Isometric Quadriceps Strength Research Articles

Feasibility and Health Benefits of an Individualized Physical Activity Intervention in Women With Metastatic Breast Cancer: Intervention Study.

BackgroundThere is limited knowledge regarding the potential benefits of physical activity in patients with metastatic breast cancer.ObjectiveThe Advanced stage Breast cancer and Lifestyle Exercise (ABLE) Trial aimed to assess the feasibility of a physical activity intervention in women with metastatic breast cancer and to explore the effects of physical activity on functional, psychological, and clinical parameters.MethodsThe ABLE Trial was a single-arm, 6-month intervention study with a home-based, unsupervised, and personalized walking program using an activity tracker. At baseline and 6 months, we assessed anthropometrics, functional fitness, physical activity level, sedentary behavior, quality of life, fatigue, and tumor progression. Paired proportions were compared using the McNemar test and changes of parameters during the intervention were analyzed using the Wilcoxon signed-rank test, the Mann-Whitney test, and Spearman rank correlations.ResultsOverall, 49 participants (mean age 55 years; recruitment rate 94%) were enrolled and 96% adhered to the exercise prescription (attrition rate 2%). Statistically significant improvements in the 6-minute walking distance test (+7%, P<.001) and isometric quadriceps strength (+22%, P<.001), as well as decreases in body mass index (-2.5%, P=.03) and hip circumference (-4.0%, P<.001) were observed at 6 months. Quality of life remained stable and a nonstatistically significant decrease (-16%, P=.07) in fatigue was observed.ConclusionsThe high recruitment and adherence rates suggest the willingness of patients with metastatic breast cancer to participate in a physical activity program. The beneficial outcomes regarding physical fitness and anthropometry of this unsupervised physical activity program may encourage these patients to maintain a physically active lifestyle. Future randomized controlled trials with larger sample sizes are warranted.Trial RegistrationClinicalTrials.gov NCT03148886; https://clinicaltrials.gov/ct2/show/NCT03148886

Association between sarcopenia and atherosclerosis in elderly patients with ischemic heart disease.

Compared to the general population, elderly patients with cardiovascular disease have a higher prevalence of sarcopenia, and it shows an association with increased mortality risk. Although several studies have indicated that atherosclerosis may cause sarcopenia in community dwelling elderly subjects, the association between sarcopenia and atherosclerosis is not clear in patients with ischemic heart disease (IHD). The present study was performed to examine the association between muscle function and atherosclerosis in elderly patients with IHD. We reviewed the findings of 321 consecutive patients ≥ 65years old with IHD. Three measures of muscle function were examined, i.e., gait speed, quadriceps isometric strength, and handgrip strength, just before hospital discharge. In addition, we measured intima-media thickness (IMT) as a parameter of arteriosclerosis. To investigate the association between sarcopenia and atherosclerosis, patients were divided into Group H (high), Group M (middle), and Group L (low) according to the tertiles of muscle function, and IMT was compared between the three groups. In addition, we considered the association between IMT thickening and muscle function. The mean age of the study population was 74.1 ± 6.0years and 73.2% of the patients were men. IMT was compared between groups stratified according to gait speed and quadriceps isometric strength, and the results indicated that IMT was significantly lower in Group H than in Groups L and M (p < 0.05). In addition, gait speed and quadriceps isometric strength were associated with IMT thickening (p < 0.05). Parameters reflecting muscle function of the lower limbs are associated with atherosclerosis in patients with IHD.

126 Development of a Falls Prediction Tool for People with Diabetes Mellitus

Abstract Introduction Diabetes mellitus (DM), aging and falls have been recognized as a growing and a challenging triad. Despite many tools to assess risk of falls, they may not be applicable for fall risk assessment in DM patients. The aim of the study was to develop a low- cost tool to predict the faller status of DM people. Methods People with DM (n=103) were recruited from diabetic clinics in Sri Lanka. Demographic, neuropathy status, contrast sensitivity (Melbourne Edge test) lower limb (LL) sensation, cognitive functions, fear of falling (Icon-FES), LL strength (maximal isometric quadriceps strength), hand reaction time, balance abilities (postural sway, maximal balance range, coordinated stability, unipedal stand time (UST) and tandem and near tandem standing ability), mobility (Timed up and go test-TUG) and gait parameters were assessed. Falls were prospectively recorded over six months. Data were analyzed using SPSS and STATA with negative binominal regression. Results Fall rates were significantly associated with DM symptoms (p=0.001) and examination scores (p=0.026), HbA1c (p=0.012), contrast sensitivity (p=0.033), TUG (p=0.006), quadriceps strength (p=0.015), sway path on floor eyes closed (p=0.002), sway on foam eyes opened (p=0.009), near tandem (p=0.006) and tandem (p=0.008) balance, UST (p=0.027), stride length (p=0.009), TUG times with cognitive task (p=0.007), dual task backward walking (p=0.005). A multivariate negative binomial regression model comprised two significant and independent variables influencing falls: quadriceps strength and tandem balance ability (likelihood ratio Chi square=12.43, p=0.002). For 1kg increase in quadriceps strength fall rates decreased by 0.94% and the presence of poor tandem balance increased fall rates by a factor of 2.48. Discussion and Conclusion We identified multiple factors that elucidate why people with DM fall. A simple, easy to use tool comprising two independent risk factors: tests of quadriceps strength and tandem balance ability are suggested as a simple screen for fall risk in this population. Such patients may then warrant further detailed assessment and a tailored intervention.

Changes in isometric quadriceps strength after the application of ultrasound-guided percutaneous neuromodulation. A case study

Abstract Background Ultrasound-guided percutaneous neuromodulation (US-guided PNM) is an invasive physiotherapy technique which is employed for neurofunctional improvement and treatment of pain. To date, no study has related this technique with muscle stimulation and dynamometry changes. Within the functional assessment tools, dynamometry tests were performed with devices which enable the calculation of variables related with isometric and isokinetic movement. Aim To assess the changes in maximum isometric strength after the application of US-guided PNM. Material and Methods A retrospective case study comprising 13 subjects (26 lower limbs) receiving US-guided PNM, with pre and post-intervention measurements.The inclusion criteria comprised subjects without pain at the time of study, with coefficients of variation (COV) below 15% and in the process of improving loading work. We excluded subjects with pathology provoking pain at the time of the measurements and with contraindications for dynamometry or US-guided PNM. An isometricmeasurement was performed using the KINEO dynamometry system with 90° hip flexion and 45° knee extension, without strapping and with manual grips in lateral supports of the system. The lever arm was placed at 2 cm of the malleoli in the ventral aspect without strapping the ankle and a pre-intervention measurement was performed of the maximum isometric strength based on a mean of 3 repetitions (3 seconds' contraction and 6 seconds' relaxation). Subsequently, the US-guided PNM technique was performed on the femoral nerve, using the Physio Invasiva device and the PES modality (10 Hz frequency, 240 μs pulse width). Ten maximal and pain free stimulations were performed lasting 10 seconds each, with a 10 second rest between each contraction. After the intervention, a post intervention measurement was performed, in the same manner as the previous measurement. Results In total, 13 volunteer subjects participated in the study, aged between 27 and 59 years, of which, 2 were women and 11 were men. After the application of US-guided PNM on the femoral nerve, changes were observed in the maximum mean isometric strength of the quadriceps, which increased from 26.75 kg in the pre-intervention mean with a standard deviation of 7.42 kg to 30.05 kg for the post-intervention mean, with a standard deviation of 9.23 kg. The results were statistically significant with p &lt; 0.000. Conclusion US-guided PNM applied to the femoral nerve is able to produce changes in maximum isometric strength measured using dynamometry.

Associations between isometric quadriceps strength characteristics, knee flexion angles, and knee extension moments during single leg step down and landing tasks after anterior cruciate ligament reconstruction

BackgroundIt is unclear of how peak knee extension torque and early rate of torque development outcomes are related to lower extremity loading and sagittal plane movement in activities of daily living and landing tasks despite consistent deficits after anterior cruciate ligament reconstruction. The purpose of this cross-section study is to assess the ability of quadriceps strength characteristics to predict movement patterns during a step down and single leg drop crossover hopping tasks. MethodsFifty-two individuals with a unilateral history of anterior cruciate ligament reconstruction completed three trials of the step down and crossover hopping tasks on their involved limb. Participants completed three isometric knee extension contractions at 90° knee flexion with visual feedback to assess peak knee extension torque and rate of torque development during the first 0–100 ms and 100–200 ms of the contraction. FindingsPeak knee extension torque explained the greatest variance in peak knee extension moment (R2 = 40.4%, p < 0.001) and knee flexion angle (R2 = 46.7%, p < 0.001) during the crossover hop landing. Rate of torque development (0–100 ms) was the only predictor of knee flexion angle (R2 = 19.8%, p = 0.01) at initial contact during the crossover hopping landing. Rate of torque development (100–200 ms) explained 17.6% of the variance in peak knee extension moment during the step down (p = .03). InterpretationPeak knee extension torque and early rate of torque development outcomes demonstrate limited relationships between movement of activities of daily living and sport-specific tasks. These limitations should be considered when interpreting the results of isometric strength testing in a clinical setting.

Mechanisms to Attenuate Load in the Intact Limb of Transtibial Amputees When Performing a Unilateral Drop Landing.

Individuals with unilateral transtibial amputations experience greater work demand and loading on the intact limb compared with the prosthetic limb, placing this limb at a greater risk of knee joint degenerative conditions. It is possible that increased loading on the intact side may occur due to strength deficits and joint absorption mechanics. This study investigated the intact limb mechanics utilized to attenuate load, independent of prosthetic limb contributions and requirements for forward progression, which could provide an indication of deficiencies in the intact limb. Amputee and healthy control participants completed 3 unilateral drop landings from a 30-cm drop height. Joint angles at touchdown; range of motion; coupling angles; peak powers; and negative work of the ankle, knee, and hip were extracted together with isometric quadriceps strength measures. No significant differences were found in the load or movement mechanics (P ≥ .31, g ≤ 0.42), despite deficits in isometric maximum (20%) and explosive (25%) strength (P ≤ .13, g ≥ 0.61) in the intact limb. These results demonstrate that, when the influence from the prosthetic limb and task demand are absent, and despite deficits in strength, the intact limb adopts joint mechanics similar to able-bodied controls to attenuate limb loading.

P3106Atrial fibrillation is not associated with the responses to exercise training in heart failure patients with preserved ejection fraction

Abstract Background Atrial fibrillation (AF) is known as a common arrhythmia in heart failure patients with preserved left ventricular ejection fraction (HFpEF). Several studies have reported that HFpEF patients with AF show lower exercise tolerance and poorer prognosis as compared with those with sinus rhythm (SR). On the other hand, exercise training is documented to improve peripheral muscle function and exercise tolerance in HFpEF patients. However, the relationship between AF status and outcomes due to exercise training is still unclear in these patients. Purpose We aimed to investigate the influence of AF on the responses to outcomes with exercise training in HFpEF patients. Methods We studied 426 patients with HFpEF who received 5-month cardiac rehabilitation including exercise training during hospitalization and after hospital discharge. As clinical characteristics, we obtained body mass index, disease aetiology, comorbidity conditions, blood examination and echocardiographic variables from medical records. We also measured isometric quadriceps strength (QS) and 6-minute walk distance (6MWD) as peripheral muscle strength and exercise tolerance, respectively. The QS and 6MWD were assessed at hospital discharge as the baseline and 5 months later. AF status was determined by the presence on electrocardiogram at baseline 6MWD or medical history of AF during hospitalization. In statistical analysis, we compared baseline clinical characteristics, QS and 6MWD between the rhythm status (SR group or AF group). We also examined the changes in QS and 6MWD from baseline to the 5-month observation period (ΔQS and Δ6MWD) and compared them between the 2 groups using analysis of covariance with adjustment for baseline clinical confounding factors. Results At baseline, 289 patients (68%) were in SR, and 111 patients (26%) had AF. The AF was associated significantly with older age (P&lt;0.001) and lower levels of estimated glomerular filtration rate (P=0.013), QS (P&lt;0.001) and 6MWD (P&lt;0.001) at baseline. The QS increased significantly from 25.2±11.0 kg at baseline to 30.8±13.0 kg after 5-month cardiac rehabilitation in the SR group, and from 21.1±8.3 kg to 26.0±9.4 kg in the AF group (P&lt;0.001, respectively). The 6MWD also increased significantly from 394.8±129.2 to 463.5±133.5 meters in the SR, and from 343.7±107.9 to 403.0±114.5 meters in the AF (P&lt;0.001, respectively). There were no significant differences in ΔQS and Δ6MWD between the SR and AF groups even after adjustment for clinical confounding factors including baseline QS or 6MWD (Figure). Conclusions The AF status in HFpEF patients was associated with older age, lower peripheral muscle function and also lower exercise tolerance at baseline, but not associated with the responses to exercise training. Acknowledgement/Funding JSPS KAKENHI JP16K16442

Functional electrical stimulation following anterior cruciate ligament reconstruction: a randomized controlled pilot study

BackgroundInadequate quadriceps strength following anterior cruciate ligament reconstruction (ACLR) often results in alterations in gait pattern that are usually reported during loading response. Neuro-muscular electrical stimulation (NMES) is frequently used to overcome this quadriceps weakness. Despite the beneficial effects of NMES, persistent deficits in strength and gait are reported. The aim of this study was to investigate the feasibility of applying quadriceps functional electrical stimulation (FES) during walking in addition to standard rehabilitation, in the initial stage of ACLR rehabilitation.MethodsSubjects were randomized to quadriceps FES synchronized with walking group (n = 10) or quadriceps NMES (duty cycle of 10 s on/10 s off) group (n = 13). Both interventions were performed for 10 min three days a week, in addition to a standard rehabilitation program. Assessments were performed up to 2 weeks before the ACLR (pre-ACLR), and 4 weeks postoperatively. Outcomes measured were gait speed, single limb stance gait symmetry, quadriceps isometric peak strength ratio (peak strength at 4 weeks/peak strength pre-ACLR) and peak strength inter-limb symmetry. Gait outcomes were also assessed 1-week post-surgery.ResultsSubjects in both groups regained pre-ACLR gait speed and symmetry after 4 weeks of rehabilitation, with no difference between groups. However, although pre-ACLR quadriceps peak strength was similar between groups (FES - 205 Nm, NMES − 225 Nm, p = 0.605), subjects in the FES group regained 82% of their pre-quadriceps strength compared to 47% in the NMES group (p = 0.02). In addition, after 4 weeks, the FES group had significantly better inter-limb strength symmetry 0.63 ± 0.15 vs. 0.39 ± 0.18 in the NMES group (p = 0.01).ConclusionsQuadriceps FES combined with traditional rehabilitation is a feasible, early intervention treatment option, post-ACLR. Furthermore, at 4 weeks post-surgery, FES was more effective in recovering quadriceps muscle strength than was NMES. While spatiotemporal gait parameters did not differ between groups, kinetic and kinematic studies may be useful to further understand the effects of quadriceps FES post-ACLR. The promising results of this preliminary investigation suggest that such studies are warranted.Trial registrationISRCTN 02817399. First posted June 29, 2016.

The relationship between quadriceps strength asymmetry and knee biomechanics asymmetry during walking in individuals with anterior cruciate ligament reconstruction

BackgroundLower extremity movement asymmetries may lead to re-injury and knee osteoarthritis after anterior cruciate ligament (ACL) reconstruction surgery. However, there is no consensus regarding the effect of quadriceps strength asymmetry on lower extremity movement asymmetry after ACL reconstruction. Research questionWhat is the relationship between quadriceps strength asymmetry and asymmetries in lower extremity kinematics and kinetics during walking in individuals who underwent ACL reconstruction surgery?. MethodsIsometric quadriceps strength, kinematic, and kinetic data during walking were collected from 24 men with unilateral ACL reconstruction. Knee joint angles and moments were reduced. Pearson correlation coefficients between asymmetry in selected knee biomechanics and isometric quadriceps strength asymmetry were determined. ResultsThe isometric quadriceps strength of the injured leg was significantly lower than that of the uninjured leg (P < 0.001). Knee flexion angles and knee extension moments were smaller in the injured leg than that in the uninjured leg during both loading response (P = 0.007, P = 0.047) and mid-stance phases (P = 0.005, P = 0.028). Isometric quadriceps strength asymmetry was significantly correlated with asymmetry in the peak knee flexion angle during loading response and mid-stance phases (r = −0.48, P = 0.017, r = −0.48, P = 0.017). Isometric quadriceps strength asymmetry was also significantly correlated with asymmetry in the peak knee extension moment during the mid-stance phase (r = −0.44, P = 0.033). SignificanceIndividuals with ACL reconstruction demonstrate knee movement asymmetry in the sagittal plane. Isometric quadriceps strength asymmetry is significantly correlated with asymmetry in knee flexion angles during the early stance phase and knee extension moments during the mid-stance phase. Rehabilitation programs should emphasise eccentric exercise to beneficially modify quadriceps neuromuscular control.

Rate of Force Development vs Isometric Strength of Quadriceps

Rate of Force Development vs Isometric Strength of Quadriceps

Blood Flow Restriction Training Does Not Improve Quadriceps Strength After Anterior Cruciate Ligament Reconstruction

Objectives: Blood flow restriction training (BFRT) involves obstruction of venous outflow of working muscles during exercise and may lead to more substantial recovery of quadriceps strength after anterior cruciate ligament (ACL) reconstruction. The purpose of this study is to examine the effects of BFRT in ACL reconstruction patients before and after exposure to BFRT. Methods: This study was a randomized controlled trial in which 36 patients who had torn their ACL and were scheduled to undergo ACL reconstructive surgery (ACLR) with an autograft were randomized to receive exercise with BFRT (N=18) or exercise without BFRT (N=18). Participants in both groups performed the same exercise, but either did or did not have blood flow restricted. The exercise component of the intervention consisted of all subjects performing a single-leg isokinetic leg press, at an intensity of 70% of the subjects’ one-repetition maximum, for four sets of ten repetitions two times per week for 8 weeks beginning at 8 weeks post-operatively. Patients randomized to the BFRT group performed the leg-press exercise with a blood flow restriction cuff applied to the thigh and set to a limb occlusion pressure of 80 percent. All participants were concurrently undergoing standard ACL rehabilitation at the same physical therapy clinic. Bilateral isometric (recorded at a knee angle of 90°) and isokinetic (60°/second) quadriceps strength were recorded using a Biodex dynamometer (System 4, Shirley, NY) prior to ACLR and after the conclusion of the 8-week intervention. Peak isometric and isokinetic quadriceps strength were utilized to generate isometric and isokinetic quadriceps symmetry indices ((ACLR limb strength/Healthy limb strength) x100). Change from baseline symmetry scores were then generated using the following equation: (post-intervention symmetry - pre-intervention symmetry)/pre-intervention symmetry in order to account for possible differences in strength between groups prior to intervention delivery. Change from baseline isometric and isokinetic quadriceps symmetry scores were then compared between groups (exercise with BFRT, exercise without BFRT) using one-way analysis of variance tests with an a priori α set to P≤ 0.05. Effect sizes (Cohen’s d) and 95% confidence intervals were also computed. Results: No significant differences were found for change from baseline isokinetic quadriceps symmetry index (P=0.39, BFRT mean=-0.05, Control mean=-0.19) or change from baseline isometric quadriceps symmetry index (P=0.62, BFRT mean=-0.04, control mean=-0.10). The effect sizes for isokinetic quadriceps symmetry index (d=0.28, 95% CI= -0.37, 0.93) and isometric quadriceps symmetry (d=0.16, 95% CI= -0.49, 0.80) were small with confidence intervals that crossed zero. Conclusion: An 8-week blood flow resistance training + exercise intervention did not increase quadriceps muscle strength in patients who had undergone ACL reconstruction. Based on our findings, application of blood flow restriction training in ACL reconstruction patients to improve quadriceps strength may not be warranted. Future studies may benefit from a longer follow-up and larger sample size.

Quadricep Femoris Strength at Return to Sport Identifies Limb at Increased Risk of Future ACL Injury after ACL Reconstruction in Young Athletes

Objectives: The ability of current return to sport (RTS) criteria to identify young, active patients after ACL reconstruction (ACLR) independently, at high risk for future ipsilateral or contralateral ACL injury is limited. The purpose of this study was to determine if meeting current, standard RTS criteria collectively, or in part, would identify young athletes at risk for an ipsilateral or contralateral ACL injury after primary ACLR and RTS. The tested hypothesis was the likelihood of an ipsilateral or contralateral 2nd ACL injury in the first 2 years after RTS would be the same in groups that successfully met or failed to meet all RTS criteria prior to RTS. The second hypothesis was that quadriceps femoris strength at the time of RTS would identify which limb was at greatest risk for future ACL injury. Methods: One hundred eighty-one patients (116 female) with a mean age of 16.7±2.9 years old underwent ACLR and were released to return to pivoting/cutting sports. These patients were enrolled in a prospective, observational cohort study, completed a RTS assessment and were tracked for occurrence of an ipsilateral graft tear or contralateral ACL injury after ACLR for 24 months. The RTS assessment included 6 tests: isometric quadriceps strength, 4 functional hop tests and the International Knee Documentation Committee (IKDC) patient reported outcome survey. Limb symmetry index (LSI) was calculated for strength and hop test assessments [(inv/uninv)*100]. Subjects were classified into groups that successfully passed all 6 RTS tests at a level of 90 compared to those that failed to meet all 6 criteria. Chi Square tests and Fisher Exact Tests were used to determine if successfully passing all 6 RTS measures resulted in a reduced risk of 2nd ACL injury in the first 24 months after RTS as well as to assess if ability to successfully pass individual RTS criteria resulted in reduced risk of 2nd ACL injury. Results: Thirty-nine (21.5%) patients suffered a 2nd ACL injury with 18 ipsilateral graft failures and 21 contralateral ACL tears in the first 24 months after RTS following ACLR. At the time of RTS, 57 patients (31.5%) achieved LSI values of 90% or greater on all testing as well as an IDKC value of 90 or greater. At this level, there was no difference in ipsilateral graft failures between patients who passed all RTS criteria (15.8%) and those who failed at least 1 criterion (7.3%; p=0.08). There was also no difference in contralateral ACL injuries between patients who passed all RTS criteria (7.0%) and those who failed at least 1 criterion (13.7%; p=0.22). When individual RTS criterion were evaluated, patients who failed to achieve 90% quadriceps strength LSI were 84% less likely to suffer an ipsilateral graft failure (OR=0.16; 95%CI: 0.04, 0.74;p=0.009), but 3 times more likely to suffer a contralateral ACL injury (OR=2.5; 95%CI:1.0, 6.5;p=0.05). Conclusion: Current criteria to evaluate readiness to return young athletes to pivoting and cutting sports, may not identify young, active patients independently at high risk for a future ipsilateral graft tear or contralateral ACL injury. Inability to achieve 90% LSI on an isometric quadriceps strength assessment resulted in a reduced risk of ipsilateral graft failure, but an increased risk in contralateral ACL injury after ACLR and RTS. Further investigation is needed on the relationship between quad strength and side of future ACL injury and whether other factors may help contribute to a predictive model of future ACL injury specific to limb.

A prospective randomized trial examining the use of a closed suction drain shows no influence on strength or function in primary total knee arthroplasty.

The aim of this study was to determine whether closed suction drain (CSD) use influences recovery of quadriceps strength and to examine the effects of drain use on secondary outcomes: quadriceps activation, intra-articular effusion, bioelectrical measure of swelling, range of movement (ROM), pain, and wound healing complications. A total of 29 patients undergoing simultaneous bilateral total knee arthroplasty (TKA) were enrolled in a prospective, randomized blinded study. Patients were randomized to receive a CSD in one limb while the contralateral limb had the use of a subcutaneous drain (SCDRN) without the use of suction ('sham drain'). Isometric quadriceps strength was collected as the primary outcome. Secondary outcomes consisted of quadriceps activation, intra-articular effusion measured via ultrasound, lower limb swelling measured with bioelectrical impendence and limb girth, knee ROM, and pain. Outcomes were assessed preoperatively and postoperatively at day two, two and six weeks, and three months. Differences between limbs were determined using paired Student's t-tests or Wilcoxon's signed-rank tests. No significant differences were identified between limbs prior to surgery for the primary or secondary outcomes. No significant differences in quadriceps strength were seen between CSD and SCDRN limbs at postoperative day two (p = 0.09), two weeks (primary endpoint) (p = 0.7), six weeks (p = 0.3), or three months (p = 0.5). The secondary outcome of knee extension ROM was significantly greater in the CSD limb compared with the SCDRN (p = 0.01) at two weeks following surgery, but this difference was absent at all other intervals. Secondary outcomes of quadriceps activation, intra-articular effusion, lower limb swelling, and pain were not found to differ significantly at any timepoint following surgery. The use of CSD during TKA did not influence quadriceps strength, quadriceps activation, intra-articular effusion, lower limb swelling, ROM, or pain. These results have limited drain use by the authors in primary uncomplicated TKA. Cite this article: Bone Joint J 2019;101-B (7 Supple C):84-90.

Structured Total Knee Replacement Rehabilitation Programme and Quality of Life following Two Different Surgical Approaches - A Randomised Controlled Trial.

Introduction: The key important factor influencing the outcomes following rehabilitation is the surgical approach involved in Total Knee Replacement (TKR). Most studies have analysed the functional outcome in comparing the approaches on surgical perspective rather on post-operative therapeutic interventions. The current study was to analyse the effects of structured TKR rehabilitation programme on the quality of life and joint specific outcomes between two different surgical approaches.Materials and Methods: In this double-blind randomised controlled trial, participants were randomly allocated to one of two groups: Group 1- those who underwent medial parapatellar approach and Group 2- those who underwent mid-vastus approach. Both groups received three-phase structured rehabilitation protocol for 12 weeks. The outcome measures of SF-36, knee mobility, isometric knee musculature strength and six-minute walk distance were measured at baseline, on discharge and at review after three months.Results: The quality of life and joint specific outcome scores were better in mid-vastus approach than the popular medial parapatellar approach. The outcomes of knee flexion mobility (p=0.04), knee extension mobility (p=0.03), isometric muscle strength of quadriceps (p=0.001), isometric muscle strength of hamstrings (p=0.03), six-minute walk distance (p=0.001) and Physical Cumulative Scores (PCS) (p=0.03) were found to exhibit significant improvements at three months follow up.Conclusion: The mid-vastus approach was found to exhibit better improvements following structured rehabilitation care, in physical summary scores of quality of life and joint specific outcomes than medial parapatellar approach.

Effect of Sports and Growth on Hamstrings and Quadriceps Development in Young Female Athletes: Cross-Sectional Study.

Context: Lower extremity muscular strength may vary by different sport participation during growth process. Objective: To investigate effect of sport participation and growth by comparing strength of the hamstrings, quadriceps, and hamstrings to quadriceps strength ratio (H:Q ratio) between young female figure skaters and soccer players. Design: Cross-sectional. Settings: Laboratory affiliated with regional sports medicine center. Participants: pediatric and adolescent female athletes. Procedures: Isometric hamstrings and quadriceps strength were measured. Main Outcome Measures: Strength of the hamstrings, quadriceps, and hamstrings to quadriceps strength ratio (H:Q ratio). Statistical Analysis: Effect of sport participation and growth was analyzed through a two-way (two sports: figure skaters and soccer players; three age groups: <12 years, 13–16 years, and >17 years) analysis of covariance. Results: Hamstrings strength was significantly greater in figure skaters than soccer players. Also, hamstring strength of 13–16 years and >17 years was higher compared to <12 years. Additionally, significantly higher H:Q ratio in figure skaters compared to soccer players. Conclusions: There is effect of growth on hamstrings strength among 13–16 years and >17 years compared to <12 years. Figure skaters showed greater hamstrings strength and H:Q ratio than female soccer players.

Associations among falls, gait variability, and balance function in idiopathic normal pressure hydrocephalus

ObjectivesThe factors influencing falls in idiopathic normal pressure hydrocephalus (iNPH) remain unclear, although iNPH-associated gait and balance disturbances can lead to an increased risk of falls. This study aimed to investigate the associations among fall status, gait variability, balance function in iNPH, and to identify fall-related factors in iNPH. Patients and methodsSixty-three patients with iNPH with a positive cerebrospinal fluid tap test result according to the iNPH diagnosis criteria participated in this prospective cross-sectional study. Patients were assessed using the 10-meter walk test (10MWT), the Functional Gait Assessment (FGA), the Berg Balance Scale (BBS), and the isometric quadriceps strength (QS). We also investigated each patient’s history of falls in the past 6 months. Gait variability was measured using a triaxial accelerometer attached to the patient’s torso at the L3 vertebra level during the 10MWT. ResultsFall status correlated significantly with gait variability (measured as the coefficient of variation; CV) in step time and movement trajectory amplitude (i.e., center of mass movement) in the medial/lateral (ML) and vertical (VT) directions, with balance function as assessed by FGA and BBS scores. In contrast, QS was not correlated with fall status. The independent variables associated with the risk of falling were step time CV, FGA score, and age. ConclusionThe factors associated with the risk of falling in iNPH were aging and gait-balance instability, particularly temporal gait variability and dynamic balance dysfunction. Our results may enable physicians to identify the patients with iNPH who are at risk of falling and implement suitable prevention strategies.

Gait Asymmetry Can Predict Functional Performance Post ACL Reconstruction: A Pilot Study

Wearable inertial sensors are practical and inexpensive technology that can be used to detect gait asymmetries following anterior cruciate ligament reconstruction (ACLR). Specifically, individuals after ACLR walk with asymmetries in shank angular velocity (SAV) during landing, which may be indicative of abnormal knee joint loading. However, it is unknown whether these asymmetries in SAV detected at early stage of rehabilitation can predict functional performance at 6 months after ACLR. PURPOSE: To investigate whether SAV asymmetries during walking at 4 months after surgery can predict return-to-activity criteria at 6 months in individuals with ACLR. METHODS: Fourteen individuals (8 females; age= 27.79±7.9 y) with primary unilateral ACLR participated in the study. Participants were instructed to walk at a self-selected speed along a 12-meter straight walkway at 4 months after surgery. SAV peak was calculated bilaterally during landing as the first negative peak value after heel strike in the sagittal plane. The average SAV peak was calculated for each limb. At 6 months after surgery, participants completed return-to-activity criteria testing (isometric quadriceps index, single-legged hop tests, Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), and Global Rating Score (GRS)). Inter-limb symmetry (ACLR limb/uninjured limb*100) was calculated for SAV peak and functional measures. Linear regression models were used to determine whether SAV peak at 4 months would predict functional performance at 6 months following surgery. RESULTS: Asymmetry in SAV at 4 months was a significant predictor for asymmetries in the isometric quadriceps strength (r2=0.39, p=.02), single hop for distance (r2=0.36, p=.02), triple hop for distance (r2=0.34, p=.03), and triple-crossover hop for distance (r2=0.51, p=.001), but not for the 6-meter timed hop (r2=0.17, p=.14) at 6 months. Greater SAV asymmetry was a significant predictor for worse scores on the KOS-ADLS (r2=0.49, p=.006) and GRS (r2=0.46, p=.008). CONCLUSIONS: This pilot study showed that gait asymmetry detected by inertial sensors at early stage of rehabilitation can predict functional performance at 6 months after ACLR. Implementing these sensors in clinical practice may help clinicians to monitor gait on a regular basis during rehabilitation.

Changes in Maximal Isometric Quadriceps Strength after the Application of Ultrasound-Guided Percutaneous Neuromodulation of the Femoral Nerve: A Case Series

Abstract Introduction For those individuals who have suffered an injury to the knee or undergone a surgical intervention, the early recovery of the muscle strength contraction properties of the quadriceps is essential for a favorable recovery and for a return to the activities of daily living and other work- or sports-related activities. Objectives To evaluate the changes in maximal isometric strength (MIS) of the quadriceps muscle after the application of ultrasound-guided percutaneous neuromodulation (US-guided PNM) on the femoral nerve. Materials and Methods A case series involving subjects who had previously presented unilateral knee pathology and were in the stage of recovery of quadriceps strength. The subjects were pain-free at the time of the dynamometry measurements, which were performed before and after the application of the US-guided PNM technique. The isometric measurement was performed using the KINEO dynamometry system, performing a preintervention measurement of the mean maximal isometric strength (mMIS) based on 3 repetitions (3 seconds contraction and 6 seconds relaxation). The US-guided PNM technique was performed on the femoral nerve, using the Physio Invasiva CE0120 device (Prim Physio, Madrid, Spain) and a GE Logiq e R7 ultrasound (GE Healthcare, Chicago, IL, USA). Results In total, 13 subjects participated in the present study. Significant changes were obtained (p &lt; 0.001) in the mMIS of the quadriceps of the affected knee, which progressed from a mean strength of 25.91 kg (standard deviation [SD]: 7.17 kg) to a mean strength of 29.98 kg (SD: 9.06 kg). Discussion In subjects with knee pathology, the quadriceps muscle is inhibited despite being pain-free during the strength measurements. This process of inhibition can improve with the application of low frequency percutaneous electrical stimulation on the femoral nerve. This technique represents a complementary strategy for the recovery of the normal strength values in pathological knees with or without prior surgery. Conclusions Ultrasound-guided PNM is an effective technique for the reestablishment of quadriceps strength in inhibited muscles.

Effects of electrical muscle stimulation in frail elderly patients during haemodialysis (DIAL): rationale and protocol for a crossover randomised controlled trial

IntroductionThe phenomenon of population ageing is accompanied by increases in the number of elderly haemodialysis patients worldwide. The incidence of frailty is high in the haemodialysis population and is associated...

Improvement in body composition following a supervised exercise-training program of adult patients with cystic fibrosis

ObjectivesMaintenance of optimal nutritional status is a crucial issue for cystic fibrosis (CF) patients. Here, we evaluate the effects of an 8-week exercise training (ET) program on body composition in CF patients. MethodsThis prospective pilot observational study was conducted in adult CF subjects in stable condition following their annual check-up. The ET program consisted of three sessions per week and included aerobic training (≥30min), muscle strengthening, circuit training, and relaxation. Exercise tolerance (6-minute walk test, 6MWT), pulmonary function, quadriceps isometric strength, and body composition (bioelectrical impedance analysis of fat-free mass [FFM], fat mass, and body cell mass) were analyzed before and immediately after the ET program. A control group of CF patients who preferred not to participate in the ET program received the same evaluations. ResultsA total of 43 CF patients were enrolled and offered the ET program; 28 accepted (aged 28±5 years, forced expiratory volume in 1s [FEV1] 48.8±19% predicted) and 15 declined the ET program but agreed to be part of the control group (matched for age and CF severity: 30.8±9 years, FEV1 51.8±16.5%). Pulmonary function was unchanged at the end of the ET program, but significant improvements were observed in 6MWT distance (from 520±96m to 562±105m, P<0.001) and muscle strength (331±141N to 379±168N, P<0.001). Although mean body mass index did not change, the ET group showed significantly increased FFM (43.85±8kg to 44.5±9.2kg, P=0.03) and a trend towards increased body cell mass (21.4±6 to 22.1±6.6kg, P=0.06). All other parameters were unchanged by ET. There were no significant correlations between the increase in FFM and the improvements in either 6MWT distance or muscle strength. The CF control group exhibited no significant changes in any parameters between evaluations. ConclusionsET significantly improved FFM, but not body mass index, in CF patients. The results illustrate the superiority of bioimpedancemetry for assessing changes in body composition and reveal the importance of ET for improving not only exercise tolerance but also nutritional status in these patients.