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BACKGROUND: This study introduces two novel outcomes that could be used to identify people with knee osteoarthritis from healthy controls. These outcomes examine the lengths of paths on a sphere derived from knee angle and knee position during gait. METHODS: Participants with moderate knee osteoarthritis (n=47) and no knee pathology (n=51) walked overground. The time-varying orientation matrices and position vectors of the knee (leg relative to the thigh) were measured, then arclength (constant speed) parameterized. The orientation matrix column aligned with the long axis of the leg, and the tangent, normal and binormal vectors (Frenet Frame) along the position vectors were calculated. These unit length vectors all scribe paths (indicatrices) on a unit sphere. The path lengths of these indicatrices, for all or part of a gait cycle, were the novel outcomes. A stepwise discriminant analysis defined a linear function that included those outcomes that best allocated a participant to the osteoarthritis or control group. FINDINGS: Group differences were best detected with the indicatrix lengths associated with the orientation of the leg's long axis over a gait cycle (P<0.001) and the tangent vector over the stance phase (P=0.014). Both outcomes were smaller in the knee osteoarthritis compared to control group. Walking speed was poorly correlated with all indicatrix lengths (rho<|0.484|) and a discriminate analysis correctly classified 83.7% of the participants. INTERPRETATION: Smaller indicatrix measures distinguished those with knee osteoarthritis from healthy controls. These outcomes introduce a promising new kinematic approach when examining gait data. [ABSTRACT FROM AUTHOR]

It has been hypothesised that those with medial compartment knee osteoarthritis tend to externally rotate their foot during gait in order to unload the diseased compartment. This has been found to decrease the adduction moment at the knee during late stance, although the effects of foot rotation on shear forces at the knee have not yet been determined. Also, the effects of internal foot rotation on the knee during gait are not clear. This study performed a gait analysis on 11 healthy participants (M: 6; mean age 22.9+/-1.8 years) in three conditions: (1) natural foot rotation position; (2) internal foot rotation and (3) external foot rotation. Three-dimensional gait analysis calculated the knee adduction moment and lateral-medial shear force for all three foot rotation conditions. Internal rotation of the foot increased the knee adduction moment and lateral-medial shear force magnitude during late stance, while external rotation of the foot decreased the magnitude of both these measures. This implies that walking with an externally and internally rotated foot may unload the diseased compartment for those with medial and lateral compartment knee OA, respectively. Also, the relationship of foot rotation angle to the adduction moment and lateral-medial shear force was strengthened when data were corrected for the subject's normal walking condition. Knee OA subject data revealed that they were able to reduce the knee adduction moment more than normal subjects during late stance, indicating that other factors besides the rotation of the foot need to be investigated. [ABSTRACT FROM AUTHOR]

Abstract Background This investigation characterized the time-history pattern of the free moment (FM) during walking and, additionally, assessed whether walking with either an internally or externally rotated foot position altered the FM's time-history. Methods Force plate and foot kinematic data were acquired simultaneously for 11 healthy subjects (6 males, 5 females) while walking at their self-selected comfortable speed in 3 foot rotation conditions (normal, internal and external). The FM was calculated and normalized by the product of each participant's body weight and height prior to extraction of peak FM, occurrence of peak FM in stance and net relative impulse. Differences in these values across foot rotation conditions were assessed using separate one-way, repeated measures analysis of variance and subsequent pair-wise comparisons. Results The average FM pattern during normal walking exhibits a biphasic shape: resisting inward rotation during approximately the first half of stance and outward rotation during the latter part of stance. While no differences in peak FM or net relative impulse were observed between the internal foot rotation condition and normal walking, the external foot rotation condition resulted in significantly greater peak FM and relative net impulse in comparison to normal walking. Conclusion The differences in selected FM variables between normal walking and the external foot rotation condition are attributable to individual subject response to walking with an externally rotated foot. In this condition, some subjects displayed a FM pattern that was similar to that recorded during normal walking, while others displayed markedly larger FM patterns that are comparable in magnitude to those reported for running. The larger FM values in these latter subjects are speculated to be a result of excessive transverse plane body movements. Whilst further investigation is warranted regarding the FM time-history characteristics during walking, our results indicate that the FM may provide useful information in assessment of gait.

To combat the devastating effects of improvised explosive devices (IEDs), body armor that provides extended coverage has been developed. However, this extended coverage increases the armor's weight and may restrict movement. Throughout this case study, a novel technique to assess several armor systems was investigated. Four soldiers performed shoulder and trunk movements while wearing each of the six different armor inserts. Electromyography (EMG) was used to quantify muscular activity and inertial motion sensors were used to determine joint range of motion (ROM). Outcome measures included maximum ROM, integrated EMG, and the soldiers' subjective rankings. For the shoulder tasks, objective ROM and EMG measures were related to each other as well as to subjective rankings and armor material properties. Conversely, little agreement was found between measures for the trunk tasks. Results of this preliminary investigation indicate that combining shoulder ROM and EMG measures has the potential to provide an objective assessment of body armor systems. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, telework best practices decreased in importance compared to the need for social distancing. It is important that ergonomics assessments for home office workstations are equally as effective as assessment for traditional offices to maintain teleworker wellbeing. The purpose of this case study is to compare a remote, picture-based, home office assessment to a traditional, in-person, office assessment for employees of one Canadian University. Intraclass Correlation Coefficients (ICCs) and Bland-Altman Analyses (BAAs) revealed that the two methods provide repeatable results, with good agreement. Feedback from the participants suggested that picture-based assessments were as effective as in-person assessments; but that picture-based assessments could be improved with video conferencing to discuss findings and ask follow-up questions. Participants found value in remote assessments and, while they preferred in-person assessments, picture-based assessments are suitable when needed as they allow for many assessments to be completed without violating social distancing restrictions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Technological advancements have increased occupational flexibility for employees and employers alike. However, while effective telework requires planning, the COVID-19 pandemic required many employees to quickly shift to working from home without ensuring that the requirements for telework were in place. This study evaluated the transition to telework on university faculty and staff and investigated the effect of one's telework setup and ergonomics training on work-related discomfort in the at-home environment. Fifty-one percent of respondents reported increases in their existing discomfort while 24% reported new discomfort since working from home. These results suggest a need for ergonomic interventions including ergonomic training and individual ergonomic assessments for those who work from home., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Evaluating the dynamic knee function of patients after anterior cruciate ligament reconstruction is a challenge. A variety of objective tests have been developed but for various reasons few are regularly used in the clinic. It may be practical to perform the step-up-and-over test with an accelerometer., Methods: A control group (N=26) and an experimental group with a reconstructed anterior cruciate ligament (N=25) completed questionnaires quantifying subjective knee function and fear of re-injury and then completed the step-up-and-over test., Findings: Results showed that the experimental group performed differently than the control group for the step-up-and-over test's Lift Symmetry and Impact Symmetry (P<0.05) and performance on these measures was related to the participant's subjective knee function (ρ=-0.46, P<0.01; ρ=-0.33, P<0.05, respectively). Supplemental results for individual leg performance and the patient's fear of re-injury are also reported and discussed., Interpretation: Performance on the step-up-and-over test is different for participants with anterior cruciate ligament reconstruction than for those with intact anterior cruciate ligaments, and that performance is related to one's opinion of their knee's function., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The step-up-and-over test has been used successfully to examine knee function after knee injury. Knee function is quantified using the following variables extracted from force plate data: the maximal force exerted during the lift, the maximal impact force at landing, and the total time to complete the step. For various reasons, including space and cost, it is unlikely that all clinicians will have access to a force plate. The purpose of the study was to determine if the step-up-and-over test could be simplified by using an accelerometer. The step-up-and-over test was performed by 17 healthy young adults while being measured with both a force plate and a 3-axis accelerometer mounted at the low back. Results showed that the accelerometer and force plate measures were strongly correlated for all 3 variables (r = .90-.98, Ps < .001) and that the accelerometer values for the lift and impact indices were 6-7% higher (Ps < .01) and occurred 0.07-0.1 s later than the force plate (Ps < .05). The accelerometer returned values highly correlated to those from a force plate. Compared with a force plate, a wireless, 3-axis accelerometer is a less expensive and more portable system with which to measure the step-up-and-over test.

Background: The Mark 3 (M3) water power pump is an integral piece of wildfire fighting equipment. However, it is provided to fire stations without a carrying harness. The currently-used carrying harness is very uncomfortable, especially when carrying the pumps considerable distance in a forest to reach a water source., Objective: The purpose of this study was to advise the Ontario Ministry of Natural Resources on the selection of a new M3 load carriage system., Participants: Twenty Fire Rangers wore the three systems (Original, Prototype, and Modified) through a circuit of tasks representative of their working environment., Methods: Subjective and objective approaches were combined to assess and rank the M3 carriage systems. Subjective visual analogue scale ratings were obtained for ease of loading/unloading, comfort, system stability, and overall performance. Tri-axial accelerometers were mounted on each pump and at the sternum of each participant to determine relative pump-carrier accelerations., Results: Overall, the Prototype was ranked as the best system; it resulted in the lowest relative pump-carrier accelerations on 10 out of 15 objective measures, and also received a first place ranking on all subjective measures., Conclusion: It was recommended that the Prototype be implemented as the M3 carriage system for fire suppression teams.

Objective: In this paper, Dr. Joan Stevenson's work on assessment of the effects of lifting, supporting and transporting loads is reviewed. A defining attribute of this work is the use of objective, biomechanical measures as the basis from which a fuller understanding of all factors affecting worker performance can be obtained, and how such performance should be measured and evaluated., Methods: The central objectives and conclusions of Dr. Stevenson's research programs spanning the years from 1985 through 2012 are summarized and discussed in terms of an overall research trajectory., Conclusions: The guiding principle of Dr. Stevenson's work is to reduce the potential harm to which workers are exposed through the development of bona fide occupational standards, a better understanding of risk factors leading to low back pain, and the establishment of an enhanced objective design process for functional load-bearing clothing and equipment.

While a stable trunk and centre of mass (CoM) trajectory are required during lifting, it is unclear how stability is controlled. Thirty healthy participants (15M, 15F) performed repetitive, symmetric lifting at 10 cycles per minute for 3 min with a load-in-hands equivalent to 10% of their maximum back strength. Short- and long-term maximum finite-time Lyapunov exponents (λ(max-s) and λ(max-l)), describing responses to small (local) perturbations, estimated the local dynamic stability of the foot, shank, thigh, pelvis, lower back, and upper back segments. Instability (λ(max-s)) significantly increased when moving up the kinematic chain (p<0.001). Therefore, to maintain trunk equilibrium and accurately regulate CoM trajectory during lifting, stability of the distal (fixed) lower limb segments is prioritized. This is contrary to previous results observed during gait, indicating that trunk control via kinematic chain stability is accomplished differently for walking and lifting., (Copyright © 2011 Elsevier B.V. All rights reserved.)

The objective of the study was to evaluate the reliability of frontal plane lower limb alignment measures using a landmark-based method by (1) comparing inter- and intra-reader reliability between measurements of alignment obtained manually with those using a computer program, and (2) determining inter- and intra-reader reliability of computer-assisted alignment measures from full-limb radiographs. An established method for measuring alignment was used, involving selection of 10 femoral and tibial bone landmarks. (1) To compare manual and computer methods, we used digital images and matching paper copies of five alignment patterns simulating healthy and malaligned limbs drawn using AutoCAD. Seven readers were trained in each system. Paper copies were measured manually and repeat measurements were performed daily for 3 days, followed by a similar routine with the digital images using the computer. (2) To examine the reliability of computer-assisted measures from full-limb radiographs, 100 images (200 limbs) were selected as a random sample from 1,500 full-limb digital radiographs which were part of the Multicenter Osteoarthritis Study. Three trained readers used the software program to measure alignment twice from the batch of 100 images, with two or more weeks between batch handling. Manual and computer measures of alignment showed excellent agreement (intraclass correlations [ICCs] 0.977-0.999 for computer analysis; 0.820-0.995 for manual measures). The computer program applied to full-limb radiographs produced alignment measurements with high inter- and intra-reader reliability (ICCs 0.839-0.998). In conclusion, alignment measures using a bone landmark-based approach and a computer program were highly reliable between multiple readers.

Introduction: Principal component analysis (PCA) has been used to reduce the volume of gait data and can also be used to identify the differences between populations. This approach has not been used on stair climbing gait data. Our objective was to use PCA to compare the gait patterns between young and older adults during stair climbing., Methods: The knee joint mechanics of 30 healthy young adults (23.9 + or - 2.6 years) and 32 healthy older adults (65.5 + or - 5.2 years) were analyzed while they ascended a custom 4-step staircase. The three-dimensional net knee joint forces, moments, and angles were calculated using typical inverse dynamics. PCA models were created for the knee joint forces, moments and angles about the three axes. The principal component scores (PC scores) generated from the model were analyzed for group differences using independent samples t-tests. A stepwise discriminant procedure determined which principal components (PCs) were most successful in differentiating the two groups., Results: The number of PCs retained for analysis was chosen using a 90% trace criterion. Of the scores generated from the PCA models nine were statistically different (p < .0019) between the two groups, four of the nine PC scores could be used to correctly classify 95% of the original group., Conclusions: The PCA and discriminant function analysis applied in this investigation identified gait pattern differences between young and older adults. Identification of stair gait pattern differences between young and older adults could help in understanding age-related changes associated with the performance of the locomotor task of stair climbing., (Copyright 2009 Elsevier B.V. All rights reserved.)

This paper investigated whether the ratio of medial-lateral hamstring muscular activation could be altered with changes in foot rotation position (both internal and external rotation) during three standard lower limb exercises. It has been suggested that those with medial compartment knee OA activate the lateral hamstrings more than the medial to help unload the diseased compartment; therefore, preferential activation of this muscle during lower limb exercise may help to further decrease the stresses on the articular cartilage and be an effective intervention for knee OA and lateral hamstring injury. Thirteen healthy young adult subjects were tested and average medial and lateral hamstring EMG data during the full exercise, as well as the concentric and eccentric phases, were used to calculate the medial-lateral (M-L) hamstring activation ratio for each exercise and foot position. Results suggest that internal foot rotation increases the M-L hamstring activation ratio while external foot rotation decreases this ratio. Therefore, altering the position of the foot during standard lower limb exercise can help selectively activate the medial or lateral hamstring muscle groups. This selective activation may have implication in treating symptoms of knee osteoarthritis and hamstring injury; but, longitudinal intervention studies would be needed to determine clinical utility.

Modeling of the body segments to estimate segment inertial parameters is required in the kinetic analysis of human motion. A new geometric model for the trunk has been developed that uses various cross-sectional shapes to estimate segment volume and adopts a non-uniform density function that is gender-specific. The goal of this study was to test the accuracy of the new model for estimating the trunk's inertial parameters by comparing it to the more current models used in biomechanical research. Trunk inertial parameters estimated from dual X-ray absorptiometry (DXA) were used as the standard. Twenty-five female and 24 male college-aged participants were recruited for the study. Comparisons of the new model to the accepted models were accomplished by determining the error between the models' trunk inertial estimates and that from DXA. Results showed that the new model was more accurate across all inertial estimates than the other models. The new model had errors within 6.0% for both genders, whereas the other models had higher average errors ranging from 10% to over 50% and were much more inconsistent between the genders. In addition, there was little consistency in the level of accuracy for the other models when estimating the different inertial parameters. These results suggest that the new model provides more accurate and consistent trunk inertial estimates than the other models for both female and male college-aged individuals. However, similar studies need to be performed using other populations, such as elderly or individuals from a distinct morphology (e.g. obese). In addition, the effect of using different models on the outcome of kinetic parameters, such as joint moments and forces needs to be assessed.

Background: To determine the effects of changing the natural foot progression angle during gait (internal and external foot rotation) on the knee's adduction moment, lateral-medial shear force, and the ratio of medial-lateral hamstring muscle activation in those with signs of knee osteoarthritis and a matched healthy control group., Methods: Twelve subjects with signs of knee osteoarthritis and 12 matched healthy control subjects were evaluated. A 3D gait analysis system calculated forces and moments at the knee while the subjects walked in three conditions: (1) normal foot position, (2) external foot rotation, (3) internal foot rotation. Medial and lateral hamstring EMG data was also collected simultaneously and used to calculate the medial-lateral hamstring activation ratio during the stance phase of the gait cycle. Repeated measures ANOVAs were used to compare foot rotation conditions within each group; while between group comparisons were performed in the normal rotation condition only using t-tests., Findings: Those with knee osteoarthritis (OA) had an increased late stance knee adduction moment and a decreased medial-lateral hamstring activation ratio as compared to the healthy control group. Also, external foot rotation decreased the late stance knee adduction moment, lateral-medial shear force, and hamstring activation ratio. However, internal foot rotation did not increase these measures., Interpretation: Changes in foot position during gait have the ability to alter both the external loading of the knee joint and hamstring muscle activation patterns during gait. This may have implication in helping to unload the knee's articular cartilage.

Background: Pain experienced by people with knee osteoarthritis is related to psychosocial factors and damage to articular tissues and/or the pain pathway itself. Mechanical factors have been speculated to trigger this pain experience; yet mechanics have not been identified as a source of pain in this population. The purpose of this study was to identify whether mechanics could explain variance in pain intensity in people with knee osteoarthritis., Methods: Data from 53 participants with physician-diagnosed knee osteoarthritis (mean age=68.5 years; standard deviation=8.6 years) were analyzed. Pain intensity was reported on the Western Ontario and McMaster Universities Osteoarthritis Index. Mechanical measures included weight-bearing varus-valgus alignment, body mass index and isokinetic quadriceps torque. Gait analysis captured the range of adduction-abduction angle, range of flexion-extension angle and external knee adduction moment during level walking., Findings: Pain intensity was significantly related to the dynamic range of flexion-extension during gait and body mass index. A total of 29% of the variance in pain intensity was explained by mechanical variables. The range of flexion-extension explained 18% of variance in pain intensity. Body mass index added 11% to the model. The knee adduction moment was unrelated to pain intensity., Interpretation: The findings support that mechanical factors are related to knee osteoarthritis pain. Because limitations in flexion-extension range of motion and body size are modifiable factors, future research could examine whether interventions targeting these mechanics would facilitate pain management.

Accurate body segment parameters are necessary to estimate joint loads when using biomechanical models. Geometric methods can provide individualized data for these models but the accuracy of the geometric methods depends on accurate segment density estimates. The trunk, which is important in many biomechanical models, has the largest variability in density along its length. Therefore, the objectives of this study were to: (1) develop a new method for modeling trunk density profiles based on dual X-ray absorptiometry (DXA) and (2) develop a trunk density function for college-aged females and males that can be used in geometric methods. To this end, the density profiles of 25 females and 24 males were determined by combining the measurements from a photogrammetric method and DXA readings. A discrete Fourier transformation was then used to develop the density functions for each sex. The individual density and average density profiles compare well with the literature. There were distinct differences between the profiles of two of participants (one female and one male), and the average for their sex. It is believed that the variations in these two participants' density profiles were a result of the amount and distribution of fat they possessed. Further studies are needed to support this possibility. The new density functions eliminate the uniform density assumption associated with some geometric models thus providing more accurate trunk segment parameter estimates. In turn, more accurate moments and forces can be estimated for the kinetic analyses of certain human movements.

Purpose: This study compared the kinematics and kinetics of the knee joint during traditional step-over-step (SOS) and compensatory step-by-step lead-leg (SBSL) and trail-leg (SBST) stair ambulation patterns., Methods: Seventeen (M:9) healthy adults completed five trials of ascent and descent using three different stepping patterns: 1) SBSL, 2) SBST, and 3) SOS. Kinematics and kinetics were collected with an optoelectronic motion-tracking system and a force plate embedded into a four-step staircase. An inverse-dynamics link-segment model (QGAIT system) was used to calculate the net joint kinetics., Results: During stair ascent, different peak anteroposterior (AP) forces were observed across all three stepping patterns (SOS > SBSL > SBST, P < 0.05). During ascent, the flexion moments of SOS (0.96 N x m x kg(-1)) and SBSL (0.97 N x m x kg(-1)) patterns were similar and much larger than the SBST moments (0.14 N x m x kg(-1)). In the descent conditions, the initial AP peak force for SOS was larger than that of SBSL and SBST. However, the second peak force for SOS (4.92 N x kg(-1)) and SBST (4.68 N x kg(-1)) were larger than SBSL (1.57 N x kg(-1)). During descent, the initial peak flexion moment for the SOS pattern was larger than SBSL and SBST, whereas during the second peak, SOS (1.05 N x m x kg(-1)) and SBST (1.11 N x m x kg(-)) were no different and larger than SBSL (0.18 N x m x kg(-1))., Conclusion: Overall, SBSL during ascent and SBST during descent had the highest loads. These results increase our understanding of alternative stepping patterns and have important clinical (reduction of loading on injured/diseased leg) and rehabilitation implications.

Background: Self-efficacy is a determinant of walking performance in older adults with knee osteoarthritis. We examined whether self-efficacy mediated the effect of age, psychosocial, impairment, and mechanical factors on walking performance., Methods: Fifty-four participants with knee osteoarthritis completed the Six Minute Walk test and Arthritis Self-Efficacy Scale. Independent variables reflected age, psychosocial (depressive symptoms), impairment (pain, stiffness), and mechanical (strength, obesity) factors., Results: Self-efficacy fully mediated the effect of age and impairments on walking. The effects of strength were only partially mediated by self-efficacy. Depressive symptoms and obesity were not mediated by self-efficacy., Conclusions: These findings are consistent with Social Cognitive Theory, according to which age may alter outcome expectations, and impairments like pain and stiffness provide negative physiological feedback to influence performance. Mechanical factors like strength and obesity may better represent a person's capabilities and interact with other variables to influence physical performance in older adults with knee osteoarthritis.

There is evidence that joint load is a factor in the development of osteoarthritis (OA) and, while altered gait profiles have been linked with OA, it is unknown if abnormal gait is a cause or effect of the disease. While the knee's adduction moment has been implicated in the development and progression of knee OA, it is also known that shearing forces are detrimental to the health of cartilage. The purpose of this pilot study was to examine the adduction moment and gait shear forces to determine if they may lead to signs of knee OA in older adults as they age. Knee gait kinetics, standardized radiographs and a questionnaire were collected on 28 older adults (M:13) during an initial visit, and 5 to 11 years later. Radiographic score increased (knees became more osteoarthritic in 15 of 28 subjects) over time. However, gait time-distance measures remained constant in disease free participants. Two returning participants developed symptoms and radiographic evidence of knee OA. The subject with the largest adduction moment developed signs of medial OA while the subject with the smallest adduction moment developed signs of lateral OA. In addition, there was a strong correlation between the magnitudes of the adduction moment and lateral-medial shear force that needs to be investigated further. Results suggest that gait can remain stable over time in older adults. Also, the medial and lateral OA case study findings suggest that the extreme gait profiles seen in these two participants may be important in explaining cartilage breakdown and the development of OA. This longitudinal study would suggest that perhaps it is the abnormal gait pattern that leads to the development of OA, although a much larger study would be needed to confirm this finding.

Background: Although gait characteristics have been well documented in people with knee osteoarthritis, little is known about the relationships between gait characteristics and performance or disability. Our purpose was to examine the role of knee kinematics and kinetics on walking performance and disability in people with knee osteoarthritis. We also examined whether pain mediated the relationship between the knee adduction moment and performance or disability., Methods: Three-dimensional gait analysis was conducted on 54 people with medial compartment knee osteoarthritis. Performance was quantified with the Six Minute Walk test and disability was self-reported on the Short Form-36. The pain subscale of the Western Ontario McMaster Universities Osteoarthritis Index and the functional self-efficacy subscale of the Arthritis Self-Efficacy scale were completed., Findings: A step-wise linear regression demonstrated that the variance in Six Minute Walk test scores was explained by functional self-efficacy (50%) and the range of knee motion (8%). The variance in Short Form-36 was explained by pain (36%), the peak extension angle (19%) and the range of knee motion (4%). Pain was unrelated to the knee adduction moment so analyses of pain as a mediator of the adduction moment on either performance or disability were halted., Interpretation: Kinematic output from the motor control system is useful in understanding some variance in current performance and disability in people with knee osteoarthritis. The knee adduction moment was unrelated to these variables and pain did not mediate between the knee adduction moment and performance or disability. Therefore this moment does not explain current clinical status in people with knee osteoarthritis based on the measures of performance and disability used in this study.

Objective: Self efficacy, the confidence an individual has to perform a task, is an important determinant of physical performance in individuals with knee osteoarthritis (OA). The purpose of this study was to determine what personal, pathophysiologic, and impairment factors relate to self efficacy for physical tasks in community-dwelling adults with knee OA., Methods: Fifty-four persons with radiographically confirmed knee OA (mean +/- SD age 68.3 +/- 8.7 years, range 50-87 years) participated. The Functional Self-Efficacy subscale of the Arthritis Self-Efficacy Scale was the dependent measure. Independent measures included age, education, scores from the Center for Epidemiologic Studies Depression and State-Trait Anxiety Inventory questionnaires, medial joint space and varus/valgus tibiofemoral angle from radiographs, body mass index, and isokinetic quadriceps and hamstrings strength. Knee pain and stiffness, assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, were independent measures., Results: Fifty-one percent of the variance of Functional Self Efficacy was explained by knee stiffness, hamstrings strength, age, and depression scores. Pain, education, anxiety, radiographic joint space, and body weight did not significantly contribute to the variance in Functional Self-Efficacy scores. Substituting quadriceps strength for hamstrings strength resulted in a regression model that included only stiffness, age, and depression, which explained nearly as much variance as the original model., Conclusion: Self efficacy for physical tasks is related to the sensation of stiffness, hamstrings strength, age, and level of depressive symptoms in persons with knee OA. Clinicians and researchers could consider these variables when assessing the level of self efficacy for physical tasks in persons with knee OA.

Objectives: To identify the determinants of self-report mobility measures in people with knee osteoarthritis (OA) and to compare self-report measures with physical performance., Design: Cross-sectional, prospective., Setting: Motor performance laboratory and human mobility research center., Participants: A convenient sample of 54 participants with medial compartment knee OA (32 women, 22 men; age 68.3+/-8.7y; range, 50-87y). Three participants were excluded because of the presence of lateral knee OA on radiographs., Interventions: Not applicable., Main Outcome Measures: Self-reports were recorded by using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Performance measures included the six-minute walk test (6MWT), Timed Up & Go (TUG) test, and a standardized stair-climbing task (STR)., Results: Stepwise linear regression analysis identified models that included pain, quadriceps and hamstrings strength, and depression to explain 62% to 73% of the variance in scores on the physical functioning subscale of the WOMAC and the SF-36. These self-report measures had a moderate relation (r range, .46-.64) with performance measures (6MWT, TUG, STR)., Conclusions: Self-report measures were strongly related to pain; physical performance measures were strongly related to self-efficacy. Regression models showed that self-report scores reflect pain, knee strength, and depression. The relation between self-report and performance measures was moderate, suggesting that these examine different aspects of mobility.

Background and Purpose: This cross-sectional study evaluated the relative contributions of psychosocial and mechanical variables to physical performance measures in people with knee osteoarthritis (OA)., Subjects: Fifty-four subjects (age, in years: mean=68.3, SD=8.7, range=50-87) with radiographically confirmed knee OA were included in this study., Methods: Physical performance measures included the Six-Minute Walk Test (SMW), the Timed "Up & Go" Test (TUG), and a stair-climbing task (STR). Responses to psychosocial questionnaires that reflect depression, anxiety, and self-efficacy (a person's confidence in his or her ability to complete a task) were collected. Mechanical variables measured included body mass index and knee strength (force-generating capacity of muscle). Stepwise linear regressions were performed with the SMW, TUG, and STR as separate dependent variables., Results: Functional self-efficacy explained the greatest amount of variance in all performance measures, contributing 45% or more. Knee strength and body weight also explained some variance in performance measures. Anxiety and depression did not explain any variance in performance., Discussion and Conclusion: Physical therapists evaluating the significance of the SMW, TUG, and STR scores in subjects with knee OA should note that a large part of each score reflects self-efficacy, or confidence, for physical tasks, with some contributions from knee strength and body weight.

Objective: To determine the reliability and validity of ankle proprioceptive measures., Design: Reliability was assessed between test occasions. Construct validity was addressed by the ability of measures to differentiate among groups., Setting: Laboratory of an educational institution., Participants: Eight healthy adults were recruited into each of 3 groups: (1) young (20-39y), (2) middle-aged (40-59y), and (3) older adults (>or=60y). Four subjects from each group (n=12) participated in retesting., Interventions: Not applicable., Main Outcome Measures: Threshold for perception of passive movement, error in active reproduction of position, error in reproduction of velocity, and error in reproduction of torque., Results: Intersession reliability was excellent (intraclass correlation coefficient [ICC] range, .79 - .95) for threshold for perception of movement, error in active reproduction, error in velocity reproduction, and error in dorsiflexion torque reproduction; intersession reliability was good for error in reproduction of plantarflexion torque (ICC=.72). Threshold for perception of movement differed between groups 1 and 3 and between groups 2 and 3 (P<.05). Error in reproduction of position was greater in group 2 than in group 1 (P<.05)., Conclusion: Differences in proprioception between the older and the 2 younger groups were best detected by using threshold for perception of passive movement.

Understanding joint kinetics during activities of daily living furthers our understanding of the factors involved in joint pathology and the effects of treatment. In this study, we examined hip and knee joint kinetics during stair climbing in 35 young healthy subjects using a subject-specific knee model to estimate bone-on-bone tibiofemoral and patello-femoral joint contact forces. The net knee forces were below one body weight while the peak posterior-anterior contact force was close to one body weight. The peak distal-proximal contact force was on average 3 times body weight and could be as high as 6 times body weight. These contact forces occurred at a high degree of knee flexion where there is a smaller joint contact area resulting in high contact stresses. The peak knee adduction moment was 0.42 (0.15) Nm/kg while the flexion moment was 1.16 (0.24) Nm/kg. Similar peak moment values, but different curve profiles, were found for the hip. The hip and knee posterior-anterior shear forces and the knee flexion moment were higher during stair climbing than during level walking. The most striking difference between stair ascent and level walking was that the peak patello-femoral contact force was 8 times higher during stair ascent. These data can be used as baseline measures in pathology studies, as input to theoretical joint models, and as input to mechanical joint simulators., (Copyright 2002 Elsevier Science B.V.)

The extent to which errors in predicting body segment parameters (SP) influence biomechanical analysis of human motion is unclear. Therefore, the current study quantitatively evaluated the differences in SP estimates using literature predictive functions and computed the effect of SP variation on the kinetic output of walking. For a group of 15 young males, significant differences (P<0. 05) were observed between SP estimates for the leg and thigh using the literature predictive functions, with mass and moment of inertial values differing by more than 40%. Using kinematic and ground reaction force data collected for each subject while walking, inverse dynamic analysis was performed iteratively to compute hip forces and moments while simultaneously varying SP values over nine intervals within +/-40% of a baseline value. SP variations were found to significantly affect (P<0.05) most of the kinetic estimates produced, particularly those taken during the swing phase. However, the magnitude of these effects was generally less than 1% of body weight. The data from the current study allows researchers to estimate the errors in kinetic measures due to SP variation. The results also indicate that the accuracy of SP prediction should be of concern in biomechanical research particularly for open chain and high acceleration activities. Further study is necessary to identify the importance of SP variation on other motion skills.

Motion analysis of the upper extremity during functional activities has only recently become more accessible. An optoelectric system (WATSMART) was subjected to testing using first a calibration dummy and then human subjects. The mean differences between the system calculated angles and those measured with potentiometers on a calibration dummy were less than 1.6° in all three planes. The test-retest reliability of the system when measuring elbow motion of human subjects yielded acceptable repeatability for measurement of functional activities. Calculation of the least significant difference found that minimum differences from 4 to 14° in flexion and from 10 to 19° in rotation can be detected using the reported set-up and protocol., (Copyright © 1993. Published by Elsevier Ltd.)

The sit-to-stand and stand-to-sit movements of 10 healthy women (mean age 52.4 years) were subjected to a descriptive analysis that yielded a definition of phases, determination of the peak angles reached, maximum angular velocity during each movement, and the sequencing of key events. While subjects showed little intrasubject variability, intersubject variability was evident. Subjects differed in the joint angles and angular velocity recorded, but the sequence of flexion/extension and rotation events were unchanged. Changes in direction of flexion/extension and rotation tended to occur very close in time, if not at the same time., (Copyright © 1993. Published by Elsevier Ltd.)

This paper describes a 3-D gait analysis system, which combines optoelectric motion tracking and a standardized X-ray procedure, to calculate the net knee-joint forces and moments of a normal subject group during walking. The optoelectric system collects kinematic data from infra-red LED markers placed at selected skin surface locations and projecting probes attached to the lower limb. A standardized X-ray procedure is used to move surface markers into their designated bony landmarks based on individual bone structure, which reduces the error caused by uncertainty of skin-surface marker locations. Based on moved-in marker information, different joint coordinate systems are proposed for kinematic and kinetic analysis of the knee joint. Normalized data of knee angles, net reaction forces and net moments from 35 young, normal subjects are presented.

The automation provided by computer-assisted motion-tracking systems allows for three-dimensional motion and force analysis. These systems combined with mathematical modelling are able to analyse quickly the intricate dynamics of human movement. Understanding the limitations of human motion analysis as performed by the present measurement techniques is essential for proper application of the results. It is necessary to validate the analysis system prior to subject testing. This paper provides a validation of an optoelectric motion-tracking system used in a dynamic knee assessment study. While the validation is shown with one particular system only, it is suggested that all systems used in two- or three-dimensional motion analysis should be tested similarly in the actual configuration used. Three simple mechanical representations of the human knee have been used in this validation. The first model provided an understanding of the source and behaviour of the error introduced to the accuracy of defining a vector between the recorded coordinates of two markers. The other two models investigated the effect of processing methods specific to the knee analysis project. Separating the markers by at least 180 mm is recommended to produce stable vectors. Relative joint angles could be calculated in all three planes of rotation. The error in calculating flexion and longitudinal rotation was less than 2.0 degrees, while calculating adduction introduced errors of 4.0 degrees. Force calculations were found to be within 8%. The system behaviour was found to be consistent within the calibrated volume about the force platform. Simple mechanical models combined with straightforward procedures can provide validation in terms of clinically relevant parameters.

A semiautomatic three-dimensional knee motion assessment system has been developed based on an optoelectric motion tracking system connected to an IBM-compatible computer. Critical decisions made in implementing the software component of the system include the modelling of the thigh and lower leg segments, calculating the knee angles, reaction forces, and moments; the file structure used and the format of the programs used to process the data are outlined. Once the subject-specific data have been collected, the system of programs requires no other user-intervention during processing. Also, selected curve parameters are automatically extracted from the output and combined with the subject-specific data that include precision X-ray and anthropometric data, which are all added to a knee motion assessment database. The automated portion of the system frees the experimenter from data processing and allows concentration on data analysis.

The mechanical energy costs of walking have been studied in ten stroke patients with hemiplegia. A two-dimensional sagittal plane cinematographic analysis of two strides of the subjects' normal walking was undertaken, yielding continuous information about the mechanical energy costs of the whole body and each of its parts, about the energy types involved, and the amounts of energy conservation. The large head, arms, and trunk (HAT) were found to dominate the total pattern. Three major disturbances were seen. In contrast to normal subjects who show energy-conserving negatively correlated potential and kinetic energy curves for the HAT, the subjects who demonstrated the first disturbance showed gross irregularity of the curves, with almost no opportunity for exchange between energy types. In a second disturbance the curves of the HAT showed some energy-conserving portions, but levels of kinetic energy curves were low, resulting in little energy exchange. In the third disturbance, some exchange was evident, but the pattern was dominated by potential energy changes in the form of a single large rise and fall, coinciding with swing phase of the affected leg. Each of these disturbances would require a different approach to treatment. Although mechanical energy analyses do not reflect certain energy costs, such as the effort required to hold the body up against the pull of gravity and that used in contracting antagonist muscles, they could be of considerable assistance in pinpointing costly variations in energy patterns during walking and in determining appropriate treatment procedures.

Mathematical modeling of human joints requires accurate information concerning anthropometric parameters such as muscle cross-sectional areas and muscle moment arms. The purpose of this study was to calculate the average crosssectional area, average volume, and length of the muscle moment arms about the spinal column for the rectus abdominis (RA) and the erector spinae (ES) for those portions of the muscles that are involved in spinal flexion and extension. Materials for this study came from archival computed tomography scans of 28 living subjects. The muscle outlines were digitized and the moment arms calculated as a percentage of anteroposterior trunk depth. The average cross-sectional area of the RA was 10.5 cm2, and 31.75 cm2 for the ES. The average volumes for the RA and ES were 356.16 cm3 and 843.46 cm3, respectively. The muscle moment arm ratio was 0.29 for the ES, while the males and females had ratios of 0.50 and 0.40, respectively, for the RA. Computed tomography scanning is a method that allows the accurate calculation of internal anthropometric parameters that will be of use in mathematical modeling. J Orthop Sports Phys Ther 1985;6(5):278-280.

The mechanical energy costs of walking were studied in 10 cerebral palsied children with hemiplegia to determine whether their values were substantially different from normal and, if so, to discover the movements that were responsible. A two-dimensional, sagittal-plane cinematographic analysis of the subjects' normal walking was undertaken. This technique provided continuous information about the mechanical energy costs of the whole body and each of its parts, the energy types involved, and the amounts of energy conserved. In most cases, the energy costs were above normal and were attributable to poor patterns of exchange between the potential and kinetic energy types of the head, arms, and trunk segment; to very low levels of kinetic energy that precluded exchange; or to both. We concluded that attention should be directed to restoring the sinusoidal pattern of motion and to the fluctuating speeds during each gait cycle when energy costs are a therapeutic consideration.