Flexion Mobility Research Articles

改良Carlson后外侧入路治疗胫骨平台单纯后外侧柱骨折

目的：探讨改良Carlson的后外侧入路锁定钢板内固定治疗胫骨平台后外侧骨折的手术方法及临床疗效。方法：自2010年1月至2013年12月，采用改良后外侧切口显露胫骨平台后外侧，对48例胫骨平台后外侧骨折进行手术治疗。男28例，女20例；年龄19~65岁，平均37岁。术后采用HSS评分标准评定关节功能，并通过对患膝TPA、PA角度的测量及关节屈伸活动度对疗效进行评估。结果：所有患者术后获12—18个月(平均15.7个月)随访，骨折均获愈合。所有患者术后3、6、12个月膝关节HSS评分差异均无统计学意义(P > 0.05)，术后即刻、3个月、6个月及12个月胫骨平台内翻角及后倾角比较差异均无统计学意义(P > 0.05)。无手术切口相关并发症发生，无腓总神经症状、无感染、内固定失效及螺钉断裂等并发症发生。结论“改良Carlson后外侧入路支撑钢板固定是治疗胫骨平台后外侧柱骨折的一种有效方法，能够充分显露手术区域，最大限度提供后外侧内固定的生物力学强度，是治疗胫骨平台后外侧柱骨折的理想入路。 Objective: To introduce a modified Carlson’s posterolateral approach using locking plate for the treatment of posterolateral coronaI fractures of the tibial plateau. Methods: From January 2010 to December 2013, 45 patients with the posterolateral coronal fracture of the tibial plateau were operated on. They were 28 males and 20 females, with a mean age of 37 years (range, from 19 to 65 years). The patients were treated with buttress plate fixation via a modified Carlson’s posterolateral approach. The knee functions were estimated with the Hospital for SpeciM Surgery (HSS) score system at 3 months, 6 months and 1 year postoperatively. Imaging data based on the measurement of angle of knee TPA, PA and joint flexion mobility to evaluate the curative effect were compared immediately, 3, 6 and 12 months after operation respectively. Results: The 48 patients were followed up for an average of 15.7 months (range, from 12 to 18 months). All patients obtained bony union. There were no significant differences regarding the mean HSS score among 3 months, 6 months and 1 year postoperation (P > 0.05). There were no significance differences regarding the tibial plateau angle and posterior slope angle oil radiographies among immediate, 3, 6 and 1 2 months postoperation(P > 0.05). No complications associated with the approach were observed and there was no infection or fixation failure either. Conclusion: Because the modified Carlson’s posterolateral approach can provide direct visual exposure to protect ligamentous structures and the soft tissue around the posterolateral fragments, utmost to provide the biomechanical strength of the posterolateral internal fixation, it can be effectively used to treat posterolateral coronal fractures of the tibial plateau.

Influence of preoperative factors on the gain in flexion after total knee arthroplasty

Final flexion mobility after a total knee arthroplasty is an important factor in patient comfort. Some patients gain in flexion mobility, others do not. Is it possible to identify the clinical factors related to the patient that predicted the final gain in flexion? Materials and methodsA multicenter retrospective study directed by the Société française de la hanche et du genou (SFHG) was conducted on 1601 cases of total knee arthroplasty that had presented no complications and a minimal follow-up of 2 years. The gain in flexion was assessed by the difference between the preoperative and the final range of flexion. The range of the gain in flexion was tested based on eight factors: age, gender, etiology, body mass index, frontal deformity, preoperative flexum deformity and four levels of preoperative mobility: < 90°, 90°–109°, 110°–129°, and ≥ 130°. ResultsA mean gain in flexion of 8.4°±14° was found for the overall series. In 66% of cases, we found an increase of flexion and in 19% a loss of flexion. In cases with BMI higher than 35, varus deformity with an HKA angle<166°, or flessum greater than 5°, the gain in flexion was significantly higher. A significantly different gain in flexion (P<0.0001) was found in the four levels of preoperative flexion: the greatest gain in flexion was found in the “<90°” group, then this gain was less in the next two groups, to become a significant decrease in the “≥130°” group. A decrease in flexion was noted in 51% of the cases in the latter group. Other factors such as age, sex, and etiology had no influence on the gain in flexion. DiscussionAfter TKA, a gain in flexion was often noted. The amount of gain depended on the preoperative range of flexion: the lower this level was, the more flexion increased. The presence of a varus deformity, morbid obesity, or flessum was associated with greater gain in flexion, even if the final flexion was lower than the mean flexion in the overall population. The search for these factors made it possible to predict a gain in flexion and discuss this with the patient. Level of evidenceLevel IV. Multicenter retrospective study.

Short-term effectiveness of spinal manipulative therapy versus functional technique in patients with chronic nonspecific low back pain: a pragmatic randomized controlled trial

Background ContextChronic low back pain (LBP) is a prevalent condition associated with pain, disability, decreased quality of life, and fear of movement. To date, no studies have compared the effectiveness of spinal manipulation and functional technique for the management of this population. PurposeThis study aimed to compare the effectiveness of spinal manipulation and functional technique on pain, disability, kinesiophobia, and quality of life in patients with chronic LBP. Study Design/SettingA single-blind pragmatic randomized controlled trial conducted in a university research clinic was carried out. Patient SampleSixty-two patients (62% female, age: 45±7) with chronic LBP comprised the patient sample. Outcome MeasuresData on disability (Roland-Morris Disability Questionnaire [RMQ], Oswestry Low Back Pain Disability Index [ODI]), pain intensity (Numerical Pain Rate Scale [NPRS]), fear of movement (Tampa Scale of Kinesiophobia [TSK]), quality of life (Short Form-36 [SF-36] quality of life questionnaire), isometric resistance of abdominal muscles (McQuade test), and spinal mobility in flexion (finger-to-floor distance) were collected at baseline immediately after the intervention phase and at 1 month postintervention by an assessor blinded to group allocation of the patients. MethodsPatients were randomly assigned to the spinal manipulative therapy group or the functional technique group and received three once-weekly sessions. ResultsIn comparison to patients receiving functional technique, those receiving spinal manipulation experienced statistically, although not clinically, significant greater reductions in terms of RMQ (standardized mean difference in score changes between groups at post-treatment: 0.1; at 1 month: 0.1) and ODI (post-treatment: 2.9; at 1 month: 1.4). Linear longitudinal analysis showed a significant improvement in both groups over time for RMQ (manipulative: F=68.51, p<.001; functional: F=28.58, p<.001) and ODI (manipulative: F=104.66, p<.001; functional: F=32.15, p=.001). However, significant treatment-by-time interactions were not detected for pain intensity (p=.488), TSK (p=.552), any domains of the SF-36 quality of life questionnaire (p≤.164), McQuade test (p=.512), and finger-to-floor distance (p=.194). Differences between and within groups were not clinically meaningful in any of the reported measures. ConclusionsIn comparison to functional technique, spinal manipulative therapy showed greater reduction in disability in patients with chronic LBP, but not in terms of pain, fear of movement, quality of life, isometric resistance of trunk flexors, or spinal mobility. However, differences in disability were not clinically meaningful; therefore, spinal manipulative therapy did not result in any clinically important short-term benefits over functional technique therapy. In addition, as neither group met the threshold for minimum clinically important difference following treatment, neither treatment resulted in a clinically meaningful benefit.

Studying Upper-Limb Kinematics Using Inertial Sensors Embedded in Mobile Phones.

BackgroundIn recent years, there has been a great interest in analyzing upper-limb kinematics. Inertial measurement with mobile phones is a convenient and portable analysis method for studying humerus kinematics in terms of angular mobility and linear acceleration.ObjectiveThe aim of this analysis was to study upper-limb kinematics via mobile phones through six physical properties that correspond to angular mobility and acceleration in the three axes of space.MethodsThis cross-sectional study recruited healthy young adult subjects. Humerus kinematics was studied in 10 young adults with the iPhone4. They performed flexion and abduction analytical tasks. Mobility angle and lineal acceleration in each of its axes (yaw, pitch, and roll) were obtained with the iPhone4. This device was placed on the right half of the body of each subject, in the middle third of the humerus, slightly posterior. Descriptive statistics were calculated.ResultsDescriptive graphics of analytical tasks performed were obtained. The biggest range of motion was found in pitch angle, and the biggest acceleration was found in the y-axis in both analytical tasks. Focusing on tridimensional kinematics, bigger range of motion and acceleration was found in abduction (209.69 degrees and 23.31 degrees per second respectively). Also, very strong correlation was found between angular mobility and linear acceleration in abduction (r=.845) and flexion (r=.860).ConclusionsThe use of an iPhone for humerus tridimensional kinematics is feasible. This supports use of the mobile phone as a device to analyze upper-limb kinematics and to facilitate the evaluation of the patient.

Short-Term Effect of Spinal Manipulation on Pain Perception, Spinal Mobility, and Full Height Recovery in Male Subjects With Degenerative Disk Disease: A Randomized Controlled Trial

ObjectiveTo evaluate the short-term effect on spinal mobility, pain perception, neural mechanosensitivity, and full height recovery after high-velocity, low-amplitude (HVLA) spinal manipulation (SM) in the lumbosacral joint (L5-S1). DesignRandomized, double-blind, controlled clinical trial with evaluations at baseline and after intervention. SettingUniversity-based physical therapy research clinic. ParticipantsMen (N=40; mean age ± SD, 38±9.14y) with diagnosed degenerative lumbar disease at L5-S1 were randomly divided into 2 groups: a treatment group (TG) (n=20; mean age ± SD, 39±9.12y) and a control group (CG) (n=20; mean age ± SD, 37±9.31y). All participants completed the intervention and follow-up evaluations. InterventionsA single L5-S1 SM technique (pull-move) was performed in the TG, whereas the CG received a single placebo intervention. Main Outcome MeasuresMeasures included assessing the subject's height using a stadiometer. The secondary outcome measures included perceived low back pain, evaluated using a visual analog scale; neural mechanosensitivity, as assessed using the passive straight-leg raise (SLR) test; and amount of spinal mobility in flexion, as measured using the finger-to-floor distance (FFD) test. ResultsThe intragroup comparison indicated a significant improvement in all variables in the TG (P<.001). There were no changes in the CG, except for the FFD test (P=.008). In the between-group comparison of the mean differences from pre- to postintervention, there was statistical significance for all cases (P<.001). ConclusionsAn HVLA SM in the lumbosacral joint performed on men with degenerative disk disease immediately improves self-perceived pain, spinal mobility in flexion, hip flexion during the passive SLR test, and subjects' full height. Future studies should include women and should evaluate the long-term results.

Spinal form and function profile: reference values for clinical use in low back pain

Functional diagnostic approaches are helpful in the treatment of low back pain (LBP) patients. Reference data of asymptomatic individuals might be helpful to understand individual case profiles of LBP patients, to derive movement therapy goals and issues and to improve quality management in therapy monitoring. Spinal form and mobility in the dorsal flexion (static and dynamic rasterstereography), as well as isometric peak forces (back extension/trunk flexion) were analyzed in a cross-sectional study of 103 pain-free volunteers (52 females, 51 males) aged 18-40 years. Reference data could be demonstrated based on percentiles (5-95 %). There were significant differences between males and females for strength values and spinal form parameters describing the lumbosacral transition (p < 0.001), but not for the strength extension/flexion ratio (Ex/Flex), lumbar mobility (dorsiflexion) or any other spine shape parameter. Despite the problem of a normal spinal alignment it is proposed to use reference data percentiles of asymptomatic persons to construct a musculoskeletal functional profile for individual LBP patients, which might emphasize the character of different LBP disorders and could be useful in screening, therapy planning and monitoring.

Screening of the spine in adolescents: inter- and intra-rater reliability and measurement error of commonly used clinical tests

BackgroundEvidence on the reliability of clinical tests used for the spinal screening of children and adolescents is currently lacking. The aim of this study was to determine the inter- and intra-rater reliability and measurement error of clinical tests commonly used when screening young spines.MethodsTwo experienced chiropractors independently assessed 111 adolescents aged 12–14 years who were recruited from a primary school in Denmark. A standardised examination protocol was used to test inter-rater reliability including tests for scoliosis, hypermobility, general mobility, inter-segmental mobility and end range pain in the spine. Seventy-five of the 111 subjects were re-examined after one to four hours to test intra-rater reliability. Percentage agreement and Cohen’s Kappa were calculated for binary variables, and interclass correlation (ICC) and Bland-Altman plots with Limits of Agreement (LoA) were calculated for continuous measures.ResultsInter-rater percentage agreement for binary data ranged from 59.5% to 100%. Kappa ranged from 0.06-1.00. Kappa ≥ 0.40 was seen for elbow, thumb, fifth finger and trunk/hip flexion hypermobility, pain response in inter-segmental mobility and end range pain in lumbar flexion and extension. For continuous data, ICCs ranged from 0.40-0.95. Only forward flexion as measured by finger-to-floor distance reached an acceptable ICC(≥ 0.75). Overall, results for intra-rater reliability were better than for inter-rater reliability but for both components, the LoA were quite wide compared with the range of assessments.ConclusionSome clinical tests showed good, and some tests poor, reliability when applied in a spinal screening of adolescents. The results could probably be improved by additional training and further test standardization. This is the first step in evaluating the value of these tests for the spinal screening of adolescents. Future research should determine the association between these tests and current and/or future neck and back pain.

Treatment of Intraarticular Middle Phalanx Fractures Using the Ligamentotaxor®

We evaluated the outcome of intraarticular middle phalanx fractures after dynamic treatment with the Ligamentotaxor® system. Ten consecutive patients (seven male, three female; mean age 52years) with intraarticular middle phalanx fractures were treated with the Ligamentotaxor® between 2009 and 2011. Proximal interphalangeal joint mobility, grip strength and 'Disabilities of the Arm, Shoulder and Hand' (DASH) score were evaluated in a 15-month follow-up. The reconstitution of the intraarticular space was measured immediately after trauma, at 6weeks and at 15months by radiograph control. The severity of the trauma was classified according to AO. We found B1 30%, C1 (Seno I + II) 50% and C3 (Seno III-V) 20%. In 60% of the cases, fractures were localized on the middle base of the fifth digit, in 20% on the third digit and in 20% on the index finger. The dynamic treatment lasted 7weeks; patients were exposed to full workload after 9weeks. The mean flexion mobility after 15months reached 73° (range 60-100°), and the extension deficit was 13° (range 0-20°) on average. Grip strength attained 71.3% (range 60-87%) of the contralateral side. Initial x-ray after trauma compared to the x-ray after 15months showed an intraarticular space reconstitution average of 0.5mm (range 0.1-0.9mm) anterior-posterior and 0.6mm (range 0.1-1mm) lateral. Patients evaluated their outcome with an average of 14.6 points (range 3.3-26.7) using the DASH score. Good results can be obtained with the Ligamentotaxor®. We recommend it for the dynamic treatment of intraarticular middle phalanx finger fractures. Larger series and long-term results are needed.

Safety of a novel high tibial osteotomy locked plate fixation for immediate full weight-bearing: a case-control study

The safety and efficacy of the novel Limmed® system (locked plate fixation) for immediate full weight-bearing after medial opening wedge high tibial osteotomy (HTO) were evaluated in patients with symptomatic varus gonarthrosis. A case series of 85 consecutive osteotomies performed with Limmed® locked plate fixation for medial opening wedge HTO was compared to a historical matched case-control series of 85 HTOs (85 patients) performed using the same implant without locked screws. Subjects were observed at seven and 15 days and three, six and 12 months after surgery. Endpoints for evaluation included the reporting of adverse events, weight-bearing status without pain, radiographic evidence of bony union and changes in correction angle during healing. Statistically significant differences were seen between groups in terms of safety (thrombophlebitis), time to weight-bearing, radiographic union and radiographic stability between the two groups. Patients of the Limmed® group reported less thrombophlebitis (one versus nine), outcome with shorter time for full weight-bearing (average 45 days difference, p = 0.01) and a shorter time for union (average four weeks difference). At the one-year follow-up the post-operative hip-knee-ankle angle was 4.2° of valgus in the Limmed® group and 2° of valgus in the control group. The adjusted mean difference of 2.2° was significant (p = 0.02) and related to loss of correction during healing in the control group with difference in implant stability. The severity of pain, knee score and walking ability improved in both groups with a significant difference before the third month (quicker for Limmed® group), while at the most recent follow-up only the difference for mobility in flexion was significant. The Limmed® medial opening wedge HTO system represents a novel method of achieving a reliable correction while producing a stable fixation allowing satisfactory stability and bone healing with immediate full weight-bearing.

Contribution of Physical Fitness Component to Health Status in Elderly Males and Females over 60 years – Short Report

The purpose of this study was to identify the physicalfitness (PF) level of a cohort of elderly people that are subjected tophysical activity (PA), and to establish a regression model for theevaluation of health status (HS) of elderly people based on their PF.This is a Cross-sectional study. Consists of 114 Participants over60 years old, that were recruited from a physical activity program.Were measured variables about anthropometric characteristics,jumping tests with jumping platform, dynamic and static balance, riskof falls, lung capacity, HS and quality of life (QoL). We used Pearson’slinear correlation with 95% Zr. We looked for simple and multiple regression models. We used the bayesianinformation criterion approach and statistical inference to find and calculated a numerical estimate of thebest regression model. We used the dependent variable physical function of SF-12. Physical fitness variablesselected for the models were weight, height, Countermovement Jump test (flight time), Functional Reachtest, lumbosacral flexion mobility, Extended Timed Get Up and Go (ETGUG) (10 meters time score andtotal time score). The HS and QoL measurement are important for the prevention of injury during physicalexercise and should be conducted whenever is possible. The regression models proposed in this study can beused as an initial screening of HS or QoL at fitness facilities and fitness clubs that do not provide HS or QoLquestionnaires. However, these models are not an alternative to health care for a detailed determination ofHS and is not intended for use as a final evaluation.

Práctica del método Pilates: cambios en composición corporal y flexibilidad en adultos sanos

Introduction Pilates Method (PM) can be described as an exercise based on Oriental and Western philosophies intended to improve general body flexibility, strength and overall wellbeing. The aim of the study was to evaluate changes in body composition and spinal flexibility in healthy adults after 20 weeks of PM intervention (2 hours/week) versus a control group. Method The study design was a controlled trial with a total sample of 41 subjects (83.3% women and 16.7% men); ages between 28 and 58 years old ( X=42.37 ± 7.86). The sample was divided into two groups: intervention (PMg) and control group (Cg). Body composition measures were: body weight, height and body fat measured from 6 skin-fold thicknesses. To asses spinal flexibility we used the Modified Schober Test. PM intervention included 20 weeks PM Matwork sessions (2 sessions of 60 minutes per week). Results After completing the 20 weeks PM intervention significant changes ( P < .05) were found in the PMg: lower sum of skinfold thicknesses in 6 sites ( P = .028), lower body fat % ( P = .016) and greater lumbar extension mobility ( p = .000) and thoracic flexion mobility ( p = .013). Conclusions A PM intervention of 20 consecutive weeks (2 days/week) positively affects body composition and spinal flexibility in a sample of 41 adults from Boadilla del Monte, Madrid.

Effect of AFO Design on Walking after Stroke

This study was conducted to compare the effects of three ankle-foot orthosis (AFO) designs on walking after stroke and determine whether an ankle plantar flexion contracture impacts response to the AFOs. A total of 30 individuals, ranging from 6-215 months post-stroke, were tested in four conditions: shoes only (SH), dorsi-assist/dorsi-stop AFO (DA-DS), plantar stop/free dorsiflexion AFO (PS), and rigid AFO (Rigid). Kinematics, kinetics, and electromyographic (EMG) activity were recorded from the hemiparetic lower extremity while participants walked at a self-selected pace. Gait parameters were compared between conditions and between participants with and without a moderate ankle plantar flexion contracture. All AFOs increased ankle dorsiflexion in swing and early stance. Anterior tibialis EMG was reduced only in the PS AFO. Both PS and Rigid AFOs restricted ankle plantar flexion and increased knee flexion in loading. Peak ankle dorsiflexion in stance and soleus EMG intensity were greatest in the PS AFO. The Rigid AFO tended to restrict dorsiflexion in stance and knee flexion in swing only in participants without a plantar flexion contracture. Individuals without a contracture benefit from an AFO that permits dorsiflexion mobility in stance and those with quadriceps weakness may more easily tolerate an AFO with plantar flexion mobility in loading.

Radiological and Mathematical Studies Regarding the Effects of Spinal Fixation on Kinematics and Mechanics at the Parafixed Segments

AbstractSpinal fixation and fusion has been adopted as a common procedure in spinal surgery. However, the degeneration as a result of parafixation may produce clinically significant problems. Previous studies have already shown increased loads, mobility, and intradiscal pressure at the parafixed segments. These may hasten the degeneration and instability of the neighboring segments. However, controversy remains regarding the correlation between surgical fixation and degeneration owing to parafixation. This study tried to elucidate their relationship by analyzing the in vivo roentgenograms of the post-fusion lumbar spine to measure the motion distribution of the fixed and adjacent unfused spinal segments. In addition, a mathematical model was developed to investigate the effects of implant fixation on the kinematics and mechanics at the parafixation segments.The current radiological studies demonstrated that spinal fixation resulted in the redistribution of intersegmental mobility. The loss of flexion mobility at the fixed segments was unequally compensated for by the increased mobility at all adjacent free segments. This mechanical model can predict the redistribution patterns of mobility and stress at the parafixation segments. This redistribution depends on the fixation levels, implant rigidity, and subject predisposition. Additionally, such compensation was more marked in the tri-segmental than in the two-segment fixation, especially among patients who underwent greater spinal load.This study concluded that the increased flexural rigidity at the fixed segment leads to the compensated kinematic and mechanical demands upon the unfixed adjacent segments. Accordingly, the cumulative effects of such increased mobility and loadings on the adjacent segments could be logically postulated to be the principal causes of accelerated degeneration of the adjacent lumbar segments, both upper and lower portions, subsequent to fusion surgery.

Effect of multilevel lumbar disc arthroplasty on spine kinematics and facet joint loads in flexion and extension: a finite element analysis

Total disc arthroplasty (TDA) has been successfully used for monosegmental treatment in the last few years. However, multi-level TDA led to controversial clinical results. We hypothesise that: (1) the more artificial discs are implanted, the stronger the increases in spinal mobility and facet joint forces in flexion and extension; (2) deviations from the optimal implant position lead to strong instabilities. A three-dimensional finite element model of the intact L1-L5 human lumbar spine was created. Additionally, models of the L1-L5 region implanted with multiple Charité discs ranging from two to four levels were created. The models took into account the possible misalignments in the antero-posterior direction of the artificial discs. All these models were exposed to an axial compression preload of 500 N and pure moments of 7.5 Nm in flexion and extension. For central implant positions and the loading case extension, a motion increase of 51% for two implants up to 91% for four implants and a facet force increase of 24% for two implants up to 38% for four implants compared to the intact spine were calculated. In flexion, a motion decrease of 5% for two implants up to 8% for four implants was predicted. Posteriorly placed implants led to a better representation of the intact spine motion. However, lift-off phenomena between the core and the implant endplates were observed in some extension simulations in which the artificial discs were anteriorly or posteriorly implanted. The more artificial discs are implanted, the stronger the motion increase in flexion and extension was predicted with respect to the intact condition. Deviations from the optimal implant position lead to unfavourable kinematics, to high facet joint forces and even to lift-off phenomena. Therefore, multilevel TDA should, if at all, only be performed in appropriate patients with good muscular conditions and by surgeons who can ensure optimal implant positions.

Coronoid fractures and elbow instability, general review and clinical presentation

Elbow joint has three articulations: (1) ulnatrochlear, (2) radiocapitellar, and (3) radioulnar. The olecranon and coronoid fossa of distal humerus separate medial and lateral columns of the distal humerus. Medial column ends with spool-shaped trochlea, and lateral column ends with spherical capitellum. The irregularity of elbow joint in anatomic means is not an impediment for the joint to be congruent. Congruity of the ulna humeral articulation is the mainstay of the osseous stability and mobility in flexion and extension plane. Fracture dislocation of the elbow is a well-defined injury, but it is difficult to achieve satisfactory good results due to some pitfalls. Coronoid process, radial head and neck or both can be fractured. Treatment decision of uncomplicated elbow fractures depends on the stability after reduction. Understanding the anatomy and the biomechanics of elbow is crucial to diagnose and treat elbow instability. Treatment of fracture dislocation of the elbow is a challenge for the orthopedic surgeon. Here, we emphasized the anatomic and biomechanical knowledge about importance of the recognition, identification, and treatment of coronoid process in restoring the sufficient stability of the elbow to allow early mobilization with an excellent functional outcome.

The gait and balance of patients with diabetes can be improved: a randomised controlled trial

Aims/hypothesisGait characteristics and balance are altered in diabetic patients. Little is known about possible treatment strategies. This study evaluates the effect of a specific training programme on gait and balance of diabetic patients.MethodsThis was a randomised controlled trial (n = 71) with an intervention (n = 35) and control group (n = 36). The intervention consisted of physiotherapeutic group training including gait and balance exercises with function-orientated strengthening (twice weekly over 12 weeks). Controls received no treatment. Individuals were allocated to the groups in a central office. Gait, balance, fear of falls, muscle strength and joint mobility were measured at baseline, after intervention and at 6-month follow-up.ResultsThe trial is closed to recruitment and follow-up. After training, the intervention group increased habitual walking speed by 0.149 m/s (p < 0.001) compared with the control group. Patients in the intervention group also significantly improved their balance (time to walk over a beam, balance index recorded on Biodex balance system), their performance-oriented mobility, their degree of concern about falling, their hip and ankle plantar flexor strength, and their hip flexion mobility compared with the control group. After 6 months, all these variables remained significant except for the Biodex sway index and ankle plantar flexor strength. Two patients developed pain in their Achilles tendon: the progression for two related exercises was slowed down.Conclusions/interpretationSpecific training can improve gait speed, balance, muscle strength and joint mobility in diabetic patients. Further studies are needed to explore the influence of these improvements on the number of reported falls, patients’ physical activity levels and quality of life.Trial registration:ClinicalTrials.gov NCT00637546Funding:This work was supported by the Swiss National Foundation (SNF): PBSKP-123446/1/Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-009-1592-4) contains supplementary material, which is available to authorised users.

Correlación entre dolor, discapacidad y rango de movilidad en pacientes con lumbalgia crónica

Aim To analyze the correlation between pain, range of motion and disability of chronic low back pain patients coming from a public Primary Care service. Material and methods Descriptive study carried out in a primary care rehabilitation service of the Institut Català de la Salut. A total of 143 patients with chronic low back pain (more than 3 months), both genders and ages between 18 and 65 years were included. Pain (Visual Analog Scale), disability (Roland-Morris's Disability Questionnaire) and range of mobility in flexion, extension and side bending were measured. Results Pain shows a significant correlation with disability (r=0.37), range of motion in extension (r=−0.23) and side bending (r between −0.18 and −0.23) but not with flexion or the other demographic variables. Disability shows a statistically significant correlation with pain, range of motion in all directions (r between −0.19 and −0.33), age (r=0.26) and symptoms duration (r=0.21). It also shows significant differences depending on gender (p<0.05) and work situation (p<0.01). Conclusions Correlations between pain, range of motion and disability, although significant, are weak, so they must be considered as independent variables. To achieve better results in the conservative treatment of chronic low-back pain, analgesic drugs must be complemented with physical therapy and ergotherapy.

LCS mobile-bearing total knee replacement. A 10-year's follow-up study

For the last three decades total knee arthroplasty surgery has been facing the renewed choice of using a traditional fixed-bearing design or a mobile-bearing system. A growing number of surgeons have elected to increase their use of mobile-bearing prostheses. We wanted to assess the reliability, in our hospital of this alternative choice. Fixed-bearing and LCS mobile-bearing knees exhibit comparable long-term clinical and radiographic results. Between January 1994 and December 1996, 126 LCS prostheses (DEPUY) were implanted by the same operator in 101 patients (mean age was 70.0 years). The predominant underlying pathology was osteoarthritis (113 prostheses); the posterior cruciate ligament was retained in 30% of these cases which permitted a tibial tray implantation using a PCR type meniscal-bearing component; 78 prostheses were cemented; 116 prostheses included a patellar button: 46 of these resurfaced patella featured a cementless metal implant and a mobile-bearing polyethylene insert. Overall function was assessed using the SF-12 and IKS scores, and on the basis of patients' satisfaction rate. Patients' review process took place between 1st October 2006 and 1st December 2006. Of the 101 patients, 59 were alive, 39 were clinically examined and 20 completed a self-assessment questionnaire; 32 had died and 10 were lost to follow-up. The average age of the patients still alive was 78 years (79 years for those operated on for osteoarthritis, 67 years for those operated on for rheumatoid polyarthritis); Mean follow-up period at the time of this review was 11.4 years. Mean body mass index (BMI) was 30.8 kg/m(2). No early infection was observed. Early complications included instability in one case, stiffness in six cases and resolutive patellar pain in three cases. Six prostheses necessitated to be revised. In the 39 reviewed patients (52 prostheses), the mean IKS knee score was 78/100, (range, 20 to 100/100), mean functional score was 66/100 (range, 0 to 100/100). Mean mobility in flexion was 105.8 degrees (range, 20 degrees to 135 degrees). The SF-12 quality of life score was assessed in 39 of the operated patients. Mean physical score was 37 (range, 22.6 to 61.2); mean mental score was 47 (range, 23.1 to 62.3). Seventeen patients were very satisfied, 18 satisfied (these combined categories representing 90% of patients), three were partially satisfied and one was unsatisfied. Forty-three radiographs were performed in 36 patients at the time of the follow-up visit: 39 of them included an A-P, a lateral and a patellar view at 30 degrees of flexion. Thirty-nine readings were normal. A radiolucent line beneath the tibial component was observed on three radiographs. An asymptomatic patellar tilt was reported in one instance. Mean tibial slope was 8 degrees (range, 1 degree to 11 degrees). Statistical analysis of these results demonstrates a significant and long-lasting improvement in the clinical score, an early improvement (both in respect to functional score and mobility) with a late minor deterioration of the quality of this initial improvement; a poorly significant negative correlation between mobility and BMI. Despite a high satisfaction rate, it does not quite match that obtained with hip arthroplasty. No correlation was found between the observed results and patient gender, prosthesis fixation method, type of prosthesis (PCR meniscal-bearings versus rotating platform, posterior cruciate ligament retention versus sacrifice), tibial slope, limb axis, and selected patellar treatment options. The mobile-bearing prostheses achieve results at least as good as comparable ones reported in other series; demonstrate a very low revision rate in relation to wear damages; and tolerate insufficient axis deformity corrections. Level IV. Therapeutic study.

Assessment of motion in the cervico-thoracic spine in patients with subacute whiplash-associated disorders

To investigate the distribution of segmental flexion mobility in the cervico-thoracic spine of men and women with whiplash-associated disorders. The study also assesses the relationship between cervical mobility and segmental flexion mobility, and whether hypomobility in C7-T1 is associated with neck pain and weakness in the hands. Finally, the study investigates the impact of fear of movement/(re)injury and pain intensity on cervical mobility. The data in this longitudinal study was obtained from a previous trial on 47 patients. Assessments were performed at baseline and 3 and 9 months following randomization using a cervical range of motion instrument, the cervico-thoracic ratio, a Grippit, a visual analogue scale, a Painmatcher, and the Tampa Scale for Kinesiophobia. Women exhibited hypomobility in C7-T1. There was no significant association between the 2 cervical measurement techniques. The correlation between flexion mobility in C7-T1 and grip strength was weak but significant (r=-0.3) (p<0.05). There was also a weak but significant negative correlation between total cervical mobility and neck pain intensity. No significant correlation was found between fear of movement/(re)injury and cervical mobility. Women with whiplash-associated disorders seem to exhibit flexion hypomobility in C7-T1. The flexion mobility in C7-T1 was weakly, but significantly, correlated with grip strength, but was not shown to predict neck pain. Neck pain may give rise to restricted range of motion.

Changes in pain and physical function during waiting time and 3 months after knee joint arthroplasty

To determine changes in physical and social function during a prolonged preoperative waiting period and at 3 months after total knee arthroplasty. Forty-three patients were evaluated on the day that surgery was decided, the day before surgery, and 3 months afterwards. Knee pain and function were assessed using a visual analogue scale and a functional assessment system. Isometric knee flexion extension strength and mobility were measured. Knee pain and muscle strength remained unchanged during the mean waiting time of 10 (standard deviation 8) months. On the affected side, knee extension strength was 19% weaker than on the contralateral side and did not change pre-operatively. Post-operatively, knee pain decreased by 50%. Knee extension strength decreased by 26% and flexion strength by 12% compared with the initial assessments. Knee extension strength of the operated side was 42% lower than on the non-operated side. Knee flexion mobility was decreased by 8%, while the initially detected knee extension deficit of 10 degrees (SD 7) remained unchanged. The functional assessment system did not detect any changes in function. Waiting time did not affect knee pain or isometric knee extension/flexion strength. Three months post-operatively, knee pain had decreased significantly, but the strength of the operated knee was significantly lower than the pre-operative level.