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Background The purpose of this prospective study was to understand the relation between gait outcomes and patient satisfaction one year after total knee arthroplasty (TKA). Methods Seventy-nine patients were evaluated before and one year after TKA using clinical gait analysis. Specific gait outcomes were analyzed: gait speed, stance phase, range of motion (ROM) knee flexion and maximal knee flexion. The parameters of interest selected for the statistical analysis were: gait speed and maximal knee flexion during gait. The Western Ontario and MacMaster Osteoarthritis Index (WOMAC) and patient satisfaction were also assessed. The satisfaction was evaluated using a questionnaire and was splited in five categories: very unsatisfied, unsatisfied, neutral, satisfied or very satisfied. To assess associations between patient satisfaction and maximal knee flexion during gait and gait speed, an unadjusted ordinal logistic regression analysis was used. The analysis was then adjusted for covariates: age and Body Mass Index (BMI) before surgery and WOMAC pain one year after surgery. Results All gait outcomes after TKA had significantly improved. The ordinal logistic regression analysis found significant associations between patient satisfaction and maximal knee flexion after TKA (unadjusted and adjusted) but not for gait speed. Conclusion These findings show that all patients improved their gait outcomes one year after TKA but only a higher maximal knee flexion during gait may influence the level of patient satisfaction.

Background Total knee arthroplasty (TKA) is the operation of choice in patients with end-stage knee osteoarthritis (OA). Up to 1 in 5 patients still encounter functional limitations after TKA, partly explaining patient dissatisfaction. Which gait ability to target after TKA remains unclear. To determine whether Minimal Clinical Important Improvement (MCII) or Patient Acceptable Symptom State (PASS) values could be derived from gait parameters recorded in patients with TKA. And, if so, to define those values. Methods In this ancillary study, we retrospectively analyzed gait parameters of patients scheduled for a unilateral TKA between 2011 and 2013. We investigated MCII and PASS values for walking speed and maximal knee flexion using anchor-based methods: 5 anchoring questions based on perceived body function and patients’ satisfaction. Results Over the study period, 79 patients performed a clinical gait analysis the week before and 1 year after surgery, and were included in the present study. All clinical and gait parameters improved 1 year after TKA. Nevertheless, changes in gait outcomes were not associated with perceived body function or patients’ satisfaction, precluding any MCII estimation in gait parameters. PASS values, however, could be determined as 1.2 m/s for walking speed and 50° for maximal knee flexion. Conclusion In this study, we found that MCII and PASS values are not necessarily determinable for gait parameters after TKA in patients with end-stage OA. Using anchor questions based on perceived body function and patient’s satisfaction, MCII could not be defined while PASS values were potentially useful. Level of evidence Level III

Introducao: Dentre os eventos incapacitantes com o avanco da idade, destaca-se a Sindrome da Fragilidade do Idoso (SFI), implicando em maior risco de quedas, incapacidade, hospitalizacao e ate mesmo a morte. Objetivo: verificar a relacao entre dinapenia, sarcopenia e mobilidade funcional de idosos frageis institucionalizados. Material e Metodos: Um estudo descritivo correlacional foi conduzido com 26 idosos institucionalizados de ambos os sexos com idade media de 82,3 ±6 anos. Todos os participantes apresentavam tres ou mais caracteristicas de fragilidade segundo criterios estabelecidos. Os instrumentos de medida utilizados como criterios de inclusao foram o Mini Exame do Estado Mental e a Escala de Depressao Geriatrica. Os instrumentos especificos foram o Questionario Internacional de Atividade Fisica, Timed Up and Go Test, dinamometro de preensao manual, dinamometro portatil para avaliar grandes grupos musculares e a equacao de Lee para estimar da massa muscular total. Resultados: A mobilidade funcional correlacionou-se de forma significativa apenas com as medidas de forca muscular (preensao manual r-0,50, membros superiores r-0,59, membros inferiores r-0,61 e a forca muscular apendicular, considerando os quatro membros r-0,63). Conclusao: Programas de prevencao e tratamento da SFI dependem do preciso diagnostico clinico. A acuracia da avaliacao da forca muscular e fundamental, e a utilizacao da dinamometria pode contribuir de forma decisiva para esta finalidade

Objetivou-se verificar as características de dois protocolos de avaliação de força de preensão manual como subsídio para prescrição de treinamento no remo. Participaram seis atletas profissionais da modalidade de remo (25 ± 5 anos) e 11 não atletas, todos homens. Dois protocolos de avaliação (contínuo e intervalar) foram efetuados. Os valores dos parâmetros de força e decréscimo percentual da força calculados foram empregados para verificar diferenças entre os membros (teste t pareado) e entre os grupos (teste t independente). O protocolo contínuo mostrou-se mais sensível para detectar diferenças nos valores de força e decréscimo percentual de força entre diferentes membros e entre os grupos, enquanto o protocolo intervalar foi eficaz para identificar os valores de força máxima. The aim of this study was verify the characteristics of two protocols for handgrip assessment as a subsidy for prescription of training in rowing. The study included 6 male professional athletes of the sport of rowing and 11 male non-athletes. Two assessment protocols (continuous and intermittent) were conducted. Parameter values of strength and percentage decrease of the force (calculated) were used to verify differences between hands (paired t test) and between the groups ( t test). The continuous protocol was more sensitive to detect differences in the values of strength and percentage decrease in strength between members and among professional rowing athletes and non-athletes. The intermittent protocol was more efficient to identify the values of maximum force of individuals. El objetivo de este estudio fue verificar la caracterización de dos protocolos de evaluación de fuerza de prensión como un subsidio para la prescripción del entrenamiento de remo. Participaron 6 atletas profesionales de remo y 11 no atletas, todos hombres con (25 ± 5 años). Dos protocolos de evaluación (continuo e intervalar) fueron efectuados. Los valores de fuerza y disminución porcentual de fuerza fueron utilizados para verificar diferencias entre los miembros (test t pareado) y entre los grupos (test t independiente). El protocolo continuo se mostró más sensible para detectar diferencias en los valores de fuerza y disminución porcentual de fuerza entre miembros y entre grupos, mientras que el protocolo intervalar fue eficaz para identificar los valores de fuerza máxima.

Objective Walking troubles represents the main limiting factor for patients with multiple sclerosis (PwMS). Fampridine, is specifically indicated in these troubles. The objective of this study was to estimate the long-term efficiency of this treatment and try to determine the profile of responder patients. Material/patients and methods A longitudinal monocentric study was realized in the University Hospital of Besancon between 2014 and 2016. The patients benefited from 4 evaluations: 1 week before the beginning of the treatment, the day of the first taking then 2 weeks and 20 months after the introduction of the treatment. An evaluation of the walking speed, the endurance, the balance as well as the subjective score were made. An analysis of the spatiotemporal parameters of walk was made using Gaitrite System. Results Fifty-eight patients were included. In total, 65.5% patients are considered as responders at 14 days. Forty-five patients were analyzed at long-term. At short-term, we find a 19% improvement of walking speed, as well as an improvement of the score MSWS-12, the TUGT and of all spatiotemporal parameters. In the long-term, we find a significant decline of all parameters in both groups. Discussion – conclusion Fampridine improves walking speed, endurance, perception of the patient and the spatiotemporal parameters of walk at short-term. In long-term, the treatment seems to allow to stabilize the patients in spite of the evolution of the disease. The treatment seems more effective at the patients presenting a MS for several years with an important infringement of walking speed.

OBJECTIVES: To analyze aspects related with wheelchair propulsion. MATERIALS AND METHODS: In order to delineate this review the search for information was carried out within electronics databases, using the following descriptors: "wheelchair propulsion", "wheelchair biomechanics" e "wheelchair users". Full papers published in English and French were included in the study. RESULTS: The wheelchair propulsion is a complex movement that requires the execution of repeated bi manual forces applications during a short time period. In this movement high levels of force must be produced due to the bad mechanical performance of the wheelchair. Could be characterized that wheelchair users are not satisfied with their wheelchair, the places are not adapted to their presence and lack of specific criteria for the adjustment of this equipment. The main points to look at are the seat height in relation to elbow flexion (100-120 degrees) with his hand in the propulsion rim and tire pressure. The semicircular mode of technique propulsion seems to be more appropriate; in this pattern the wheelchair user returns his hand under the rim after propulsion. Efforts in wheelchairs are high and the incidence of injuries in wheelchair users is high. CONCLUSION: One can conclude that in spite of researchers’ efforts there are still many divergences between topics and methods of evaluation, what makes difficult to apply the experimental results to the wheelchairs users’ daily life. OBJETIVOS: Analisar aspectos relacionados à propulsão em cadeira de rodas. MATERIAIS E MÉTODOS: Para o delineamento desta revisão, foi realizada uma busca em bases de dados eletrônicas a partir das seguintes palavras-chave: wheelchair propulsion, wheelchair biomechanics e wheelchair uses. Foram selecionados artigos completos nas línguas francesa e inglesa. RESULTADOS: A propulsão em cadeira de rodas é um movimento complexo que requer a execução de repetidas aplicações de força durante curto período de tempo. Nesse movimento são exigidos altos níveis de força em razão do baixo rendimento mecânico da cadeira. Pôde ser caracterizado que os cadeirantes não estão satisfeitos com suas cadeiras, os locais não estão adaptados à sua presença e faltam critérios específicos para o ajuste desse importante equipamento. Os principais pontos a serem observados, quanto aos ajustes, são a altura do banco em relação à posição de flexão do cotovelo (100 a 120 graus) com a mão no aro de propulsão e o cuidado com a pressão nos pneus. Quanto à técnica de propulsão, o modo semicircular parece ser o mais indicado, pois nesse padrão o cadeirante realiza a propulsão e retorna a mão por baixo do aro. Os esforços na cadeira de rodas são altos e a incidência de lesões em cadeirantes é elevada. CONCLUSÃO: Pode-se concluir que, apesar dos esforços das pesquisas, ainda existem muitas divergências entre os temas e os métodos de avaliações adotados, o que impede que boa parte dos resultados encontrados seja aplicável à vida diária dos usuários de cadeira de rodas.