclude that six weeks of FW and BW training is insufficient for eliciting changes in the body composition.

Background Falls are a common adverse event among people with stroke. Previous studies investigating risk of falls after stroke have relied primarily on retrospective fall history ranging from 6-12 months recall, with inconsistent findings. Objectives To identify factors and balance assessment tools that are associated with number of falls in individuals with chronic stroke. Design Secondary analysis of a randomized clinical trial. Setting Multisite academic and clinical institutions. Participants Data from 181 participants with stroke (age 60.67 ± 11.77 years, post stroke 4.51 ± 4.78 years) were included. Methods Study participants completed baseline testing and were prospectively asked about falls. A multivariate negative binomial regression was used to identify baseline predictive factors predicting falls: age, endurance (6 minute walk test), number of medications, motor control (Fugl-Meyer lower extremity score), depression (Patient Health Questionnaire-9), physical activity (number of steps per week), and cognition (Mini Mental Status Exam score). A second negative binomial regression analysis was used to identify baseline balance assessment scores predicting falls: gait velocity (comfortable 10 Meter Walk), Berg Balance Scale (BBS), Timed Up and Go (TUG), and Functional Reach Test (FRT). Receiver operating characteristic (ROC) and area under the curve (AUC) were used to determine the cutoff scores for significant predictors of recurrent falls. Main Outcome Measurement The number of falls during the 42-week follow-up period. Results Baseline measures that significantly predicted the number of falls included increased number of medications, higher depression scores, and decreased FRT. Cutoff scores for the number of medications were 8.5 with an AUC of 0.68. Depression scores differentiated recurrent fallers at a threshold of 2.5 scores with an AUC of 0.62. FRT differentiated recurrent fallers at a threshold of 18.15 cm with an AUC of 0.66. Conclusions Number of medications, depression scores, and decreased FRT distance at baseline were associated with increased number of falls. Increased medications might indicate multiple comorbidities or polypharmacy effect; increased depression scores may indicate psychological status; and decreased functional reach distance could indicate dynamic balance impairments. Level of Evidence II

[Purpose] Nonspecific low back pain (NSLBP) is a very common but largely self-limiting condition. Several types of tape and their associated application methods are available for different conditions. The aim of the present study was to observe the effect of Kinesio taping (KT) compared with traditional management of NSLBP. [Subjects and Methods] Forty male and female patients with a mean age of 34.8±7.54 years were randomly divided into two groups; group 1 (n=20) which underwent conventional physical therapy with KT, and group 2 (n=20), which underwent only conventional physical therapy. The intervention sessions for both groups were three times per week for four weeks. Outcomes were assessed for activities of daily living (ADL) using the Roland-Morris Disability Questionnaire, pain severity using a visual analogue scale, and ranges of motion (ROMs) of trunk flexion and extension using the modified Schober’s test. [Results] Significant differences in measures of pain, ADL, and trunk flexion and extension ROMs were observed post intervention within each group. In comparison, there were no significant differences in measures of pain, ADL, and trunk flexion and extension ROMs post intervention between groups. [Conclusion] A physical therapy program involving strengthening exercises for abdominal muscles and stretching exercises for back, hamstring, and iliopsoas muscles with or without Kinesio taping was beneficial in the treatment of chronic low back pain.

[Purpose] Osteoarthritis (OA) of the knee is the most common form of joint disease. It is one of the major causes of impaired function that reduces quality of life (QOL) worldwide. The purpose of this study was to compare exercise treatments for hamstring and quadriceps strength in the management of knee osteoarthritis. [Subjects and Methods] Forty patients with OA knee, aged 50–65 years were divided into 2 groups. The first group (57.65±4.78 years) received hot packs and performed strengthening exercises for the quadriceps and hamstring, and stretching exercises for the hamstring. The second group (58.15±5.11 years) received hot packs and performed strengthening exercises for only the quadriceps, and stretching exercise for the hamstring. Outcome measures were the WOMAC (Western Ontario and McMaster Universities OA index questionnaire), Visual Analogue Scale (VAS) assessment of pain, the Fifty-Foot Walk Test (FWS), and Handheld dynamometry. [Results] There was a significant difference between the groups. The first group showed a more significant result than the second group. [Conclusion] Strengthening of the hamstrings in addition to strengthening of the quadriceps was shown to be beneficial for improving subjective knee pain, range of motion and decreasing the limitation of functional performance of patients with knee osteoarthritis.

Background and Purpose: Carpal tunnel syndrome (CTS) is a common source of hand numbness and pain. The goal of this study was to compare longitudinal stretching of muscles and nerve to deep transverse friction massage for decreasing pain and improving hand function in patients with chronic CTS. Subjects and Methods: Thirty patients, 25 to 40 years old, were included in this study and randomized into two groups: the first group (36.8 ± 0.262) followed a physical therapy program group receiving stretching of wrist and hand flexors in combination with ultrasound, strengthening exercises of wrist and hand flexors, and wrist splint, three sessions per week for 12 weeks; and the second group (35.9 ± 0.225) followed the physical therapy program of deep transverse friction massage on the carpal tunnel site at the wrist joint, with using ultrasonic therapy, strengthening exercises of wrist and hand flexors and wrist splint, three sessions per week for 12 weeks. Outcome measures were range of motion (ROM), pain using visual analog scale (VAS), and hand grip strength measured with a sphygmomanometer. Results: There was a significant difference in both groups in all outcome measures compared to baseline. Over stretching group showed significant difference at the end of study in terms of range of motion of wrist flexion, extension and strength of handgrip when compared to deep friction massage group P < 0.05. However, there is no significant difference between groups in pain. Discussion and Conclusion: This study showed that the effect of stretching exercises is more beneficial than deep transverse friction massage in the treatment of patients with CTS in decreasing the compression of the median nerve in the tunnel.