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Introduction: The limited access to pulmonary rehabilitation (PR) in Australia has resulted in renewed interest in alternative models of care in COPD such as the Stanford Chronic Disease Self-Management (CDSM). This programme aims to improve self-efficacy, which may be advantageous given the high prevalence of anxiety and depression in COPD. The effects of anxiety and depression on CDSM are largely unknown, as are the effects of CDSM on healthcare utilization. Aim(s): To investigate the impact of anxiety and depression on hospital admissions in participants undergoing CDSM. Method(s): Retrospective, exploratory analysis of a multicentre randomized controlled trial of PR vs CDSM (PRSM). 169 participants (mean age 68 years, mean FEV1 52% pred, 73 female) attended PR (8 weeks, 16 sessions; n = 85) or CDSM (6 weeks, 6 sessions; n = 84). Hospital anxiety and depression scale (HADS) scores and self-reported hospital admissions were recorded after 3, 6 and 9 months. Data were analysed via generalized estimating equations (GEE). Result(s): Across both groups, participants with high anxiety scores (>=10) had a tendency towards more hospital days than others (p = 0.082), whilst anxiety 'responders' (reduction >=1.5 points) had more frequent hospitalizations (beta = 0.09, SE 0.05; p = 0.043). Within the CDSM group, high anxiety was associated with more hospital days (beta = 2.77, SE = 1.01; p = 0.006) but not a significantly greater need for hospitalization (p = 0.056) or more frequent hospitalizations (p = 0.197). High levels of depression did not affect any outcomes relating to hospital admissions. The effect of CDSM on hospitalizations did not differ between anxiety or depression 'responders' and 'non-responders'. Conclusion(s): The effectiveness of the Stanford CDSM programme on hospital admissions in people with COPD appears to be influenced by high levels of anxiety but not depression.

OBJECTIVE: Patellofemoral (PF) osteoarthritis (OA) is prevalent following anterior cruciate ligament reconstruction (ACLR). This study aimed to investigate differences in transverse plane rotation between knees with varus and valgus alignment during gait in people with and without PFOA after ACLR. METHODS: Thirty-six individuals who were mean ± SD 9 ± 2 years post-ACLR (18 radiographic PFOA and 18 no knee OA) participated in this cross-sectional study. Knee internal-external rotation angles were measured using a 3-dimensional motion analysis system during walking and running. Weight-bearing frontal plane knee alignment, measured with an inclinometer, was used to classify participants as having varus or valgus alignment. Two-way analysis of covariance was used to assess the effect of both PFOA and frontal plane knee alignment on dynamic knee internal-external rotation. RESULTS: Significant interactions were found between PFOA status and frontal plane alignment on knee internal-external rotation angles during walking (P = 0.019) and running (P = 0.002). Tests of simple effects revealed that during walking, individuals with valgus alignment and PFOA demonstrated a mean 3.9° (95% confidence interval [95% CI] 0.7, 7.1) less knee internal rotation than those with valgus alignment and no OA. During running this difference increased to 6.1° (95% CI 1.8, 10.4). For individuals with varus alignment, no significant effects were observed. CONCLUSION: Less knee internal rotation during gait was found in individuals with PFOA and valgus alignment. A rotational shift of this magnitude may be sufficient to initiate or accelerate patellofemoral cartilage degeneration. Prospective studies are required to determine if these altered kinematic patterns result from, or contribute to, PFOA development after reconstruction.

OBJECTIVE: To document the prevalence of radiographic osteoarthritis (OA) in the medial and lateral patellofemoral (PF) joint compartments relative to the prevalence of tibiofemoral (TF) joint OA in middle-aged and older adults with chronic PF knee pain. METHODS: A convenience sample of 224 people who volunteered for a clinical trial underwent weight-bearing posteroanterior and skyline knee radiographs of their most symptomatic eligible knee. Radiographic severity in the TF joint and in the medial and lateral PF joint compartments was independently graded by 2 examiners using the Kellgren/Lawrence (K/L) grading system. K/L grades ≥2 were considered evidence of OA. RESULTS: OA was common in this cohort, and the most prevalent pattern was combined TF joint and PF joint OA (n = 98 [44%]), followed by isolated PF joint OA (n = 57 [25%]). Isolated TF joint OA was rare. Overall, more people demonstrated radiographic OA in the PF joint (n = 155 [69%]) than in the TF joint (n = 100 [45%]). The majority of people with PF joint OA had OA in both the medial and lateral PF joint compartments (n = 98 [63%]). Even in people ages <50 years, radiographic OA was common (isolated PF joint OA, 26% [n = 21]; combined TF joint and PF joint OA, 29% [n = 23]). The severity of PF joint OA was similar across men and women. CONCLUSION: PF joint OA was highly prevalent, more so than TF joint OA, and even in individuals ages <50 years. Further research is needed to elucidate the cause and effect relationship between chronic PF pain and PF joint OA.

Item does not contain fulltext, The International Ankle Consortium is an international community of researchers and clinicians whose primary scholastic purpose is to promote scholarship and dissemination of research-informed knowledge related to pathologies of the ankle complex. The constituents of the International Ankle Consortium and other similar organizations have yet to properly define the clinical phenomenon known as chronic ankle instability (CAI) and its related characteristics for consistent patient recruitment and advancement of research in this area. Although research on CAI and awareness of its impact on society and healthcare systems have grown substantially in the last 2 decades, the inconsistency in participant/patient selection criteria across studies presents a potential obstacle to addressing the problem properly. This major gap within the literature limits the ability to generalize this evidence to the target patient population. Therefore, there is a need to provide standards for patient/participant selection criteria in research focused on CAI, with justifications using the best available evidence.J Orthop Sports Phys Ther 2013;43(8):585-591. doi:10.2519/jospt.2013.0303.

BACKGROUND: Patellofemoral pain syndrome (PFP) is a common musculoskeletal condition that has a tendency to become chronic and problematic in a proportion of affected individuals. The objective of this study was to identify prognostic factors that may have clinical utility in predicting poor outcome on measures of pain and function in individuals with PFP. METHODS: A prospective follow-up study was conducted of 179 participants in a randomised clinical trial. Nine baseline factors (age, gender, body mass index, arch height, duration of knee pain, worst pain visual analogue scale, Kujala Patellofemoral Score (KPS), functional index questionnaire (FIQ), step down repetitions) were investigated for their prognostic ability on outcome assessed at six, 12 and 52 weeks (worst pain, KPS and FIQ). Factors with significant univariate associations were entered into multivariate linear regression models to identify a group of factors independently associated with poor outcome. RESULTS: Long symptom duration was the most consistent predictor of poor outcome over 52 weeks rated on the KPS and the FIQ (beta-0.07, 95% confidence interval -0.1 to -0.03, p < 0.000; and -0.02, -0.03 to -0.01, p < 0.000, respectively). Worse KPS at baseline was predictive of outcome at six, 12 and 52 weeks. Gender, body mass index and arch height were generally not associated with outcome (univariate analysis), while age, worst pain, FIQ and step downs were excluded during multivariate analyses. CONCLUSIONS: Patients presenting with PFP of long duration who score worse on the KPS have a poorer prognosis, irrespective of age, gender and morphometry. These results suggest that strategies aimed at preventing chronicity of more severe PFP may optimise prognosis.

BACKGROUND: Previous studies have suggested that increased plantar surface area, associated with pes planus, is a risk factor for the development of lower extremity overuse injuries. The intent of this study was to determine if a single or combination of foot anthropometric measures could be used to predict plantar surface area. METHODS: Six foot measurements were collected on 155 subjects (97 females, 58 males, mean age 24.5 +/- 3.5 years). The measurements as well as one ratio were entered into a stepwise regression analysis to determine the optimal set of measurements associated with total plantar contact area either including or excluding the toe region. The predicted values were used to calculate plantar surface area and were compared to the actual values obtained dynamically using a pressure sensor platform. RESULTS: A three variable model was found to describe the relationship between the foot measures/ratio and total plantar contact area (R2 = 0.77, p < 0.0001)). A three variable model was also found to describe the relationship between the foot measures/ratio and plantar contact area minus the toe region (R2 = 0.76, p < 0.0001). CONCLUSION: The results of this study indicate that the clinician can use a combination of simple, reliable, and time efficient foot anthropometric measurements to explain over 75% of the plantar surface contact area, either including or excluding the toe region.

BACKGROUND: Corticosteroid injection and physiotherapy are two commonly prescribed interventions for management of lateral epicondylalgia. Corticosteroid injections are the most clinically efficacious in the short term but are associated with high recurrence rates and delayed recovery, while physiotherapy is similar to injections at 6 weeks but with significantly lower recurrence rates. Whilst practitioners frequently recommend combining physiotherapy and injection to overcome harmful effects and improve outcomes, study of the benefits of this combination of treatments is lacking. Clinicians are also faced with the paradox that the powerful anti-inflammatory corticosteroid injections work well, albeit in the short term, for a non-inflammatory condition like lateral epicondylalgia. Surprisingly, these injections have not been rigorously tested against placebo injections. This study primarily addresses both of these issues. METHODS: A randomised placebo-controlled clinical trial with a 2 x 2 factorial design will evaluate the clinical efficacy, cost-effectiveness and recurrence rates of adding physiotherapy to an injection. In addition, the clinical efficacy and adverse effects of corticosteroid injection beyond that of a placebo saline injection will be studied. 132 participants with a diagnosis of lateral epicondylalgia will be randomly assigned by concealed allocation to one of four treatment groups - corticosteroid injection, saline injection, corticosteroid injection with physiotherapy or saline injection with physiotherapy. Physiotherapy will comprise 8 sessions of elbow manipulation and exercise over an 8 week period. Blinded follow-up assessments will be conducted at baseline, 4, 8, 12, 26 and 52 weeks after randomisation. The primary outcome will be a participant rating of global improvement, from which measures of success and recurrence will be derived. Analyses will be conducted on an intention-to-treat basis using linear mixed and logistic regression model

BACKGROUND: A study was conducted to determine the reliability and minimal detectable change for a new composite measure of the vertical and medial-lateral mobility of the midfoot called the foot mobility magnitude. METHODS: Three hundred and forty-five healthy participants volunteered to take part in the study. The change in dorsal arch height between weight bearing and non-weight bearing as well as the change in midfoot width between weight bearing and non-weight bearing were measured at 50% of total foot length and used to calculate the foot mobility magnitude. The reliability and minimal detectable change for the measurements were then determined based on the assessment of the measurements by three raters with different levels of clinical experience. RESULTS: The change in dorsal arch height between weight bearing and non-weight bearing, midfoot width between weight bearing and non-weight bearing, and the foot mobility magnitude were shown to have high levels of intra-rater and inter-rater reliability. Normative data are provided for the left and right feet of both the female (n = 211) and male (n = 134) subjects. CONCLUSION: While the measurements of navicular drop and drift have been used as a clinical method to assess both the vertical and medial-lateral mobility of the midfoot, poor to fair levels of inter-rater reliability have been reported. The results of the current study suggest that the foot mobility magnitude provides the clinician and researcher with a highly reliable measure of vertical and medial-lateral midfoot mobility.

BACKGROUND: Patellofemoral pain syndrome is a highly prevalent musculoskeletal overuse condition that has a significant impact on participation in daily and physical activities. A recent systematic review highlighted the lack of high quality evidence from randomised controlled trials for the conservative management of patellofemoral pain syndrome. Although foot orthoses are a commonly used intervention for patellofemoral pain syndrome, only two pilot studies with short term follow up have been conducted into their clinical efficacy. METHODS/DESIGN: A randomised single-blinded clinical trial will be conducted to investigate the clinical efficacy and cost effectiveness of foot orthoses in the management of patellofemoral pain syndrome. One hundred and seventy-six participants aged 18-40 with anterior or retropatellar knee pain of non-traumatic origin and at least six weeks duration will be recruited from the greater Brisbane area in Queensland, Australia through print, radio and television advertising. Suitable participants will be randomly allocated to receive either foot orthoses, flat insoles, physiotherapy or a combined intervention of foot orthoses and physiotherapy, and will attend six visits with a physiotherapist over a 6 week period. Outcome will be measured at 6, 12 and 52 weeks using primary outcome measures of usual and worst pain visual analogue scale, patient perceived treatment effect, perceived global effect, the Functional Index Questionnaire, and the Anterior Knee Pain Scale. Secondary outcome measures will include the Lower Extremity Functional Scale, McGill Pain Questionnaire, 36-Item Short-Form Health Survey, Hospital Anxiety and Depression Scale, Patient-Specific Functional Scale, Physical Activity Level in the Previous Week, pressure pain threshold and physical measures of step and squat tests. Cost-effectiveness analysis will be based on treatment effectiveness against resource usage recorded in treatment logs and self-reported diaries. DISCUSS

BACKGROUND: The patellofemoral joint (PFJ) is one compartment of the knee that is frequently affected by osteoarthritis (OA) and is a potent source of OA symptoms. However, there is a dearth of evidence for compartment-specific treatments for PFJ OA. Therefore, this project aims to evaluate whether a physiotherapy treatment, targeted to the PFJ, results in greater improvements in pain and physical function than a physiotherapy education intervention in people with symptomatic and radiographic PFJ OA. METHODS: 90 people with PFJ OA (PFJ-specific history, signs and symptoms and radiographic evidence of PFJ OA) will be recruited from the community and randomly allocated into one of two treatments. A randomised controlled trial adhering to CONSORT guidelines will evaluate the efficacy of physiotherapy (8 individual sessions over 12 weeks, as well as a home exercise program 4 times/week) compared to a physiotherapist-delivered OA education control treatment (8 individual sessions over 12 weeks). Physiotherapy treatment will consist of (i) quadriceps muscle retraining; (ii) quadriceps and hip muscle strengthening; (iii) patellar taping; (iv) manual PFJ and soft tissue mobilisation; and (v) OA education. Resistance and dosage of exercises will be tailored to the participant's functional level and clinical state. Primary outcomes will be evaluated by a blinded examiner at baseline, 12 weeks and 9 months using validated and reliable pain, physical function and perceived global effect scales. All analyses will be conducted on an intention-to-treat basis using linear mixed regression models, including respective baseline scores as a covariate, subjects as a random effect, treatment condition as a fixed factor and the covariate by treatment interaction. CONCLUSION: This RCT is targeting PFJ OA, an important sub-group of knee OA patients, with a specifically designed conservative intervention. The project's outcome will influence PFJ OA rehabilitation, with the potential to redu