Change In Knee Extension Strength Research Articles

Effectiveness of a Remote Monitoring-Based Home Training System for Preventing Frailty in Older Adults in Japan: A Preliminary Randomized Controlled Trial.

This study examined whether SUKUBARA®, a remotely managed training system that we developed, could improve skeletal muscle mass and muscle strength in community-dwelling older adults. SUKUBARA® is a composite exercise program that combines lower-load resistance training and balance exercises. Participants were instructed to exercise while watching individually assigned videos on YouTube, such that the research administrators could verify the viewing records of each participant. Fifteen participants (69 ± 4 years) were randomly assigned to the intervention (eight participants; the RT group) or the control group (seven participants; the CO group). The primary endpoint was a change in fat-free mass (FFM; kg), whereas the secondary endpoints included a change in knee extension strength (KES; Nm/kg). Correlation analyses were conducted to examine the relationship between FFM and KES. During the 12-week intervention period, significant differences were observed between the RT and CO groups in the changes in FFM (0.5 ± 0.5 vs. -0.1 ± 0.5) and KES (0.20 ± 0.22 vs. 0.02 ± 0.13), and significant positive correlations were found between the changes. Thus, SUKUBARA®-based interventions have the potential to improve muscle hypertrophy and enhance muscle strength among community-dwelling older adults. Thus, SUKUBARA® -based interventions show promise in improving muscle hypertrophy and enhance muscle strength among community-dwelling older adults. However, appropriately powered future research is needed to replicate these findings.

Prediction of 1-year change in knee extension strength by neuromuscular properties in older adults.

Improving muscle strength and preventing muscle weakness are important for older adults. The change in strength can be effectively explained by skeletal muscle mass and neural factors. Neural factors are important for older adults because the variation of neural components is greater in older than in young adults, and any decline in strength cannot solely be explained by a decrease in skeletal muscle mass. The purpose of the present study was to investigate whether skeletal muscle mass or motor unit firing properties could explain the change in muscle strength after 1year. Thirty-eight older adults (75.0 ± 4.7years, 156.6 ± 7.7cm, 55.5 ± 9.4kg, 26 women) performed maximum voluntary knee extension and their skeletal muscle mass was measured using a bioimpedance device. During a submaximal contraction task, high-density surface electromyography was recorded and the signals were decomposed into individual motor unit firing. As an index of motor unit firing properties, the slope and y-intercept (MU intercept) were calculated from the regression line between recruitment thresholds and firing rates in each participant. After 1year, their maximum knee extension torque was evaluated again. A stepwise multiple regression linear model with sex and age as covariates indicated that MU intercept was a significant explanation with a negative association for the 1-year change in muscle strength (β = - 0.493, p = 0.004), but not skeletal muscle mass (p = 0.364). The results suggest that neural components might be predictors of increasing and decreasing muscle strength rather than skeletal muscle mass.

Mechanisms of action of therapeutic exercise for knee and hip OA remain a black box phenomenon: an individual patient data mediation study with the OA Trial Bank

ObjectivesTo evaluate mediating factors for the effect of therapeutic exercise on pain and physical function in people with knee/hip osteoarthritis (OA).MethodsFor Subgrouping and TargetEd Exercise pRogrammes for knee and hip...

Association Between Knee Extension Strength and Functional Capacity After Intensive Care Unit Discharge: A 6-Mo Prospective Cohort Study.

Assessing functional improvement after intensive care unit discharge is particularly challenging. The aim of this study was to measure the association between (1) changes in knee extension muscle strength or quadriceps femoris and rectus femoris muscle thickness and (2) changes in functionality/function-related measurements in post-intensive care unit patients. This prospective cohort study included adult patients without previous disability, consecutively selected after intensive care unit discharge. Some parameters, such as Short-Form 36, 6-min walking test, 1-min sit-to-stand, and Short Physical Performance Battery, were measured at baseline and 3 and 6 mos after discharge. Correlations were assessed and regression models were built to assess the association between evolution in knee extension strength or muscle thickness and evolution in functional tests. Thirty patients completed the follow-up. Moderate correlation was found between knee extension strength change and Short-Form 36 physical functioning (correlation coefficient [ ρ ] = 0.53), 6-min walking test ( ρ = 0.38), 1-min sit-to-stand ( ρ = 0.52), and Short Physical Performance Battery ( ρ = 0.38). Baseline values and changes in knee extension strength moderately predicted evolution in Short-Form 36 physical functioning ( r2 = 0.32, P = 0.006). Changes in muscle thickness were overall not associated with changes in functional variables. Changes in knee extension muscle strength may inform on functional progression over time after intensive care unit discharge, although confirmatory studies are needed.

Efficacy of the SOAR knee health program: protocol for a two-arm stepped-wedge randomized delayed-controlled trial

BackgroundKnee trauma permanently elevates one’s risk for knee osteoarthritis. Despite this, people at-risk of post-traumatic knee osteoarthritis rarely seek or receive care, and accessible and efficacious interventions to promote knee health after injury are lacking. Exercise can ameliorate some mechanisms and independent risk factors for osteoarthritis and, education and action-planning improve adherence to exercise and promote healthy behaviours.MethodsTo assess the efficacy of a virtually-delivered, physiotherapist-guided exercise-based program (SOAR) to improve knee health in persons discharged from care after an activity-related knee injury, 70 people (16–35 years of age, 12–48 months post-injury) in Vancouver Canada will be recruited for a two-arm step-wedged assessor-blinded delayed-control randomized trial. Participants will be randomly allocated to receive the intervention immediately or after a 10-week delay. The program consists of 1) one-time Knee Camp (group education, 1:1 individualized exercise and activity goal-setting); 2) weekly individualized home-based exercise and activity program with tracking, and; 3) weekly 1:1 physiotherapy-guided action-planning with optional group exercise class. Outcomes will be measured at baseline, 9- (primary endpoint), and 18-weeks. The primary outcome is 9-week change in knee extension strength (normalized peak concentric torque; isokinetic dynamometer). Secondary outcomes include 9-week change in moderate-to-vigorous physical activity (accelerometer) and self-reported knee-related quality-of-life (Knee injury and OA Outcome Score subscale) and self-efficacy (Knee Self Efficacy Scale). Exploratory outcomes include 18-week change in primary and secondary outcomes, and 9- and 18- week change in other components of knee extensor and flexor muscle function, hop function, and self-reported symptoms, function, physical activity, social support, perceived self-care and kinesiophobia. Secondary study objectives will assess the feasibility of a future hybrid effectiveness-implementation trial protocol, determine the optimal intervention length, and explore stakeholder experiences.DiscussionThis study will assess the efficacy of a novel, virtually-delivered, physiotherapist-guided exercise-based program to optimize knee health in persons at increased risk of osteoarthritis due to a past knee injury. Findings will provide valuable information to inform the management of osteoarthritis risk after knee trauma and the conduct of a future effectiveness-implementation trial.Trial registrationClinicaltrials.gov reference: NTC04956393. Registered August 5, 2021, https://clinicaltrials.gov/ct2/show/NCT04956393?term=SOAR&cond=osteoarthritis&cntry=CA&city=Vancouver&draw=2&rank=1

Effects of exercise in patients with connective tissue disease receiving high-dose glucocorticoids: A pilot prospective cohort study.

High doses of glucocorticoids induce skeletal muscle weakness. The aim of this study was to evaluate the effects of exercise therapy on skeletal muscle strength, mass, and exercise capacity in patients with connective tissue disease treated with high doses of glucocorticoids. This prospective, observational, single-center, cohort study included 35 patients aged ≥ 15years diagnosed with connective tissue disease who received high-dose glucocorticoids and physical training. Exercise therapy, including moderate aerobic and strength training, was performed five times a week. Knee extension strength, skeletal muscle mass, anaerobic threshold, and peak oxygen consumption were measured at the beginning of exercise therapy and at discharge. After 6weeks of aerobic and strength exercises, skeletal muscle mass significantly decreased by 5.5%, right knee extension decreased by 11.6%, and left knee extension decreased by 9.7%. The anaerobic threshold and peak oxygen consumption significantly increased by 13.0% and 9.0%, respectively. The increase in glucocorticoid dose was inversely correlated with changes in knee extension strength. In patients with connective tissue disease being treated with high-dose glucocorticoids, exercise therapy might attenuate the decrease in skeletal muscle mass and strength and increase the anaerobic threshold and peak oxygen consumption, thus moderating the side effects of high-dose glucocorticoid treatment. Trial registration The trial is registered with UMIN (University Hospital Medical Information Network), ID number UMIN000038836.

Effects of resistance training using elastic bands on muscle strength with or without a leucine supplement for 48 weeks in elderly patients with type 2 diabetes.

Type 2 diabetes is associated with sarcopenia. Resistance training and appropriate nutritional therapy are reported to be effective for muscle strength and mass. This study aimed to evaluate the effect of resistance training using elastic bands at home combined with a leucine-rich amino acid supplement on muscle strength, physical function, and muscle mass in elderly type 2 diabetes. We conducted a 48-week prospective single-center randomized controlled trial in 60 patients who were randomly allocated to one of three groups: control (C), resistance exercise (R), and resistance exercise plus supplement (RL). R and RL groups performed daily bodyweight resistance training with elastic bands exercises at home, and the RL group also took 6 g of a leucine-rich amino acid supplement daily. Knee extension strength (muscle strength), grip strength, usual gait speed (physical function), muscle mass, and cognitive function were assessed at 0 and 48 weeks. Although the change in knee extension strength from baseline was significantly increased by 6.4 Nm (95% CI 1.0, 11.7) in the RL group (p = 0.036), no significant difference was observed among the three groups (p = 0.090). Physical function, muscle mass, and cognitive function also had no changes during the study period among the three groups. No additive effect of a leucine-rich amino acid supplement on muscle strength or mass was observed. Although a post hoc analysis comparing with or without resistance training (C group vs. R + RL group) found that knee extension strength was significantly increased (p = 0.028), and cognitive decline was less (p = 0.046) than in the C group.

Changes in muscle strength and physical function in older patients during and after hospitalisation: a prospective repeated-measures cohort study.

to investigate changes in knee-extension strength and physical function in older adults during and after acute hospital admission, and the contributions of illness severity, frailty and sedentary activity to changes in knee-extension strength. prospective repeated-measures cohort study on a sample of participants aged ≥75 recruited within 24hours of acute hospital admission. Knee-extension, grip strength and functional mobility (de Morton Mobility Index, DEMMI) were measured at recruitment, day 7 (or discharge if earlier), and at follow-up 4-6weeks later. During the first 7days, continuous measurement of physical activity and daily measurements of muscle strength were taken. Participants recalled the functional ability they had 2-weeks before admission and self-reported it at follow-up (Barthel Index, BI). sixty-five of 70 participants (median age 84years) had at least one repeated measure of muscle strength in hospital. Knee-extension strength declined during hospitalisation by 11% (P< 0.001), but did not change post-hospitalisation (P= 0.458). Grip strength did not change during hospitalisation (P= 0.665) or from discharge to follow-up (P= 0.508). General functional ability (BI) deteriorated between 2weeks before admission and follow-up (P< 0.001). Functional mobility (DEMMI) improved during hospitalisation (P< 0.001), but did not change post-hospitalisation (P= 0.508). A repeated-measures mixed model showed that greater loss in knee-extension strength during hospitalisation was associated with increased sedentary time, frailty and baseline strength and lower baseline inflammatory levels. our observations add to a growing body of evidence on potential risk factors for hospital-associated deconditioning.

Supplementation with Whey Protein, Omega-3 Fatty Acids and Polyphenols Combined with Electrical Muscle Stimulation Increases Muscle Strength in Elderly Adults with Limited Mobility: A Randomized Controlled Trial.

Age-related sarcopenia is a progressive and generalized skeletal muscle disorder associated with adverse outcomes. Herein, we evaluate the effects of a combination of electrical muscle stimulation (EMS) and a whey-based nutritional supplement (with or without polyphenols and fish oil-derived omega-3 fatty acids) on muscle function and size. Free-living elderly participants with mobility limitations were included in this study. They received 2 sessions of EMS per week and were randomly assigned to ingest an isocaloric beverage and capsules for 12 weeks: (1) carbohydrate + placebo capsules (CHO, n = 12), (2) whey protein isolate + placebo capsules (WPI, n = 15) and (3) whey protein isolate + bioactives (BIO) capsules containing omega-3 fatty acids, rutin, and curcumin (WPI + BIO, n = 10). The change in knee extension strength was significantly improved by 13% in the WPI + BIO group versus CHO on top of EMS, while WPI alone did not provide a significant benefit over CHO. On top of this, there was the largest improvement in gait speed (8%). The combination of EMS and this specific nutritional intervention could be considered as a new approach for the prevention of sarcopenia but more work is needed before this approach should be recommended. This trial was registered at the Japanese University Hospital Medical Information Network (UMIN) clinical trial registry (UMIN000008382).

71 Changes in Muscle Strength in Older Patients During Hospitalisation: A Prospective Repeated Measures Cohort Study

Abstract Introduction Hospital associated deconditioning is a well-established phenomenon. Whilst mechanisms are not well understood, one is thought to be skeletal muscle wasting and/or loss of muscle strength. The primary aim of this study was to investigate changes in knee-extension muscle strength in older patients during and after an acute-hospital admission. We also aimed to explore the potential contributions of frailty, acute-illness severity and sedentary activity, with changes in knee-extension strength. Methods This was a prospective repeated-measures cohort study. Measurements of muscle strength and functional mobility were taken at recruitment, on day 7 of admission (or at discharge if earlier) and again 4-6 weeks post-hospitalisation. During the first 7 days of admission, daily measurements of muscle strength were taken. Results We recruited 70 participants, of which 65 had at least one repeated measure in hospital. Median age was 84 years, and participants participated in the study for a median of 6 days whilst in hospital, on average participants were ‘active’ for less than 4% of the day. Knee-extension strength significantly reduced by approximately 11% during hospitalisation, but no significant changes occurred post-hospitalisation. A repeated-measures mixed model included 292 observations from 62 participants and showed a significant decrease in the reduction in muscle strength as patients' sedentary time decreased on days 2 to 7 of the study. Additionally, the model showed that a higher frailty score, higher baseline knee-extension strength, lower baseline c-reactive protein levels were associated with greater loss in knee-extension strength during hospitalisation. Association between change in functional mobility after hospitalisation and change in knee-extension strength during hospitalisation was non-significant. Conclusion Our findings provide an important link in understanding the mechanisms and relative contributions of risk factors to hospital associated deconditioning. Further research is needed to confirm these findings and examine the impact of reducing sedentary time on muscle strength during and post-hospitalisation.

Preoperative methylprednisolone does not reduce loss of knee-extension strength after total knee arthroplasty

Background and purpose — Patients undergoing total knee arthroplasty (TKA) face challenges related to postoperative reduction in knee-extension strength. We evaluated whether inhibition of the inflammatory response by a single preoperative dose of methylprednisolone (MP) reduces the pronounced loss of knee-extension strength at discharge after fast-track TKA.Patients and methods — 70 patients undergoing elective unilateral TKA were randomized (1:1) to preoperative intravenous (IV) MP 125 mg (group MP) or isotonic saline IV (group C). All procedures were performed under spinal anesthesia without tourniquet, and with a standardized multimodal analgesic regime. The primary outcome was change in knee-extension strength from baseline to 48 hours postoperatively. Secondary outcomes were knee joint circumference, functional performance using the Timed Up and Go (TUG) test, pain during the aforementioned tests, rescue analgesic requirements, and plasma C-reactive protein (CRP) changes.Results — 61 patients completed the follow-up. The loss in quadriceps muscle strength was similar between groups; group MP 1.04 (0.22–1.91) Nm/kg (–89%) vs. group C 1.02 (0.22–1.57) Nm/kg (–88%). Also between-group differences were similar for knee circumference, TUG test, and pain scores. MP reduced the inflammatory response (CRP) at 24 hours postoperatively; group MP 33 (IQR 21–50) mg/L vs. group C 72 (IQR 58–92) mg/L (p < 0.001), and 48 hours postoperatively; group MP 83 (IQR 56–125) mg/L vs. group C 192 (IQR 147–265) mg/L (p < 0.001), respectively.Interpretation — Preoperative systemic administration of MP 125 mg did not reduce the pronounced loss of knee-extension strength or other functional outcomes at discharge after fast-track TKA despite a reduced systemic inflammatory response.

Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial

BackgroundThigh tourniquet is commonly used in total knee arthroplasty (TKA) but may contribute to pain and muscle damage. Consequently, the reduction in knee-extension strength after TKA may be caused by quadriceps muscle ischaemia underneath the cuff. AimTo examine if not using a thigh tourniquet during surgery was more effective than using a thigh tourniquet in preserving knee-extension strength 48h after fast-track TKA. MethodsA total of 64 patients undergoing TKA were randomized (1:1) to the use of tourniquet (T-group) or no tourniquet (NT-group). In the T-group the tourniquet cuff pressure was based on the patient's systolic pressure and a margin of 100mmHg. It was inflated immediately before surgery and deflated as soon as surgery ended. The primary outcome was the change in knee-extension strength from pre-surgery to 48h after surgery (primary end point). Secondary outcomes were pain, nausea, length of hospital stay (LOS) and periarticular swelling. ResultsKnee-extension strength 48h after surgery was substantially reduced by about 90% in both groups, with no statistically significant difference between groups (mean difference 1.5N/kg, 95% CI 1.3–1.6). Among the secondary outcomes, the T-group had less bleeding during surgery (56 vs 182mL, P<0.01) compared with the NT-group. There was no difference in postoperative haemoglobin levels, pain, nausea, LOS or periarticular swelling between the groups. ConclusionNot using a thigh tourniquet during surgery was not superior in preserving knee-extension strength at the primary endpoint 48h after fast-track TKA, compared to using a tourniquet.

Four-year longitudinal study of clinical and functional endpoints in sporadic inclusion body myositis: Implications for therapeutic trials

Natural history studies in sporadic inclusion body myositis are of fundamental interest for future therapeutic trials. Previous works have demonstrated the particular relevance of knee extension strength in the follow-up of this disease. This work aimed to extend a preceding natural history over 9 months to a four year period. Thirteen patients were assessed using clinical and functional scales and dynamometry. Except wrist extension torque and manual muscle testing composite score, all the measurements presented a significant decline. The most important changes were observed for knee extension and ankle flexion and extension. The relative change in knee extension strength correlated with the level of strength at baseline. A non-linear correlation was found between 6-minute walk distance and knee extension strength. This study confirms that knee extension strength is particularly relevant to follow patients with sporadic inclusion body myositis. It also shows that a strength loss does not have linear consequences on motor ability. Finally strength and motor ability are complementing each other in the understanding of disease progression.

OP0264 Effect of vitamin D supplementation and physical activity in preventing sarcopenia in older adults with osteoporosis: A randomized controlled trial

BackgroundAgeing is associated with changes in body composition and due to the ageing of the populations and the lessened physical activity (PA), sarcopenia and osteopenia/osteoporosis are emerging as major health...

Minimal Detectable Change of Knee Extension Force Measurements Obtained by Handheld Dynamometry From Older Patients in 2 Settings

The measurement properties of handheld dynamometry (HHD) have been studied extensively, but information about the responsiveness of the procedure is scant. The purpose of this study, therefore, was to determine the responsiveness (minimal detectable change [MDC]) for measurements of knee extension force obtained by HHD from older adult patients in 2 different settings. This study involved the retrospective retrieval of knee extension force data of the left and right sides from 2 sources (acute rehabilitation [n = 53] and home care [n = 46]). The standard deviation of the forces and the weighted mean intraclass correlation coefficient (ICC) from 3 previous studies (ICC = 0.90) were then used to calculate the MDC95%. The MDC95% ranged from 46.0 to 79.0 N. It was lower for patients measured in a home care setting than for those measured in an acute rehabilitation setting. By describing the MDC for knee extension force obtained by HHD from older adults in 2 settings, this study provides an indication of the changes in force that would have to be surpassed to conclude that a real change in knee extension strength was observed. The MDCs reported have a role in the interpretation of repeated measurements and in setting goals for changes in knee extension force.

Effect of knee joint icing on knee extension strength and knee pain early after total knee arthroplasty: a randomized cross-over study

Objective: To investigate the acute effect of knee joint icing on knee extension strength and knee pain in patients shortly after total knee arthroplasty. Design: A prospective, single-blinded, randomized, cross-over study. Setting: A fast-track orthopaedic arthroplasty unit at a university hospital. Participants: Twenty patients (mean age 66 years; 10 women) scheduled for primary unilateral total knee arthroplasty. Interventions: The patients were treated on two days (day 7 and day 10) postoperatively. On one day they received 30 minutes of knee icing (active treatment) and on the other day they received 30 minutes of elbow icing (control treatment). The order of treatments was randomized. Main outcome measures: Maximal knee extension strength (primary outcome), knee pain at rest and knee pain during the maximal knee extensions were measured 2–5 minutes before and 2–5 minutes after both treatments by an assessor blinded for active or control treatment. Results: The change in knee extension strength associated with knee icing was not significantly different from that of elbow icing (knee icing change (mean (1 SD)) –0.01 (0.07) Nm/kg, elbow icing change –0.02 (0.07) Nm/kg, P = 0.493). Likewise, the changes in knee pain at rest (P = 0.475), or knee pain during the knee extension strength measurements (P = 0.422) were not different between treatments. Conclusions: In contrast to observations in experimental knee effusion models and inflamed knee joints, knee joint icing for 30 minutes shortly after total knee arthroplasty had no acute effect on knee extension strength or knee pain.

Thigh and Knee Circumference, Knee-Extension Strength, and Functional Performance After Fast-Track Total Hip Arthroplasty

To (1) quantify changes in knee-extension strength and functional-performance at discharge after fast-track total hip arthroplasty (THA) and (2) investigate whether these changes correlate to changes in thigh and knee circumference (ie, swelling) or pain. A prospective, descriptive, hypothesis-generating study. A special unit for fast-track hip and knee arthroplasty operations at a university hospital. Twenty-four patients (20 women and 4 men; ages 69 ± 6.1 years) scheduled for primary unilateral THA. All patients were evaluated before surgery and on the day of hospital discharge. Knee-extension strength, thigh and knee joint circumference, hip pain, and functional performance (Timed Up & Go, 30-Second Chair Stand, and 10-Meter Walk tests). All investigated variables changed significantly from before to after surgery, except for hip pain. The average loss in knee-extension strength after surgery (32%, P = .01) did not correlate with increased thigh circumference (6%, P < .01) or knee circumference (3%, P < .01) or with reductions in functional performance: Timed Up & Go test (114%, P = .01), 30-Second Chair Stand test (36%, P = .01), and 10-Meter Walk test (50%, P < .01). Only the increase in knee circumference correlated significantly with reduced performance in the 10-Meter Walk test time (R = -0.59, P < .01), explaining 34% of the variance in the 10-Meter Walk test. No correlations between changes in hip pain and functional performance or knee-extension strength were found. Mean postoperative hospital stay was 2.1 days. Knee-extension strength is considerably reduced at discharge after THA, but the early strength reduction does not correlate with changes in thigh or knee circumferences. Because functional performance is also considerably reduced at discharge (unrelated to reduced knee-extension strength), other mechanisms such as fear, avoidance of movement, or decreased hip-muscle strength also may be involved.

Loss of Knee-Extension Strength Is Related to Knee Swelling After Total Knee Arthroplasty

Holm B, Kristensen MT, Bencke J, Husted H, Kehlet H, Bandholm T. Loss of knee-extension strength is related to knee swelling after total knee arthroplasty. Objective To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA). Design Prospective, descriptive, hypothesis-generating study. Setting A fast-track orthopedic arthroplasty unit at a university hospital. Participants Patients (N=24; mean age, 66y; 13 women) scheduled for primary unilateral TKA were investigated 1 week before surgery and on the day of hospital discharge 2.4 days postsurgery. Interventions Not applicable. Main Outcome Measures We assessed all patients for knee-joint circumference, knee-extension strength, and functional performance using the Timed Up & Go, 30-second Chair Stand, and 10-m fast speed walking tests, together with knee pain during all active test procedures. Results All investigated variables changed significantly from pre- to postsurgery independent of knee pain. Importantly, knee circumference increased (knee swelling) and correlated significantly with the decrease in knee-extension strength ( r=−.51; P=.01). Reduced fast-speed walking correlated significantly with decreased knee-extension strength ( r=.59; P=.003) and decreased knee flexion ( r=.52; P=.011). Multiple linear regression showed that knee swelling ( P=.023), adjusted for age and sex, could explain 27% of the decrease in knee-extension strength. Another model showed that changes in knee-extension strength ( P=.009) and knee flexion ( P=.018) were associated independently with decreased performance in fast-speed walking, explaining 57% of the variation in fast-speed walking. Conclusions Our results indicate that the well-known finding of decreased knee-extension strength, which decreases functional performance shortly after TKA, is caused in part by postoperative knee swelling. Future studies may look at specific interventions aimed at decreasing knee swelling postsurgery to preserve knee-extension strength and facilitate physical rehabilitation after TKA.

Hand-held dynamometry in patients with haematological malignancies: measurement error in the clinical assessment of knee extension strength.

BackgroundHand-held dynamometry is a portable and inexpensive method to quantify muscle strength. To determine if muscle strength has changed, an examiner must know what part of the difference between a patient's pre-treatment and post-treatment measurements is attributable to real change, and what part is due to measurement error. This study aimed to determine the relative and absolute reliability of intra and inter-observer strength measurements with a hand-held dynamometer (HHD).MethodsTwo observers performed maximum voluntary peak torque measurements (MVPT) for isometric knee extension in 24 patients with haematological malignancies. For each patient, the measurements were carried out on the same day. The main outcome measures were the intraclass correlation coefficient (ICC ± 95%CI), the standard error of measurement (SEM), the smallest detectable difference (SDD), the relative values as % of the grand mean of the SEM and SDD, and the limits of agreement for the intra- and inter-observer '3 repetition average' and the 'highest value of 3 MVPT' knee extension strength measures.ResultsThe intra-observer ICCs were 0.94 for the average of 3 MVPT (95%CI: 0.86–0.97) and 0.86 for the highest value of 3 MVPT (95%CI: 0.71–0.94). The ICCs for the inter-observer measurements were 0.89 for the average of 3 MVPT (95%CI: 0.75–0.95) and 0.77 for the highest value of 3 MVPT (95%CI: 0.54–0.90). The SEMs for the intra-observer measurements were 6.22 Nm (3.98% of the grand mean (GM) and 9.83 Nm (5.88% of GM). For the inter-observer measurements, the SEMs were 9.65 Nm (6.65% of GM) and 11.41 Nm (6.73% of GM). The SDDs for the generated parameters varied from 17.23 Nm (11.04% of GM) to 27.26 Nm (17.09% of GM) for intra-observer measurements, and 26.76 Nm (16.77% of GM) to 31.62 Nm (18.66% of GM) for inter-observer measurements, with similar results for the limits of agreement.ConclusionThe results indicate that there is acceptable relative reliability for evaluating knee strength with a HHD, while the measurement error observed was modest. The HHD may be useful in detecting changes in knee extension strength at the individual patient level.

Postoperative Physical Training following Colorectal Surgery: A Randomised, Placebo-Controlled Study

Major surgery is often followed by fatigue and reduced physical function. We wished to study if postoperative physical training reduced fatigue and improved physical function. Randomised, placebo-controlled, single-blinded study. Participants were unselected patients > or = 60 years undergoing elective colorectal surgery without disseminated cancer or inflammatory bowel disease. Group A trained muscular strength and work capacity. Group B performed relaxation exercises and received hot wrappings and massage. Main outcome measures were: fatigue (visual analogue scale), muscular strength, walking speed, physical performance test, and physical function questions (SF-36). Preoperatively the two groups were similar except that A was more fatigued than B. By postoperative day seven fatigue had increased compared to preoperatively, more in B than A, but by day 30 and 90 there were no significant differences between groups. All indices of physical function decreased postoperative day seven and were at the preoperative level day 90 with no significant differences between groups in change in function. Day seven the change in knee extension strength tended to be lower in B than A but by day 30 changes were similar in both groups. Postoperative training did not improve physical function, but reduced fatigue in hospital.