Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials

Background: Treatment efficacy of physical agents in osteoarthritis of the knee (OAK) pain has been largely unknown, and this systematic review was aimed at assessing their short-term efficacies for pain relief. Methods: Systematic review with meta-analysis of efficacy within 1–4 weeks and at follow up at 1–12 weeks after the end of treament. Results: 36 randomised placebo-controlled trials (RCTs) were identified with 2434 patients where 1391 patients received active treatment. 33 trials satisfied three or more out of five methodological criteria (Jadad scale). The patient sample had a mean age of 65.1 years and mean baseline pain of 62.9 mm on a 100 mm visual analogue scale (VAS). Within 4 weeks of the commencement of treatment manual acupuncture, static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo. Pulsed electromagnetic fields offered a small reduction in pain of 6.9 mm [95% CI: 2.2 to 11.6] (n = 487). Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low level laser therapy (LLLT) offered clinically relevant pain relieving effects of 18.8 mm [95% CI: 9.6 to 28.1] (n = 414), 21.9 mm [95% CI: 17.3 to 26.5] (n = 73) and 17.7 mm [95% CI: 8.1 to 27.3] (n = 343) on VAS respectively versus placebo control. In a subgroup analysis of trials with assumed optimal doses, short-term efficacy increased to 22.2 mm [95% CI: 18.1 to 26.3] for TENS, and 24.2 mm [95% CI: 17.3 to 31.3] for LLLT on VAS. Follow-up data up to 12 weeks were sparse, but positive effects seemed to persist for at least 4 weeks after the course of LLLT, EA and TENS treatment was stopped. Conclusion: TENS, EA and LLLT administered with optimal doses in an intensive 2–4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK

The association between cognitive impairment, gait speed, and Walk ratio

Background: Gait speed has been found to be associated with cognitive function. However, gait speed is an unspecific measure that may not be informative about gait patterns. The Walk ratio (step length divided by step frequency) can be measured without specialized equipment, and has been suggested as an indicator of central gait control. However, the association with cognitive function is unknown. Research question: Is there a relationship between Walk ratio and cognitive function, and gait speed and cognitive function? Methods: This was a systematic literature review of studies where spatiotemporal gait parameters was reported in populations with cognitive impairment. The search was performed through PubMed, PEDro, AMED, Cochrane, Embase, MEDLINE, and PsycINFO. The studies had to contain either the Walk ratio, or report average step length and average step frequency. In the latter case, the average step length was divided by the average step frequency. The studies also had to report gait speed and the minimal mental state examination (MMSE). Studies testing patients on treadmills or that did not state the exclusion of patients with neurologic or orthopedic diseases, possible affecting gait ability, were excluded. Results: A total of 24 studies were included, consisting of 909 patients with cognitive impairment and 4,108 healthy controls. The patient group had a lower Walk ratio (mean difference 0.07, p ≤ 0.001) and gait speed (mean difference 0.26, p ≤ 0.001) than the healthy controls. Using linear regression models, we found an association between the MMSE and the Walk ratio (R2 = 0.29, p < 0.001) and gait speed (R2 = 0.41, p < 0.001) in separate, unadjusted models. In a final model with Walk ratio, gait speed and age, Walk ratio was not significantly associated with MMSE, while gait speed was. Significance: Our results suggest that preferred gait speed may be preferable to the Walk ratio when assessing older adults with cognitive impairment.publishedVersio

Gjenvinning av mobilitet etter hoftebrudd – en prospektiv kohortestudie

Hensikt: Å undersøke hva som karakteriserer eldre med hoftebrudd som ikke gjenvinner mobilitet, samt å beskrive mengden fysioterapi denne gruppen mottar det første året etter hoftebrudd. Design: Prospektiv kohortestudie. Materiale: 129 hjemmeboende eldre (≥ 70 år) med hoftebrudd gjennomførte testing under sykehusoppholdet, og etter fire og 12 måneder postoperativt. Metode: Gjenvinning av mobilitet etter 12 måneder ble klassifisert ved bruk av mobilitetsskalaen på Nottingham I-ADL Skala. Logistisk regresjon ble benyttet for å evaluere sammenhengen mellom å ikke gjenvinne mobilitet og fysisk funksjon (Short Physical Performance Battery), kognitiv funksjon (Klinisk demens vurdering og Mini Mental Status Evaluering), smerte ved gange (numerisk smerteskala), bekymring for fall (Short Falls Efficacy Scale International), depresjon (Geriatrisk depresjonsskala) og antall fysioterapikonsultasjoner basert på tall fra HELFO og kommunal journal. Resultat: Gjennomsnittsalder i utvalget var 82.8 år (±6.26), og 55% av deltakerne gjenvant ikke mobilitet 12 måneder etter hoftebrudd. Fysisk funksjon ved fire måneder var en uavhengig prediktor for å ikke gjenvinne mobilitet (OR 0.68; p<0.001; KI 0.56-0.83). Det var stor variasjon i mengde fysioterapi deltakerne mottok (fra 1-98), med 32 konsultasjoner som median. Konklusjon: En stor andel av eldre som gjennomgår hoftebrudd gjenvinner ikke samme mobilitet som før bruddet. Fysisk funksjon ved fire måneder er viktig for gjenvinning av mobilitet, mens mengpublishedVersio

Gjenvinning av mobilitet etter hoftebrudd – en prospektiv kohortestudie

Hensikt: Å undersøke hva som karakteriserer eldre med hoftebrudd som ikke gjenvinner mobilitet, samt å beskrive mengden fysioterapi denne gruppen mottar det første året etter hoftebrudd. Design: Prospektiv kohortestudie. Materiale: 129 hjemmeboende eldre (≥ 70 år) med hoftebrudd gjennomførte testing under sykehusoppholdet, og etter fire og 12 måneder postoperativt. Metode: Gjenvinning av mobilitet etter 12 måneder ble klassifisert ved bruk av mobilitetsskalaen på Nottingham I-ADL Skala. Logistisk regresjon ble benyttet for å evaluere sammenhengen mellom å ikke gjenvinne mobilitet og fysisk funksjon (Short Physical Performance Battery), kognitiv funksjon (Klinisk demens vurdering og Mini Mental Status Evaluering), smerte ved gange (numerisk smerteskala), bekymring for fall (Short Falls Efficacy Scale International), depresjon (Geriatrisk depresjonsskala) og antall fysioterapikonsultasjoner basert på tall fra HELFO og kommunal journal. Resultat: Gjennomsnittsalder i utvalget var 82.8 år (±6.26), og 55% av deltakerne gjenvant ikke mobilitet 12 måneder etter hoftebrudd. Fysisk funksjon ved fire måneder var en uavhengig prediktor for å ikke gjenvinne mobilitet (OR 0.68; p<0.001; KI 0.56-0.83). Det var stor variasjon i mengde fysioterapi deltakerne mottok (fra 1-98), med 32 konsultasjoner som median. Konklusjon: En stor andel av eldre som gjennomgår hoftebrudd gjenvinner ikke samme mobilitet som før bruddet. Fysisk funksjon ved fire måneder er viktig for gjenvinning av mobilitet, mens mengde fysioterapi ikke viste noen sammenheng med mobilitet ett år etter hoftebrudd.publishedVersio

Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials.

BACKGROUND: Treatment efficacy of physical agents in osteoarthritis of the knee (OAK) pain has been largely unknown, and this systematic review was aimed at assessing their short-term efficacies for pain relief. METHODS: Systematic review with meta-analysis of efficacy within 1-4 weeks and at follow up at 1-12 weeks after the end of treatment. RESULTS: 36 randomised placebo-controlled trials (RCTs) were identified with 2434 patients where 1391 patients received active treatment. 33 trials satisfied three or more out of five methodological criteria (Jadad scale). The patient sample had a mean age of 65.1 years and mean baseline pain of 62.9 mm on a 100 mm visual analogue scale (VAS). Within 4 weeks of the commencement of treatment manual acupuncture, static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo. Pulsed electromagnetic fields offered a small reduction in pain of 6.9 mm [95% CI: 2.2 to 11.6] (n = 487). Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low level laser therapy (LLLT) offered clinically relevant pain relieving effects of 18.8 mm [95% CI: 9.6 to 28.1] (n = 414), 21.9 mm [95% CI: 17.3 to 26.5] (n = 73) and 17.7 mm [95% CI: 8.1 to 27.3] (n = 343) on VAS respectively versus placebo control. In a subgroup analysis of trials with assumed optimal doses, short-term efficacy increased to 22.2 mm [95% CI: 18.1 to 26.3] for TENS, and 24.2 mm [95% CI: 17.3 to 31.3] for LLLT on VAS. Follow-up data up to 12 weeks were sparse, but positive effects seemed to persist for at least 4 weeks after the course of LLLT, EA and TENS treatment was stopped. CONCLUSION: TENS, EA and LLLT administered with optimal doses in an intensive 2-4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK

Ballistic strength training in adults with cerebral palsy may increase rate of force development in plantar fexors, but transition to walking remains unclear: a case series

Background Persons with cerebral palsy (CP) walk with reduced ankle plantar flexor power compared to typically developing. In this study, we investigated whether a ballistic strength-training programme targeting ankle plantar flexors could improve muscle strength, muscle architecture and walking function in adults with CP. Methods Eight adults (mildly affected CP) underwent eight weeks of ballistic strength training, with two sessions per week. Before and after the intervention preferred walking speed, ankle plantar flexion rate of force development (RFD), maximal voluntary contraction (MVC), muscle thickness, pennation angle and fascicle length were measured. Data are presented for individuals, as well as for groups. Group changes were analysed using the Wilcoxon signed-rank test. Results Data were analysed for eight participants (five women, mean age 37.9 years; six GMFCS I and two GMFCS II). Two participants increased their walking speed, but there were no significant group changes. In terms of muscle strength, there were significant group changes for RFD at 100 ms and MVC. In the case of muscle architecture, there were no group changes. Conclusion In this study, we found that eight weeks of ballistic strength training improved ankle plantar flexor muscle strength but walking function and muscle architecture were unchanged. Larger studies will be needed to obtain conclusive evidence of the efficacy of this training method.publishedVersio

The Role of Psychological Readiness in Return to Sport Assessment After Anterior Cruciate Ligament Reconstruction

Background: Knowledge about the predictive value of return to sport (RTS) test batteries applied after anterior cruciate ligament reconstruction (ACLR) is limited. Adding assessment of psychological readiness has been recommended, but knowledge of how this affects the predictive ability of test batteries is lacking. Purpose: To examine the predictive ability of a RTS test battery on return to preinjury level of sport and reinjury when evaluation of psychological readiness was incorporated. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 129 patients were recruited 9 months after ACLR. Inclusion criteria were age ≥16 years and engagement in sports before injury. Patients with concomitant ligamentous surgery or ACL revision surgery were excluded. Baseline testing included single-leg hop tests, isokinetic strength tests, the International Knee Documentation Committee (IKDC) Subjective Knee Form 2000, a custom-made RTS questionnaire, and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale. The RTS criteria were IKDC 2000 score ≥85% and ≥85% leg symmetry index on hop and strength test. At a 2-year follow-up evaluation, further knee surgery and reinjuries were registered and the RTS questionnaire was completed again. Regression analyses and receiver operating characteristic analyses were performed to study the predictive ability of the test battery. Results: Out of the 103 patients who completed the 2-year follow-up, 42% returned to their preinjury level of sport. ACL-RSI 9 months after surgery (odds ratio [OR], 1.03) and age (OR, 1.05) predicted RTS. An ACL-RSI score <47 indicated that a patient was at risk of not returning to sport (area under the curve 0.69; 95% CI, 0.58-0.79), with 85% sensitivity and 45% specificity. The functional tests did not predict RTS. Six patients sustained ACL reinjuries and 7 underwent surgery for other knee complaints/injuries after RTS testing. None of the 29 patients who passed all RTS criteria, and were therefore cleared for RTS, sustained a second knee injury. Conclusion: ACL-RSI and age were predictors of 2-year RTS, while functional tests were not informative. Another main finding was that none of the patients who passed the 85% RTS criteria sustained another knee injury.publishedVersio

Anterior cruciate ligament—return to sport after injury scale: validation of the Norwegian language version

Purpose Evidence is emerging on the importance of psychological readiness to return to sport after anterior cruciate ligament (ACL) reconstruction. The ACL-Return to Sport after Injury scale (ACL-RSI) is developed to assess this. The aim of the current study was to translate ACL-RSI into Norwegian and examine the measurement properties of the Norwegian version (ACL-RSI-No). Methods ACL-RSI was translated according to international guidelines. A cohort of 197 ACL-reconstructed patients completed ACL-RSI-No and related questionnaires nine months post-surgery. One hundred and forty-six patients completed hop tests and 142 patients completed strength tests. Face and structural validity (confirmative factor analysis and explorative analyses), internal consistency [Cronbach’s alpha (α)], test–retest reliability [Intraclass Correlation Coefficients (ICC)], measurement error [Standard error of measurement (SEM) and smallest detectable change at individual (SDCind) and group level (SDCgroup)] and construct validity (hypotheses testing; independent t tests, Pearson’s r) were examined. Results ACL-RSI-No had good face validity. Factor analyses suggested that the use of a sum score is reasonable. Internal consistency and test–retest reliability were good (α 0.95, ICC 0.94 (95% CI 0.84–0.97) and measurement error low (SEM 5.7). SDCind was 15.8 points and SDCgroup was 2.0. Six of seven hypotheses were confirmed. Conclusions ACL-RSI-No displayed good measurement properties. Factor analyses suggested one underlying explanatory factor for “psychological readiness”—supporting the use of a single sum score. ACL-RSI-No can be used in the evaluation of psychological readiness to return to sport after ACL injury. Level of evidence III.publishedVersio

Walking and balance in older adults with age-related hearing loss: A cross-sectional study of cases and matched controls

Background: Hearing loss (HL) is prevalent in older individuals. It is suggested that there is an association between age-related HL, walking and balance, leading to poorer function and increased risk of falls in older individuals. Research question: Is HL associated with physical performance, gait variability, and postural sway in older adults, and will additional dizziness moderate the effect of HL on balance? Methods: In this cross-sectional study we examined 100 older individuals (age ≥70 years, 60 % females), divided in two groups, with or without age-related HL. Physical function and balance were evaluated by the Short Physical Performance Battery (SPPB), postural sway measured on a force platform (posturography), and balance in walking (gait variability) measured with a body-worn sensor. Multiple linear regression was used to examine the relationships between the variables, with physical function and balance as outcomes and HL as a dichotomous exposure (>30 dB). For all analyses, we further tested if associations were modified by self-reported dizziness. Results: Multiple regression analysis with HL, age, sex, education, diabetes, and cardiovascular disease revealed a significant association between reduced SPPB and HL. Multiple linear regression analysis also showed that HL was associated with increased postural sway on firm surface with eyes open and closed after adjusting for age, sex, education, diabetes, and cardiovascular disease. There was significant association between HL and increased gait variability during dual task walking in all directions after adjusting for age, sex, education, diabetes, and cardiovascular disease. Further, we found that the association between HL and SPPB was significantly stronger in those with dizziness compared with those without dizziness. Dizziness also modified the association of HL with the other SPPB sub-scores but not for the other outcomes of postural sway or gait variability. Significance: In this study, age-related HL was associated with worse physical performance as measured by SPPB, postural sway, and gait variability. This relationship illustrates the importance of assessing physical performance in people with HL to prevent risk of falls and disability.publishedVersio