Activities Of Daily Living Subscale Research Articles

Neurofunctional Correlates of Activities of Daily Living in Patients with Posterior Cortical Atrophy

AbstractBackgroundResearch on posterior cortical atrophy (PCA) has concentrated on cognitive decline, especially visual processing deficits. However, few studies have focused on the activities of daily living (ADL), and no study has investigated the neurometabolic basis of ADL impairments. We aimed to identify regions of hypometabolism associated with ADL in PCA patients.MethodTwenty‐nine PCA patients, 35 typical Alzheimer’s disease (tAD) patients, and 26 healthy volunteers were recruited. Each subject completed a scale for total ADL [TADL, including basic ADL (BADL) and instrumental ADL (IADL) subscales] and 18F fluorodeoxyglucose positron emission tomography. Voxel‐wise multivariable regression analysis was conducted at the level of the whole‐brain, PCA‐related hypometabolism patterns, and PCA‐specific hypometabolism patterns.ResultThe general cognitive status of PCA patients was similar to tAD patients; however, they performed worse in TADL, BADL, and IADL. In all analysis levels, TADL was associated with the bilateral parietal lobe, including the right superior parietal lobe, right inferior parietal cortex, right angular gyrus, and left superior parietal lobe. BADL was associated with the bilateral parietal lobe located in the right superior parietal lobe, right inferior parietal cortex, and left superior parietal lobe. IADL was associated with the bilateral superior parietal lobe. Bilateral superior parietal lobe hypometabolism was associated with TADL, BADL, and IADL.ConclusionHypo‐metabolism in the bilateral superior parietal lobes contributes to the decline of ADL in PCA, which is a promising target for future non‐invasive neuromodulation interventions.

Radiographic and Clinical Results of 4rd Generation Minimally Invasive Bunion Surgery for Symptomatic Hallux Valgus

Category: Bunion; Other Introduction/Purpose: Minimally invasive techniques for surgical treatment of hallux valgus has gained popularity over the past few years. Most published reports involve combined minimally invasive Chevron and Akin osteotomies (MICA) performed by a single surgeon. This study reports radiographic and clinical results on patients who underwent minimally invasive transverse distal 1st metatarsal and Akin osteotomies by 3 fellowship trained Foot & Ankle orthopedic surgeons. A minimally invasive transverse distal 1st metatarsal osteotomy has advantages over MIS chevron osteotomy as it is less technically demanding and in theory, the surgeon can control 1st metatarsal head rotation to improve sesamoid position. Methods: Ninety-five consecutive patients between 2019 and 2021 with symptomatic Hallux valgus without 1st tarsometatarsal or metatarsal phalangeal joint arthritis or TMT joint instability were followed for at least one year. Primary radiographic outcomes include pre and postoperative hallux valgus and 1-2 intermetatarsal angles. Pain relief was measured by VAS scores. Patient Reported Outcomes (PROMS) used were Foot and Ankle Mobility (FAAM) scores in the dimension of activities of daily living (ADL) and sports. PROMS measured at one year follow-up. Radiographic recurrence was defined as a change in HVA >2.6 degrees between any 2 postoperative radiographs and an HVA >15 degrees. Z-Scores were calculated depending on the patient's demographics based on normative values to assess the deviation from a normal population FAAM scores. Results: Demographics and preoperative bunion classification of all patients included in this study can be found in table 1. Average pre-op HVA and IMA were 24.9 and 12.2 degrees respectively and improved to 8.43 and 5.86 degrees (p < 0.01) at 3 months. From the 3 months to 12 months, the patients’ HVA and IMA average was 9.39 and 6.85, but this change was not statistically significant (p = 0.35). VAS scores improved from 5.37 preoperatively to 1.9 at final follow up (p < 0.01). The average postoperative FAAM ADL score was (86.34 +/- 17.18) and z-score was (-0.08 +/- 1.16). The average postoperative FAAM sport score was (66.12 +/- 30.93) and z-score was (-0.26 +/- 1.94). Conclusion: Overall, the results of the study affirm the literature that third generation MIS hallux valgus surgery remains a good option. This study showed no infections in patients undergoing MIS hallux valgus surgery and the correction of the hallux valgus angles that persisted at 12 months with low recurrence rates. At this time, the results show a trend toward lower FAAM scores postoperatively at one year follow-up that was significant in the sports subscore but the difference from a normal population is not significant in the ADL subscore. Longer follow-up is needed to evaluate the trend further.

A Comparative Study of Clinical Outcomes Between Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty: A Propensity Score-Matched Cohort Study.

We investigated a comparison of clinical outcomes between cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty. However, it is still controversial which design leads to better clinical results. In clinical settings, choosing either CR or PS is likely based on the surgeon's preferences. In this study, short-term clinical outcomes between CR and PS in patients who received a single knee prosthesis were compared using propensity score matching. Two hundred and twelve CR and 43 PS of a single knee prosthesis were enrolled in this study. After propensity score matching, 34 knees each in the CR and PS groups were chosen and were without significant differences in age at operation, gender, BMI, preoperative range of motion (ROM), preoperative femorotibial angle (FTA), and presence or absence of patellar replacement. Clinical scores, including ROM, Knee Society score (KSS), knee injury and osteoarthritis outcome score (KOOS), except for the sports subscale, were compared between the CR and PS groups preoperatively and two years postoperatively. Postoperatively, there were no significant differences in FTA, ROM, or KSS. Preoperative scores for the KOOS except for the pain subscale were comparable between the groups. Postoperatively, however, the PS group had a significantly higher score in the ADL subscale compared to the CR group (PS: 89.5 vs. CR: 80.8,p= 0.017). The KOOS subscales other than activities of daily living (ADL) were comparable between the groups. In this propensity score-matched cohort study, PS showed a better outcome for the ADL than the CR design. These findings suggest that choosing either CR or PS should not depend on the surgeon's preferences. A PS design may be preferable to CR for elderly patients.

Factors associated with persistent pain in college athletes with a history of lateral ankle sprain

ObjectivesTo determine the factors associated with and prevalence of persistent pain in college athletes with chronic ankle instability (CAI) and with previous lateral ankle sprain (LAS) without CAI. DesignCross-Sectional Study. SettingOnline survey at one university. ParticipantsOf the 385 respondents surveyed online, 140 were identified as having experienced at least one LAS (CAI group: 69, coper group: 24, LAS group not classified as either: 47). Main outcome measuresFactors associated with the presence of pain during activities of daily living (ADL) and sports were identified using multivariate logistic regression analyses. Independent variables were demographics, injury characteristics, the Identification of Functional Ankle Instability (IdFAI) score, the Foot and Ankle Ability Measure Sports (FAAM-Sports) and ADL subscales, and the Tampa Scale for Kinesiophobia-11 score. ResultsThe prevalence of pain during ADL and sports in the three groups was 16.7%–42.0% and 33.3%–56.5%, respectively. FAAM-Sports and IdFAI score were significantly associated with pain during ADL and sports in the CAI group (odd ratio: 0.923 and 1.145), respectively. No significant pain-related factors were found in the coper and LAS groups. ConclusionsLower self-reported function and greater perceived ankle instability may be important factors in pain management in athletes with CAI.

Impact of Calcium Fructoborate on WOMAC and McGill Subscales and Individual WOMAC Questions: Post-Hoc Analyses of Data from a Previously Published 90-Day Randomized Clinical Trial

Calcium fructoborate (CFB) has been shown to reduce overall joint discomfort on the Western Ontario and McMaster University Arthritis Index (WOMAC) and the McGill Pain Questionnaire (MPQ). No study has addressed the impact of CFB on the subscales of these measures, nor on individual questions. Here, we re-examined data from a previously peer reviewed and published 90-day, double-blind, randomized, placebo-controlled study on CFB to determine whether there were subscale or individual questions differences. In the original study participants were randomized into three groups: 1) placebo, 2) a morning dose of 216mg of CFB and evening dose of placebo (CFB1), or 3) a morning and evening dose of 108mg of CFB (CFB2). Our new analyses indicated that by day 30, both CFB groups were distinguishable from placebo on the WOMAC Pain and WOMAC Activities of Daily Living subscales. Furthermore, they were distinguishable from the WOMAC Stiffness subscale by days 60 and 90 (CFB1, CFB2, respectively). Importantly, analyses of individual WOMAC questions revealed differences in at little as 14 days. For the McGill pain subscale, differences emerged by day 7 and 14 between placebo and CFB1/CFB2 groups, respectively, while the affective dimension was different from CFB groups by day 60. For the miscellaneous dimension, placebo was differentiable by day 60 and 90 (CFB1/CFB2, respectively). These data provide greater visibility into CFB’s joint health benefits and suggest that CFB’s effects support real improvements in practical aspects of daily physical activity.

Patient-Reported Outcome Measures After Surgical Management of Unstable Lisfranc Injuries in Athletes.

Athletes sustaining Lisfranc joint instability after a low-energy injury often undergo surgical fixation. Limited studies report validated patient-reported outcome measures (PROMs) for this specific patient population. Our purpose was to report PROMs of athletes experiencing instability after a low-energy Lisfranc injury and undergoing surgical fixation. Twenty-nine athletes (23 competitive, 6 recreational) sustained an unstable Lisfranc injury (14 acute, 15 chronic) and met our inclusion criteria. Injuries were classified as acute if surgically managed within 6 weeks. All athletes completed validated PROMs pre- and postoperatively. The cohort underwent various open reduction internal fixation methods. We evaluated outcomes with the Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL) and sports subscales. Fourteen of 29 (48%) athletes reported PROMs at ≥2 years with a median follow-up time of 44.5 months. Substantial improvement for both FAAM ADL (50% vs 93%; P < .001) and sports (14.1% vs 80%; P = .002) subscales were found, when comparing preoperative to postoperative scores at ≥2 years. This study provides outcomes information for the young athletic population that were treated operatively for low-energy Lisfranc injury with apparent joint instability. Based on the FAAM sports subscale, these patients on average improved between their 6-month evaluation and their final ≥2 years but still scored 80% of the possible 100%, which indicates continued but "slight" difficulty with lower extremity function. Level IV, case series.

Functional Outcomes of Arthroscopic OS Trigonum Excision in Adolescents

Background:Outcomes of symptomatic os trigonum excision have been well described as a successful treatment in adults; however, the literature lacks information on standardized longer term functional outcomes in the pediatric population.Hypothesis/Purpose:This study intends to report functional outcomes of arthroscopic os trigonum excision in adolescents who failed conservative management, with the hypothesis that these younger patients would have similar, successful outcomes of adult patients.Methods:A retrospective study was performed on adolescents who underwent arthroscopic os trigonum excision at a single institution between 2011 and 2017. Patient demographic, clinical history, radiographic, and operative data were documented. Outcome measures included the Foot and Ankle Ability Measure (FAAM) score comprised of the Activities of Daily Living (ADL) and Sports subscales, Single Assessment Numeric Evaluation (SANE) score, ability to return to the same level of sport, and any additional foot/ankle surgery.Results:Ten patients (12 ankles) met criteria with a mean age at surgery of 15.4 years (range, 12 to 18 years) and a mean follow-up of 6.5 years (range, 2.8 to 9.1 years). Mean FAAM ADL subscale, Sports subscale, and SANE scores were 91.0 ± 15.5, 76.3 ± 29.1, and 88.6 ± 15.1 respectively. A chronic duration of symptoms prior to surgery was associated with a lower FAAM Sports current level of function score (p=0.032). Four patients (40%) discontinued their sport due to continued ankle issues and reported significantly lower FAAM ADL subscale (p=0.01), Sports subscale (p<0.001), and SANE scores (p = 0.002).Conclusion:Os trigonum syndrome in the adolescent population may not have the same rate of success as that seen in adult athletes over the long term. However, if proven to be refractory to conservative measures and surgical intervention is indicated, patients and their families should be counseled about the risk for persistent ankle symptoms and the possibility that they may not be able to return to their previous level of sport.

Association between sensorimotor function and visual assessment of postural orientation in patients with ACL injury

ObjectivesTo investigate the association between sensorimotor function and visual assessment of postural orientation during execution of weight-bearing activities in patients with anterior cruciate ligament reconstruction (ACLR). DesignCross-sectional study. SettingLaboratory. ParticipantsFifty-two individuals (23 women and 29 men, mean (SD) age 26.5 (6.4)) approximately 7 months after ACLR. Main outcome measuresSensorimotor function (proprioception, ankle dorsiflexion range of motion, and isometric muscle strength of the hip, knee, and trunk) were recorded on the injured leg. Postural orientation errors (POEs) were visually scored from video-recordings of the injured leg during execution of 5 functional tasks, and POE subscales activities of daily living (ADL) and Sport, and Total POE score were used in the analysis. ResultsLower hip external rotation strength was associated with higher Total POE score (B = −24.4, p = 0.041) and higher POE subscale ADL score (B = −24.9, p = 0.03). No associations between sensorimotor function and POE subscale Sport were found. ConclusionsDecreased hip external rotation strength might contribute to higher scores on the POE subscale ADL and the Total POE score, in men and women following ACLR. Future studies will reveal if strengthening of hip external rotation strength improves postural orientation.

Both Intraoperative Medial and Lateral Joint Stabilities at Midflexion Influence Postoperative Patient-Reported Outcome Measures Following Bi-Cruciate Stabilized Total Knee Arthroplasty.

Bi-cruciate stabilized (BCS) total knee arthroplasty (TKA) was developed to approximate normal knee kinematics and is expected to improve clinical outcomes. However, the effects of soft tissue balance at the medial or lateral compartment on patient-reported outcome measures (PROMs) following BCS TKA are unclear. The purpose of this study was to clarify the relationship between the medial or lateral component gaps and PROMs following BCS TKA. One hundred seventeen knees with varus deformities which underwent BCS TKA were included in this study. They were divided into two groups according to the validated Japanese version of the Knee Injury and Osteoarthritis Outcome Score for each subscale of pain, symptoms, and activities of daily living (ADL) at 1 year postoperatively: group H consisted of patients with ≥90 points and group L consisted of patients with <90 points. Intraoperative medial and lateral joint laxities at 0°, 30°, 60°, 90°, and 120° flexion measured using a tensor device were compared between the two groups in each subscale. In the pain subscale, the medial joint laxities at 30° (p < 0.05) and 60° flexion (p < 0.05) in group H were significantly smaller than those in group L. In the ADL subscale, the medial joint laxity at 60° flexion in group H was significantly smaller than that in group L (p < 0.05). In the symptom subscale, the lateral joint laxity at 60° flexion in group H was significantly smaller than that in group L (p < 0.05). Surgeons should pay attention to the importance of both medial and lateral joint stabilities to achieve better postoperative PROMs following BCS TKA.

Predictors of Disparities in Patient-Reported Outcomes before and after Arthroscopic Meniscectomy.

The purpose of this study is to identify predictors of disparities in patient-reported outcome measures (PROMs) before and after arthroscopic meniscectomy. Knee injury and Osteoarthritis Outcome Score (KOOS) was used in this study. All patients who underwent single-knee arthroscopic meniscectomy from January 2012 to March 2018 performed by a single surgeon at an academic safety-net hospital were identified. We excluded patients who had undergone ipsilateral previous knee surgery, bilateral meniscectomy, or concomitant ligament, cartilage, or osteotomy procedures, and those with severe radiographic osteoarthritis in the operated knee, missing preoperative data, or military insurance. Data abstracted from medical records included demographics (age, sex, race, insurance type), clinical characteristics (body mass index, Charlson comorbidity index, and Kellgren-Lawrence [KL] grade), procedure codes, and KOOS assessed before and 90 days after surgery. Multivariable analyses investigated the associations between patient characteristics and the KOOS Pain, other Symptoms, and Function in activities of daily living (ADL) subscales. Among 251 eligible patients, most were female (65.5%), half were of nonwhite race (50.2%), and almost one third were insured by Medicaid (28.6%). Medicaid and black race were statistically significant (p < 0.05) predictors of worse preoperative values for all three KOOS subscales. Medicaid insurance also predicted a lower likelihood of successful surgery, defined as meeting the 10-point minimal clinically important difference, for the KOOS symptoms (p < 0.05) and KOOS ADL (p < 0.05) subscales. Compared with patients without definitive evidence of radiographic osteoarthrosis (KL grade 1), those with moderate radiographic osteoarthritis (KL grade 3) were less likely to have a successful surgical outcome (p < 0.05 for all subscales). Worse preoperative KOOS values predicted worse postoperative KOOS values (p < 0.001 for all subscales) and a lower likelihood of surgical success (p < 0.01 for all subscales). Insurance-based disparities in access to orthopaedic care for meniscus tears may explain worse preoperative PROMs and lower success rates of meniscectomy among Medicaid patients. Patients with meniscus tears and radiological and/or magnetic resonance imaging evidence of osteoarthritis should be carefully evaluated to determine the appropriateness of arthroscopic meniscectomy.

Correlation between Level of Functional Ability and Sports Performance among Football Players with Chronic Ankle Instability (CAI)

Background: Chronic ankle instability (CAI) is the most common injury among the football players and it occurs with the players who have history of repetitive ankle sprain. This will result in limitation of functional ability and sport performance of a football player. However, most of the sport rehabilitation focused on the sport performance of an athletic after ankle sprain injury and the functional ability was not stressed on during the return to sport process. It is because the relationship between the level functional ability and sport performance among the football players with CAI is still unclear.&#x0D; Objectives: To determine the relationship between the level of functional ability and sports performance among the football players with chronic ankle instability (CAI).&#x0D; Study Design: Correlation study.&#x0D; Methods: Forty two (n=42) of football players were involved in this study by convenience sampling design. Football players filled in the questionnaire which was Foot and Ankle Ability Measure (FAAM) which included the activities of daily living (ADL) subscale and sports subscale. The total score of each subscale for all the players were calculated and Pearson’s Correlation Coefficient was used to analyze the relationship.&#x0D; Results: A total of twenty five (60%) of the football players had higher ADL score than the sports score while seventeen (40%) of them had higher sports score than ADL score. The mean score for ADL subscale was 79.63±20.64 (%) whereas for sports subscale was 75.59±25.43 (%).  Pearson’s correlation was .92 (r=.92) and it is significant at .01 level (p &lt;.00).&#x0D; Conclusion: There is a significant relationship between the level of functional ability and sports performance among the football players with chronic ankle instability (CAI).&#x0D; Implication: It provides a guideline for the physiotherapy or football player to plan a more structured rehabilitation in order to improve the quality of return to sport performance.

Structural and Construct Validity of the Foot and Ankle Ability Measure (FAAM) With an Emphasis on Pain and Functionality After Foot Surgery: A Multicenter Study

The Foot and Ankle Ability Measure (FAAM) is a patient-reported outcome measure that is available in several languages. We aim to assess the structural and construct validity of the FAAM with an emphasis on pain and functionality after foot surgery. The activities of daily living (ADL) and Sports subscales of the Finnish version of the FAAM were completed by 182 patients who underwent operative treatment for disorders of the foot. Convergent validity was assessed by principal component analysis using Spearman's correlation coefficient between the FAAM subscales and the principal components (Function-PC and Pain-PC) derived from validated patient-reported outcome measures. Subscales were studied for floor and ceiling effects, internal consistency and unidimensionality. Internal consistency was examined with Cronbach's alpha and the subscale structure with exploratory factor analysis. FAAM-ADL had high correlation with the Function-PC (r=0.87, 95% confidence interval [CI] 0.81-0.91) and the Pain-PC (r=0.75, 95% CI 0.65-0.83). FAAM-Sports had moderate correlation (r=0.64, 95% CI 0.50-0.74) with the Function-PC and high correlation (r=0.74, 95% CI 0.64-0.82) with the Pain-PC. No floor or ceiling effects were observed. Cronbach's alpha was 0.97 (95% CI 0.96-0.98) for the ADL and 0.93 (95% CI 0.91-0.95) for the Sports subscales. The results supported the unidimensionality of the FAAM-Sports. Within the ADL subscale, 3 factors were identified, suggesting a 3-factor model for the FAAM overall. Results highlighted the inter-relationship of pain and physical function. Further research on longitudinal validity is needed.

Foot and ankle ability measure: validación de la versión española de 29 ítems en el área de rehabilitación

ObjectiveThe Foot and Ankle Ability Measure (FAAM) is an internationally widely used outcome measure of foot and ankle disorders available in several languages. The purpose of this study was to develop and validate a FAAM Spanish-version with 29 items of Activities of Daily Living (ADL) and SPORT subscales in rehabilitation setting. Materials and methodsA two-stage observational study was conducted. The FAAM was cross-culturally adapted to Spanish through a double-forward translation and a double-backward translation; the psychometric properties were then validated. The participants (n = 147), with various chronic foot and ankle disorders, completed the Spanish version of the Foot and Ankle Ability Measure ADL and SPORT, SF-36, and a pain intensity visual analogue scale (Pain VAS). The full sample was used to determine the factor structure, the internal consistency, and the convergent criterion validity, and a subgroup (n = 46) was used to determine the reliability at 48–72 h. ResultsThe factor structure of Spanish version of FAAM ADL and SPORT subscales were both one-dimensional, demonstrating high internal consistency (α = 0.97 and α = 0.93, respectively). The reliability values were ICC = 0.90 and ICC = 0.76, respectively. The convergent validity criterion of Spanish version of FAAM with the Pain VAS (r = 0.50) and Physical Function of SF-36 (r = 0.64) were moderately correlated. ConclusionsThe Spanish version of FAAM with 29 items are a valid foot and ankle disorder outcome measure with similar psychometric properties to the original version and versions in other languages.

Effect of Concomitant Meniscal Lesions and Meniscal Surgery in ACL Reconstruction With 5-Year Follow-Up: A Nationwide Prospective Cohort Study From Norway and Sweden of 8408 Patients.

Background:Increased knowledge of the factors predicting outcome after anterior cruciate ligament reconstruction (ACLR) is needed.Purpose:To determine the effect of concomitant meniscal lesions, and the surgical management thereof, on patient-reported outcomes 5 years after ACLR.Study Design:Prospective cohort study; Level of evidence, 2.Methods:A total of 15,706 patients who underwent primary unilateral ACLR between 2005 and 2008 were enrolled prospectively and evaluated longitudinally. All patients were part of the Norwegian and Swedish national knee ligament registries. Outcomes at 5-year follow-up were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS). A multivariable linear regression model was used to assess possible effects on prognosis, as measured by KOOS, of a concomitant meniscal lesion and its associated surgical treatment.Results:At a mean follow-up of 5.1 ± 0.2 years, KOOS data were available from 8408 patients: 4774 (57%) patients with no and 3634 (43%) patients with concomitant meniscal lesions (mean patient age, 33.8 ± 10.7 years). Patients with concomitant meniscal lesions reported equal crude mean scores compared with patients without meniscal lesions in all KOOS subscales 5 years after ACLR. The mean improvement in scores from preoperative to the 5-year follow-up was greater for patients with a concomitant meniscal lesion for the KOOS Pain, Activities of Daily Living (ADL), and Sport and Recreation subscales. In the adjusted regression analyses, using patients without concomitant meniscal lesions as the reference, neither no treatment nor resection or repair of medial meniscal lesions were significantly associated with KOOS scores 5 years after ACLR. Except for the ADL subscale, in which a repaired lateral meniscal lesion was associated with better outcome, no significant associations between any of the lateral meniscal lesion treatment categories and KOOS outcome at 5-year follow-up were identified.Conclusion:Concomitant meniscal lesions at the time of ACLR conferred no negative effects on patient-reported outcomes 5 years after ACLR. The improvement in selected KOOS subscales from preoperative to the 5-year follow-up was significantly greater for patients with concomitant meniscal lesions than for patients without such lesions.

Functional Outcomes of Arthroscopic Os Trigonum Excision in Adolescents.

Outcomes of symptomatic os trigonum excision have been well described as a successful treatment in adults; however, the literature lacks information on standardized longer term functional outcomes in the pediatric population. This study intends to report functional outcomes of arthroscopic os trigonum excision in adolescents who failed conservative management, with the hypothesis that these younger patients would have similar, successful outcomes of adult patients. A retrospective study was performed on adolescents who underwent arthroscopic os trigonum excision at a single institution between 2011 and 2017. Patient demographic, clinical history, radiographic, and operative data were documented. Outcome measures included the Foot and Ankle Ability Measure (FAAM) score comprised of the Activities of Daily Living (ADL) and Sports subscales, Single Assessment Numeric Evaluation (SANE) score, ability to return to the same level of sport, and any additional foot/ankle surgery. Ten patients (12 ankles) met criteria with a mean age at surgery of 15.4 years (range, 12 to 18 y) and a mean follow-up of 6.5 years (range, 2.8 to 9.1 y). Mean FAAM ADL subscale, Sports subscale, and SANE scores were 91.0±15.5, 76.3±29.1, and 88.6±15.1, respectively. A chronic duration of symptoms before surgery was associated with a lower FAAM Sports current level of function score (P=0.032). Four patients (40%) discontinued their sport due to continued ankle issues and reported significantly lower FAAM ADL subscale (P=0.01), Sports subscale (P<0.001), and SANE scores (P=0.002). Os trigonum syndrome in the adolescent population may not have the same rate of success as that seen in adult athletes over the long-term. However, if proven to be refractory to conservative measures and surgical intervention is indicated, patients and their families should be counseled about the risk for persistent ankle symptoms and the possibility that they may not be able to return to their previous level of sport. Level IV-case series.

An Investigation of Knee Injury Profiles among Iranian Elite Karatekas: Observations from a Cross-Sectional Study.

Karate training, despite the many positive health benefits, carries a risk of injury for participants. The current cross-sectional study aimed to investigate knee injury profiles among Iranian elite karatekas. Participants who attended the national team qualifiers, which included 390 male Kumite karatekas (age 24 ± 3 years old and weight 63 ± 12 kg), participated in this study. Information on knee injuries (injury history, type of injury mechanisms, and effects of knee symptoms on the ability to perform daily activities and recreational activities) were obtained using the Knee Outcome Survey (KOS). Using Pearson’s correlation coefficient, the study examined the relationships between different variables, including KOS subscales and levels of self-reported knee joint function. Our findings indicated that 287 karatekas (73.6%) experienced knee injuries. The anterior cruciate ligament (ACL) rupture (6.9%), articular cartilage (5.4%), and meniscus damage (3.8%) were the main typology of injury. In addition, there were no differences in knee injuries between the non-dominant and dominant legs. Most injuries occurred during the preparatory period (n = 162, 50%), especially during training periods. The KOS subscales scores (Mean ± Sd) for activities of daily living (ADL) and sports activity (SAS) were, respectively, 89 ± 11 and 91 ± 9. The self-reported scores for both the ADL and SAS subscales were, respectively, 89 ± 11 and 90 ± 10. Pearson coefficients of ADL and SAS subscales with their self-reported score were r = 0.761 (p < 0.0001) and r = 0.782 and (p < 0.0001), respectively. The profile of knee injuries in the current investigation is similar to previous surveys that reported lower extremity injury patterns. The findings of this study could be adopted to inform practice aimed at planning interventions for the reduction and prevention of knee injuries among karatekas.

Can the Knee Outcome and Osteoarthritis Score (KOOS) Function Subscale Be Linked to the PROMIS Physical Function to Crosswalk Equivalent Scores?

An increased focus on patient-reported outcome measures (PROMs) has led to a proliferation of these measures in orthopaedic surgery. Mandating a single PROM in clinical and research orthopaedics is not feasible given the breadth of data already collected with older measures and the emergence of psychometrically superior measures. Creating crosswalk tables for scores between measures allows providers to maintain control of measure choice. Furthermore, crosswalk tables permit providers to compare scores collected with older outcome measures with newly collected ones. Given the widespread use of the newer Patient-reported Outcome Measure Information System Physical Function (PROMIS PF) and the established Knee Outcome and Osteoarthritis Score (KOOS), it would be clinically useful to link these two measures. Can the KOOS Function in Activities of Daily Living (ADL) subscale be robustly linked to the PROMIS PF to create a crosswalk table of equivalent scores that accurately reflects a patient's reported physical function level on both scales? We sought to establish a common standardized metric for collected responses to the PROMIS PF and the KOOS ADL to develop equations for converting a PROMIS PF score to a score for the KOOS-ADL subscale and vice versa. To do this, we performed a retrospective, observational study at two academic medical centers and two community hospitals in an urban and suburban healthcare system. Patients 18 years and older who underwent TKA were identified. Between January 2017 and July 2020, we treated 8165 patients with a TKA, 93% of whom had a diagnosis of primary osteoarthritis. Of those, we considered patients who had completed a full KOOS and PROMIS PF 10a on the same date as potentially eligible. Twenty-one percent (1708 of 8165) of patients were excluded because no PROMs were collected at any point, and another 67% (5454 of 8165) were excluded because they completed only one of the required PROMs, leaving 12% (1003 of 8165) for analysis here. PROMs were collected each time they visited the health system before and after their TKAs. Physical function was measured by the PROMIS PF version 1.0 SF 10a and KOOS ADL scale. Analyses to accurately create a crosswalk of equivalent scores between the measures were performed using the equipercentile linking method with both unsmoothed and log linear smoothed score distributions. Crosswalks were created, and adequate validation results supported their validity; we also created tables to allow clinicians and clinician scientists to convert individual patients' scores easily. The mean difference between the observed PROMIS PF scores and the scores converted by the crosswalk from the KOOS-ADL scores was -0.08 ± 4.82. A sensitivity analysis was conducted, confirming the effectiveness of these crosswalks to link the scores of two measures from patients both before and after surgery. The PROMIS PF 10a can be robustly linked to the KOOS ADL measure. The developed crosswalk table can be used to convert PROMIS PF scores from KOOS ADL and vice versa. The creation of a crosswalk table between the KOOS Function in ADL subscale and PROMIS PF allows clinicians and researchers to easily convert scores between the measures, thus permitting greater choice in PROM selection while preserving comparability between patient cohorts and PROM data collected from older outcome measures. Creating a crosswalk, or concordance table, between the two scales will facilitate this comparison, especially when pooling data for meta-analyses.

The Foot and Ankle Outcome Score (FAOS) During Early Recovery After Ankle Fracture.

Several patient-reported outcome measures (PROMs) are available for assessing the outcomes following ankle fractures. This study aimed to evaluate validity, reliability, and responsiveness and detect the minimal clinically important difference of the Foot and Ankle Outcome Score (FAOS) in patients with ankle fractures. The study design is a prospective cohort study, including all patients treated both conservatively and surgically following an ankle fracture (AO-43A/B/C). Content validity, test-retest reliability, responsiveness, and minimal clinically important difference were evaluated from 14 days to 3 months following the fracture. The study population consisted of 52 females and 24 males. The mean age was 52.0 years (range, 15-75 years). The percentage of patients at 12 weeks reporting the 5 subscales at least somewhat relevant were pain, 77%; symptoms, 75%; activities of daily living (ADL), 64%; sport, 81%; and quality of life (QOL), 88%. High test-retest reliability of the FAOS questionnaire was observed. The interclass coefficients were 0.78, 0.77, 0.71, 0.73, and 0.74 for the pain, symptoms, ADL, sport, and QOL subscales, respectively. Responsiveness was evaluated with high effect size for the symptoms (0.83), ADL (1.19), sport (4.36), and QOL (2.12) subscales. The minimal clinically important difference of the FAOS was 14 (95% CI, 12-17). The FAOS during early recovery after ankle fracture has high reliability and validity. Level II, prospective cohort study.

Counterpunching to improve the health of people with Parkinson's disease.

Boxing programs designed specifically for people with Parkinson's disease (PD) can be beneficial in improving the physical, mental, and functional health of persons with PD. This study examined the effect of a boxing program, Rock Steady Boxing (RSB), on the health of people with PD from both the boxers' and their caregivers' perspectives as well as evaluated balance, quality of life (QoL), and depressive symptoms after 12 weeks of RSB. A mixed methods, one-group experimental design with focus groups were embedded within an intervention study. Six boxers completed baseline and 12-week postassessments. The majority of boxers maintained or improved scores for balance, QoL, and reduced depressive symptoms. Findings indicate physical and mental benefits of RSB among persons with PD and this was further validated by qualitative data from boxers and caregivers, along with quantitative data of boxers. Caregivers and boxers reported that boxers' ability to perform activities of daily living (ADLs) improved and is supported by quantitative improvements in the Parkinson's disease Questionnaire-39 ADL subscale. All boxers reported reduced stigma, and caregivers and boxers valued the opportunity to work out in an environment free of stigma, a finding not previously reported. It is important for nurse practitioners to recognize exercise benefits for people with PD and recommend the program to patients and include caregivers in their overall assessment of health and wellness. Nurse practitioners and other health practitioners may consider recommending a boxing program, such as RSB, for their PD patients as a sole or supplemental exercise program.

Application of Computerized Adaptive Testing to the Foot and Ankle Ability Measure.

Patient-reported outcome measures are an increasingly important tool for assessing the impact of treatments orthopedic surgeons render. Despite their importance, they can present a burden. We examined the validity and utility of a computerized adaptive testing (CAT) method to reduce the number of questions on the Foot and Ankle Ability Measure (FAAM), a validated anatomy-specific outcome measure. A previously developed FAAM CAT system was applied to the responses of patients undergoing foot and ankle evaluation and treatment over a 3-year period (2017-2019). A total of 15 902 responses for the Activities of Daily Living (ADL) subscale and a total of 14 344 responses for the Sports subscale were analyzed. The accuracy of the CAT to replicate the full-form score was assessed. The CAT system required 11 questions to be answered for the ADL subscale in 85.1% of cases (range, 11-12). The number of questions answered on the Sports subscale was 6 (range, 5-6) in 66.4% of cases. The mean difference between the full FAAM ADL subscale and CAT was 0.63 of a point. The mean difference between the FAAM Sports subscale and CAT was 0.65 of a point. The FAAM CAT was able to reduce the number of responses a patient would need to answer by nearly 50%, while still providing a valid outcome score. This measure can therefore be directly correlated with previously obtained full FAAM scores in addition to providing a foot/ankle-specific measure, which previously reported CAT systems are not able to do. Level IV, case series.