Range Of Motion In Patients Research Articles

Higher Grit Scores Are Associated With Earlier Increases in Knee Flexion Following Anterior Cruciate Ligament Reconstruction With Meniscus Repair in Pediatric Patients.

The Grit Scale is used to measure grit, defined by Duckworth and colleagues as the disposition to show perseverance and passion for long-term goals. It has been shown that psychological factors like motivation, coachability, and coping with adversity are correlated with faster readiness for return to sport (RTS) in patients undergoing anterior cruciate ligament reconstruction (ACLR). This study investigates the association between pediatric patients' baseline grit scores and; preoperative Patient-reported Outcomes Measurement Information System (PROMIS) Pain scores and the recovery of range of motion (ROM) after ACLR. The investigators hypothesized that higher preoperative grit scores would predict lower preoperative pain scores and earlier return of knee ROM in patients undergoing ACLR. This is a retrospective cohort study. Pediatric patients who underwent primary ACLR were assigned the pediatric Grit Scale. Patients were subdivided by meniscal procedures due to differences in postoperative protocols. ACLR alone or with meniscectomy (ACLR ± meniscectomy) were grouped together and ACLR with meniscal repair (ACLR + meniscus repair) represented the other cohort. Patients above the 50th grit percentile were considered "high grit". Patients below the 50th percentile were considered "low grit". Baseline PROMIS pain intensity and interference were collected. ROM was compared by grit cohort using the Mann-Whitney U test with a significance threshold of P ≤ 0.05. A total of 58 patients undergoing ACLR were analyzed: 20 ACLR ± meniscectomy and 38 ACLR + meniscus repair. The mean age was 15.0 ± 2.1 years with 41.4% of participants identifying as females. No significant difference was noted between baseline PROMIS pain intensity and interference and grit score ( P = 0.82, P = 0.91, respectively). Three months postoperatively, for those in the ACLR + meniscus repair cohort, low grit ROM was 130 degrees (interquartile range = 10 degrees), whereas high grit ROM was 135 degrees (interquartile range = 8 degrees) ( P = 0.006). This study found no differences in pain scores at presentation between grit cohorts but found that patients with grit scores below the 50th percentile undergoing ACLR + meniscus repair have 5 degrees less total ROM at 3 months compared with those with high grit scores. Quicker ROM recovery in patients with high grit may be a leading indicator of these patients' likelihood to achieve other postoperative milestones and meet criteria for RTS more quickly; the relationship between grit and readiness for RTS should be further investigated. Level IV; retrospective cohort study.

Arthroscopic Lysis of Adhesions for the Stiff Total Knee Arthroplasty.

Arthroscopic lysis of adhesions is a treatment option for patients with painful, stiff knees as a result of arthrofibrosis following knee arthroplasty, in whom prior manipulation under anesthesia (MUA) has failed. Typically, nonoperative treatment in these patients has also failed, including aggressive physiotherapy, stretching, dynamic splinting, and various pain-management measures or medications. Range of motion in these patients is often suboptimal, and any gains in flexibility will likely have hit a plateau over many months. The goal of performing lysis of adhesions is to increase the range of motion in patients with knee stiffness following total knee arthroplasty, as well as to reduce pain and restore physiologic function of the knee, enabling activities of daily living. This is a straightforward surgical technique that can be performed in a single stage. The preoperative range of motion is documented after induction of general anesthesia. The procedure begins with the establishment of standard medial and lateral parapatellar arthroscopic portals. A blunt trocar is introduced into the knee, and blunt, manual lysis of adhesions is performed in the suprapatellar pouch and the medial and lateral gutters with use of a sweeping motion after piercing and perforating the scarred adhesive bands or capsular tissue. Next, the arthroscope is inserted into the knee, and a diagnostic arthroscopy is performed. Bands of fibrous tissue are released and resected with use of electrocautery and a 4.0-mm arthroscopic shaver. Next, the posterior cruciate ligament (PCL) is visualized in full flexion. If PCL tightness is observed, the PCL can be released from its femoral origin until the flexion gap is increased. This portion of the procedure can include either partial or full release of the PCL, as indicated. Next, the arthroscope is removed and the ipsilateral hip is flexed to 90° for a standard MUA. Gentle force is applied to the proximal aspect of the tibia, and the knee is flexed. After completing the MUA, immediate post-intervention range of motion of the knee is documented, and the patient is provided with a continuous passive motion (CPM) machine set to the maximum flexion and extension achieved in the operating room. Nonoperative treatment of a stiff knee following total knee arthroplasty is well documented in the current literature. Range of motion has been shown to increase in patients undergoing proper pain management, aggressive physical therapy, and closed MUA in the acute postoperative setting. Additionally, more severe cases of established arthrofibrosis despite prior MUA can be treated with an open lysis of adhesions1-3. Arthroscopic lysis of adhesions with PCL release versus resection has been well described previously. This procedure has been shown to benefit patients in whom initial nonoperative treatment has failed. Additionally, this procedure is not limited to the immediate acute postoperative period like standard MUA3. To our knowledge, no technique video has been published outlining arthroscopic lysis of adhesions for a stiff knee following total knee arthroplasty. This procedure has been shown to provide an immediate and lasting improvement in the flexion and extension arc of the knee, as well as improved functional outcomes. Patients should be educated that improvements gained in the operating room must be sustained through physical therapy. In a study of 32 patients who underwent arthroscopic lysis of adhesions for moderately severe arthrofibrosis following a total knee arthroplasty, Jerosch and Aldawoudy reported a mean postoperative flexion of 119° in the operating room and 97° at the time of the latest follow-up. Eight patients with extensor lag showed improvement from 27° to 4°. Average Knee Society scores improved from 70 points preoperatively to 86 points at the time of the latest follow-up4. Their article showed that arthroscopic treatment of stiffness following total knee arthroplasty is a safe and effective form of treatment. Perform manual lysis of adhesions with a trocar prior to inserting the arthroscope in order to improve visualization and access.Utilize all portals and accessory portals interchangeably in order to improve access.Prescribe physical therapy with or without CPM machine immediately following surgery in order to maintain correction.Utilize pump inflow in order to help distend the tightened capsule.Protect the prosthetic surface from scratches during portal establishment.Loss of flexion implies scarring in the suprapatellar pouch and/or intercondylar notch, or PCL tightness.Loss of extension implies a tight posterior capsule, posterior osteophytes, or scarring of the PCL stump.A motorized shaver is the best tool for treatment of dense fibrous tissue, but be sure not to scratch metal total knee components. TKA = total knee arthroplastyROM = range of motionCT = computed tomographyMRI = magnetic resonance imagingESR = erythrocyte sedimentation rateCRP = C-reactive protein.

Radiographic Investigation of Lumbar Vertebrae in Patients with Flexion and Extension Movement Disorder Syndrome.

The kinesiopathology model is a new rehabilitation model classifying, evaluating, and treating patients with non-specific back pain. Sahrmann proposed this model based on movement disorder syndromes. The present cross-sectional study aimed to evaluate the radiograph of the linear and angular displacement of the lumbar spine in patients with lumbar flexion impairment syndrome (LFIS) and lumbar extension impairment syndrome (LEIS). In this study, 50 adults aged 18-46 years were enrolled, including 25 patients with LFIS and 25 with LEIS. The eligible participants were referred to the radiology department for radiography in the common position of neutral, full extension, and full flexion position while standing. The White and Panjabi's method was used to measure the linear and angular displacements. Moreover, pain intensity was assessed using the visual analogue scale, and functional disability was investigated using a modified Oswestry Disability Questionnaire. The parameter of the linear displacement at the L3-L4 level was significantly different between the two groups (P=0.02). The mean duration of low back pain was longer in the LEIS, compared to the LFIS group (P=0.01). In patients with LEIS, compensatory responses occur that cause less linear displacement at the L3-L4 level, compared to the patients with LFIS. Therefore, it is important to design appropriate exercises to better control the linear displacement at the L3-L4 level during the full range of motion in patients with LFIS.

A randomized controlled trial investigating the effects of the upper limb tension test on the treatment and management of pain and range of motion in patients diagnosed with cervical radiculopathy

Introduction: The clinical diagnosis of cervical radiculopathy is a disorder of the nerve root that can be caused bya herniated disc, a spur, or cervical osteophyte. This condition is classified as a radiculopathy. Cervicalradiculopathy is a common disease that affects the spinal cord. It is also the most common cause of arm pain andsignificant functional limitation. Cervical radiculopathy can occur at any point along the cervical spine.Methods: Two arms parallel pretest-posttest experimental research design. Random sampling with total numberof 40 subjects who have been diagnosed my medical doctors were selected by simple purposive random samplingmethod after giving due consideration to inclusion and exclusion criteria.Results: The independent t-test further revealed that the readings which we got after the intervention weredifferent and this difference was statistically significant. All the dependent variables, flexion (t=-6.0303, p=0.0001),extension (t=-4.0628, p=0.0002), side flexion to right (t=-5.4393, p=0.0001), side flexion to left (t=-3.9808, p=0.0003),and VAS (t=3.758, p=0.001) showed statistically significant difference after the treatment.Conclusions: This study concluded that the Upper Limb Tension Test does reduce pain, symptoms and improvethe range of motion for the cervical spine.

Reliability and Validity of the Double Inclinometer Method for Assessing Thoracolumbar Joint Position Sense and Range of Movement in Patients with a Recent History of Low Back Pain.

The study was aimed at examining the reliability of the Double Inclinometer (DI) method for the assessment of thoracolumbar Range of Movement (ROM) and Joint Position Sense (JPS) in patients with a recent history of Low Back Pain (LBP). Twenty patients with a history of LBP in the last three months participated. The thoracolumbar ROM and JPS were examined from a standing position by using both the DI and the tape measure method. The DI method was found to have moderate to good intra-rater (ICC = 0.68-0.79, SEM = 2.20-2.77°, SDD = 6.09-7.67°), moderate inter-rater (ICC = 0.59-0.62, SEM = 2.96-3.35°, SDD = 8.19-9.27°) and poor test-retest reliability (ICC = 0.13-0.17, SEM = 3.98-4.32°, SDD = 11.02-11.96°) for the assessment of thoracolumbar JPS. For the assessment of thoracolumbar ROM, the DI method was found to have good to excellent intra-rater (ICC = 0.88-0.94, SEM = 4.25-6.20°, SDD = 11.77-17.17°), excellent inter-rater (ICC = 0.90-0.91, SEM = 7.26-7.74°, SDD = 20.11-21.43°) and excellent test-retest reliability (ICC = 0.91-0.93, SEM = 6.03-6.87°, SDD = 16.70-19.02°). The concurrent validity of the DI method with the tape measure method was found to be very weak for the assessment of thoracolumbar JPS (r = 0.02, p = 0.93) and strong for the assessment of thoracolumbar ROM (r = 0.66, p = 0.001). The DI method seems to be a very reliable method for the assessment of thoracolumbar ROM in individuals with a recent history of LBP.

Short-Term Functional Outcomes of Unicompartmental versus Total Knee Arthroplasty in an Asian Population

Unicompartmental and Total Knee Arthroplasty (UKA and TKA) are both established surgical options for the treatment of medial compartment osteoarthritis of the knee. However, the superiority of one over the other remains controversial. Our retrospective study aims to compare short-term functional outcomes in similar patients who underwent either TKA or UKA. Pre- and post-operative range of motion (ROM), the Oxford Knee Score (OKS), Knee Society Knee Score (KSKS), and Knee Society Function Score (KSFS) were used as outcome measures. Our sample included 57 patients, among which 27 underwent TKA and 30 underwent UKA, including one patient who underwent bilateral UKA. At 1 year, there were no differences in the OKS, KSKS, or KSFS scores between the two groups. There was a significantly better range of motion in patients who underwent UKA compared to TKA (122.9 ± 11.7 degrees vs 109.9 ± 13.9 degrees, p < 0.001). Functional outcomes following UKA and TKA were found to be similar. Hence, in view of its lower morbidity and shorter length of hospital stay, UKA may be considered over a TKA for the treatment of medial compartment osteoarthritis whenever deemed appropriate.

Postoperative acromiohumeral interval affects shoulder range of motions following reverse total shoulder arthroplasty

Reverse total shoulder arthroplasty (RTSA) improves function and reduces pain for patients with complex shoulder problems. However, there is a lack of literature regarding the association of radiographic parameters on clinical outcomes after RTSA. The aim of this study was to analyze various radiographic parameters that may be predictive of clinical outcomes after RTSA. A total of 55 patients treated with RTSA were enrolled. Shoulder radiographic parameters were used for measurement of critical shoulder angle, acromial index, acromiohumeral interval, deltoid lever arm, acromial angulation, glenoid version, and acromial height. Preoperative and postoperative clinical outcomes were evaluated at a minimum 2-year follow-up. An analysis of correlations between radiographic parameters and clinical outcomes was then performed. A significant change in critical shoulder angle, acromiohumeral interval, and deltoid lever arm was observed between preoperative and postoperative radiographic measurements. A significant improvement was observed in all clinical outcomes and range of motions from preoperative to postoperative (all p < 0.001). A negative correlation of postoperative acromiohumeral interval with forward flexion (r = − 0.270; p = 0.046), external rotation (r = − 0.421; p = 0.001), and internal rotation (r = 0.275; p = 0.042) was observed at final follow-up. In addition, postoperative acromiohumeral interval less than 29 mm had an 86% positive predictive value of obtaining 130° of forward flexion and 45° of external rotation. It was found that postoperative acromiohumeral interval showed an association with active range of motion in patients who underwent RTSA. In particular, excessive distalization reduced forward flexion and external rotation motion of the shoulder in patients treated with RTSA.

Effects of Open and Closed Chain Exercises on Dynamic Balance and Range of Motion in Patients with Knee Osteoarthritis: RCT

Background: Osteoarthritis is a combination of mechanical problems characterized by degradation of articular cartilage, articulating joints and subchondral space. Aim: To compare the effects of open chain kinetic exercises and closed kinetic chain exercises in improving dynamic balance and range of motion in patients with knee osteoarthritis. Study Design: Randomized controlled trial. Methodology: Study was conducted at Chugtai Medical center Lahore and sample of 46 patients were recruited and were randomly allocated in two groups. One group performed OKC exercises and the other group was asked to perform CKC exercises, while both of the groups received a common baseline treatment prior to corresponding intervention. Two session a week were given for a period of one month. Goniometry and Y-balance scale were used to assess ROM and dynamic balance pre and post treatment, respectively. Data was evaluated by using SPSS version 23. Results: In this study, the intra-group analysis illustrated that the increase in range of motion and improvement in dynamic balance was statistically significant in both groups with p-value&lt;0.05. Whereas, the inter-group analysis showed that both interventions were clinically effective in treating knee osteoarthritis with p-value&gt;0.05 during the treatment session of four weeks. Practical Implication: This study highlighted that physical training that includes open kinetic chain (OKC) and closed kinetic chain (CKC) exercises were found to be effective in improving balance and in increasing range of motion by reducing pain among osteoarthritis patients. Conclusion: It was concluded that patients with OKC exercises have shown equal improvement in ROM and dynamic balance compared to those who have been treated with CKC exercises. Keywords: Osteoarthritis, Exercises and Dynamic Balance.

Decrease in medial meniscal extrusion after physical therapy to improve knee pain and range of motion in patients with knee osteoarthritis: A retrospective study.

Medial meniscal extrusion (MME) is the medial displacement of the meniscus, which extends beyond the tibial margin. Studies have shown an association between MME and knee pain and that surgical treatment can reduce the extent of MME. Here, we describe the beneficial effects of physical therapy as a feasible conservative treatment for MME. Data of 30 patients with knee osteoarthritis who underwent stretching of the semimembranosus tendon and passive range of motion (ROM) exercises twice a week for 8 weeks were retrospectively analyzed. MME was the measured distance between the medial meniscus and the line connecting the medial borders of the femur and tibia using ultrasound. Ultrasound findings of surrounding tissues, including the deep posterior bundle of the medial collateral ligament (dMCL), were recorded. Additionally, knee extension ROM was measured, and inner knee pain when walking was evaluated using a numerical rating scale. There were significant improvements between the baseline and 8 weeks for MME in the non-weight-bearing position (3.6 ± 0.3 mm vs. 3.0 ± 0.4 mm), MME in the weight-bearing position (4.3 ± 0.4 mm vs. 3.8 ± 0.5 mm), ROM (-12.3° ± 4.1° vs. -3.1° ± 3.8°), and knee pain (7.0 ± 0.9 vs. 1.1 ± 1.4) (each p < 0.001). In almost all cases in which the knee extension ROM improved, the dMCL was bulging at the baseline; after 8 weeks, the dMCL was flattened, suggesting ligament tension on ultrasound imaging. Stretching of the semimembranosus tendon and passive ROM exercises may reduce the extent of MME in patients with knee osteoarthritis. The ultrasound findings suggest that improvement in knee extension ROM may have led to the re-acquisition of MCL tension, which may have influenced MME reduction. Therefore, physical therapy may be a feasible conservative treatment for the reduction of MME.

Latissimus Dorsi Transfer Combined with Subacromial Balloon Spacer for Bidirectional Rotator Cuff Deficiency

Patients with massive, irreparable rotator cuff tears represent a challenge for treatment, particularly those with loss of external rotation and active elevation. In the cases of glenohumeral arthropathy, reverse shoulder arthroplasty combined with transfer of the latissimus dorsi and teres major tendons has improved active external rotation and overall patient outcomes. However, the reverse shoulder prosthesis could be better used as a second-line treatment in patients without arthropathy. Several joint-preserving surgical approaches have been described for irreparable cuff tears with no substantial differences in results. Although latissimus dorsi transfer has shown long-term clinical reliability and improved functional shoulder function in relatively young patients, isolated tendon transfer appears insufficient to restore range of motion in patients with a bidirectional deficit. The subacromial balloon spacer is an additional new treatment option. This surgical procedure describes an arthroscopic-assisted transfer of the latissimus dorsi tendon followed by the implantation of the subacromial balloon. This combination potentially addresses the bidirectional deficiency by restoring the shoulder external rotational coupling, improving the deltoid load, centering the humeral head, and protecting the transferred tendon from the subacromial compression stresses.

Approach to Knee Arthropathy through 180-Degree Immersive VR Movement Visualization in Adult Patients with Severe Hemophilia: A Pilot Study.

(1) Background: Hemarthrosis is a typical clinical manifestation in patients with hemophilia. Its recurrence causes hemophilic arthropathy, characterized by chronic joint pain. Watching movement recorded from a first-person perspective and immersively can be effective in the management of chronic pain. The objective of this study was to evaluate the effectiveness of an immersive virtual reality intervention in improving the pain intensity, joint condition, muscle strength and range of motion in patients with hemophilic knee arthropathy. (2) Methods: Thirteen patients with hemophilic knee arthropathy were recruited. The patients wore virtual reality glasses and watched a flexion–extension movement of the knee on an immersive 180° video, recorded from a first-person perspective over a 28-day period. The primary variable was the pain intensity (visual analog scale). The secondary variables were the joint status (Hemophilia Joint Health Score), quadriceps and hamstring strength (dynamometry), and range of motion (goniometry). (3) Results: After the intervention period, statistically significant differences were observed in the intensity of the joint pain (Standard error [SE] = 19.31; 95% interval confidence [95%CI] = −1.05; −0.26), joint condition (SE = 18.68; 95%CI = −1.16; −0.52) and quadriceps strength (SE = 35.00; 95%CI = 2.53; 17.47). We found that 38.46% and 23.07% of the patients exhibited an improvement in their quadriceps muscle strength and joint condition above the minimum detectable change for both variables (8.21% and 1.79%, respectively). (4) Conclusions: One hundred and eighty degree immersive VR motion visualization can improve the intensity of joint pain in patients with hemophilic knee arthropathy. An intervention using immersive virtual reality can be an effective complementary approach to improve the joint condition and quadriceps strength in these patients.

180-degree immersive VR motion visualization in the treatment of haemophilic ankle arthropathy.

Patients with haemophilic arthropathy suffer chronic pain that affects and restricts their quality of life. Visualization of movement through immersive virtual reality is used for pain management. To evaluate the efficacy of 180-degree immersive VR motion visualization therapy in patients with haemophilic ankle arthropathy. Prospective, multicentre pilot study. Fifteen adult patients with bilateral haemophilic ankle arthropathy were recruited (mean age: 42.73±12.36 years). The intervention lasted 4weeks, with daily home sessions of 180-degree immersive motion visualization. The patients were given virtual reality glasses to use with their smartphones. From the YouTube mobile app® they accessed the recorded video with access from the He-Mirror App®. The study variables were joint state (Haemophilia Joint Health Score), pressure pain threshold (pressure algometer), muscle strength (dynamometry) and range of motion (goniometry). Three evaluations were performed: at baseline (T0), after the intervention (T1) and at the end of a 16-week follow-up period (T2). No patient developed ankle hemarthrosis during the experimental phase. In the repeated measures analysis we found statistically significant differences in joint state (F=51.38; η2 p =.63), pressure pain threshold of the lateral malleolus (F=12.34; η2 p =.29) and range of motion (F=11.7; η2 p =.28). Therapy using immersive motion visualization does not cause hemarthrosis. This intervention can improve joint condition, pressure pain threshold and range of motion in patients with ankle arthropathy. Changes greater than the MDC were reported in more than 40% of patients for the variables pressure pain threshold, anterior tibialis strength and range of motion, which were considered clinically relevant.

Assessing the Effect of 12 Weeks of Pilates and Aquatic Exercise on Muscle Strength and Range of Motion in Patients with Mild to Moderate Parkinson’s Disease

Background: Parkinson's disease is a chronic, progressive and degenerative disorder of the central nervous system with four main symptoms of bradykinesia, tremor, muscular rigidity, and postural instability. Objectives: The effect of 12 weeks of Pilates and aquatic exercise on muscle strength and range of motion (ROM) in male patients with Parkinson's disease was assessed in this article. Methods: In this quasi-experimental study, 25 male patients reporting to Al-Zahra Hospital, Isfahan, were selected randomly and grouped in Pilates (n = 7), Aquatic exercise (n = 10), and Control (n = 8). The experimental groups received 1-hour sessions of training three times a week for 12 weeks. Muscle strength and ROM of each patient was measured through the Biodex Isokinetic System 3 before entering the study and after the final assigned session. Results: Pilates and Aquatic exercise groups had a significant improvement in ROM, while no significant difference was observed in the control group. Muscle strength and ROM increased significantly in the experimental groups compared to the control group (P &lt; 0.05). The effect of Pilates on muscle strength was not significant (P &lt; 0.05). Conclusions: Non-pharmacological modalities could be contributive in the patients with Parkinson's disease recovery and lead to significant improvements in their physiological parameters of muscle strength and ROM. Next to the pharmacological treatments, patients could benefit from inexpensive and readily available options like Pilates and aquatic exercises to alleviate the disease symptoms. Further studies should be run to reveal the aforementioned and plausible benefits of these complementary activities.

Lateral Trans-Fibular Total Ankle Replacement Capability in Correcting Ankle Osteoarthritis Deformities and Improving Clinical Outcomes

Category: Ankle; Ankle Arthritis; Hindfoot; Other Introduction/Purpose: Total ankle replacement (TAR) has been shown as a viable surgical option to reduce pain, improve function, and preserve ankle joint range of motion in patients with Ankle osteoarthritis (AO). Standard anterior approach TAR capability in correcting deformities is already established by several studies. However, there is a paucity of literature evaluating patient outcomes as well as the potential to correct alignment using a lateral approach TAR. Therefore, the primary objective of this study was to assess the capability of lateral trans-fibular approach TAR in correcting coronal and sagittal plane deformity and secondarily to report the ability to improve patient-reported outcomes (PROs) following lateral TAR. Methods: This IRB-approved, retrospective comparative study included 14 consecutive patients that underwent lateral trans- fibular approach TAR for end-stage AO. Average age and BMI were 63.9 years (range 43-83) and 32.7 kg/m2 (SD 7.5). All patients had received pre- and post-operative weight-bearing CT imaging on the affected foot and ankle. Foot and Ankle Offset (FAO), Talar Tilt Angle (TTA), Hindfoot Moment Arm (HMA), and Lateral Talar Station (LTS) were performed. PROs were collected pre- and post-operatively at the latest clinical follow-up including: PROMIS Global Physical Health score, the Tampa Scale of Kinesiophobia (TSK), the European Foot and Ankle Society (EFAS) score, the Pain Catastrophizing Scale (PCS) and the Foot and Ankle Ability Measure (FAAM) Daily Living Score. One-way ANOVA and Wilcoxon tests were used for comparison at each interval time period. A multivariate regression analysis was then performed to evaluate the association between change in alignment and improvements of PROs. Results: Three of 14 patients (21.4%) underwent a concomitant osseous re-alignment procedure. At an average of 16.1 months (range 11 to 24), all patients demonstrated a significant deformity correction in measurements performed: FAO (7.73% - 3.63%, p=0.031), HMA (10.93mm - 5.10mm, p=0.037), TTA (7.9o - 1.5o, p=0.003), and LTS (5.25mm - 2.83mm, p=0.018). Four of the PROs demonstrated significant improvement postoperatively: TSK (42.7-34.5, p=0.012), PROMIS Global Physical Health (46.1- 54.5, p=0.011), EFAS (5-10.3, p=0.004), and FAAM (60.5-79.7, p=0.04). PROMIS was associated (p=0.0015) with optimization of FAO (p=0.00065) and LTS (p=0.00436), R2 of 0.98). Improvements in TSK were associated with changes in the HMA (p=0.0074), R2 of 0.66. Improvements in FAAM correlated (p=0.048) with improvements in FAO (p=0.023) and TTA (p=0.029), and an R2 of 0.78. Conclusion: In this retrospective comparative cohort study, the results suggest that the lateral trans-fibular TAR can correct different aspects of AO deformity. Clinical benefit was also demonstrated by the impacted PROs, particularly TSK, PROMIS Global Physical Health, EFAS, and FAAM Daily Living. Direct and strong correlations between deformity correction measurements and the significantly improved PROs were found. The obtained data might help surgeons when planning treatment and may serve as the basis for future comparative prospective studies.

VP.19 Rehab Robo: A high sensitivity patient outcome tracking and physical exercise tool for spinal muscular atrophy

In the advent of novel disease altering therapies targeting Spinal Muscular Atrophy (SMA), there is a need for appropriate outcome measures that provide higher sensitivity in tracking patient strength and function while undergoing treatment alongside a need for conjunctive rehabilitation and exercise to promote drug efficacy. ATDev is developing Rehab Robo (RR) to address the gaps in patient outcome tracking and access to rehabilitation and exercise. RR is a telehealth enabled exoskeleton that can provide assistive and resistive forces to a single joint while collecting key biomechanical metrics. Embedded sensors in the device can objectively measure range of motion (ROM) and applied torque (strength) as patients complete various exercises and activities of daily living. Each RR device consists of a base unit, which can be reused by multiple patients, and patient specific interfaces, which are custom 3D printed to match a patient's unique anatomy. The patient specific design allows even the most severely contracted or weak individuals with SMA to use RR. The bespoke design also naturally improves the biomechanical alignment of the device, thereby increasing the accuracy of ROM and strength data and enabling reliable, remote patient monitoring. Benchtop data collection with RR shows an extremely low minimal detectable change and intra-rater reliability compared to industry standard devices for ROM and isometric strength, 0.0219° MDC, 0.99 ICC and 1.15Nmm, 0.98 ICC respectively. In preliminary human subject testing (n=1) the device measured an SMA Type 2 patient's ROM within 2.13° of a goniometer over 9 repeated measurements. The device also detected repeatable bicep flexion torques of 25Nmm. Future human subject testing will be completed in conjunction with Dr. Tina Duong, DPT throughout 2022. Product development of RR is conducted by Assistive Technology Development, Inc. (ATDev) and is supported by a NIDILRR SBIR Phase 1 grant.

Mobile bearing versus fixed bearing medial unicompartmental knee replacement: an independent two center matched-pairs analysis

IntroductionThe aim of the present study was to compare clinical outcome between patients following fixed-bearing (FB) or mobile-bearing (MB) unicompartmental knee replacement (UKR) for antero-medial knee osteoarthrosis (OA) at two independent orthopedic centers.Materials and methodsMatched-pairs were built between 35 patients receiving FB-UKR and 52 patients following MB-UKR regarding age at time of surgery, body mass index (BMI) and range of motion (ROM) preoperatively. Clinical and functional outcome was measured postoperatively by the American Knee Society Score (AKSS-O/AKSS-F), ROM, Tegner Activity Scale (TAS) as well as the Short Form 36 Health Survey (SF-36).ResultsThe average treatment effect of the treated (ATT) after propensity score matching showed a significantly superior ROM in patients following MB-UKR (FB: 118°, MB: 124°). All remaining parameters had no statistically significant differences between both groups involving TAS, AKSS and SF-36.ConclusionsThe present study suggests that MB-UKR can provide a greater ROM compared to FB-UKR on comparable patients. The authors believe that both designs are suitable for adequate improvement of clinical outcome and ROM for patients suffering from antero-medial osteoarthrosis of the knee joint.Level of evidenceRetrospective cohort study, Level IV.

Effect of 3-Dimensional Versus Single-Plane Changes in Pelvic Dynamics on Range of Motion in Hips With Femoroacetabular Impingement: A Computer Simulation Analysis.

Background:Femoroacetabular impingement (FAI) is primarily caused by bony impingement between the acetabulum and femoral neck during hip motion. Increasing posterior pelvic tilt improves hip range of motion in patients with FAI.Purpose:To use computer simulation analysis to compare the effects of 3-dimensional (3D) changes in pelvic tilt (sagittal tilt [St], axial rotation, and coronal tilt) with changes in a single plane (St), with the aim of improving range of motion in patients with FAI.Study Design:Controlled laboratory study.Methods:We evaluated 43 patients with FAI treated by arthroscopic cam resection. A 3D simulation was used to construct the following pelvic models: a 5° and 10° increase posteriorly in St (St5° and St10°) and a combined 5° change in St, axial rotation, and coronal tilt (Complex5°) from the baseline of the anterior pelvic plane. Improvements in maximum internal rotation (MIR) at 45°, 70°, and 90° of hip flexion and improvements in maximum flexion with no internal rotation were compared among the St5°, St10°, and Complex5° models. The pelvic models of each single-plane change of 5° and 10° were evaluated in the same simulation.Results:At 90° and 70°, there was a significant difference between the Complex5° and St10° models with respect to improvement in MIR (P = .004 at 90° of flexion; P = .017 at 70° of flexion). There was no significant difference in MIR at 45° of flexion (P = .71) or in maximum flexion (P = .42).Conclusion:At 70° and 90° of hip flexion, a combined change in 3D pelvic alignment of 5° (ie, St, axial rotation, and coronal tilt) was more effective in improving hip MIR than a 10° change in St only.Clinical Relevance:Effective physical therapy for FAI should address pelvic motion in all 3 planes rather than in a single plane.

Efficacy of low-level laser therapy on pain, disability, pressure pain threshold, and range of motion in patients with myofascial neck pain syndrome: a systematic review and meta-analysis of randomized controlled trials.

Low-level laser therapy (LLLT) is one of recent modalities for treatment of myofascial neck pain (MNP). Several RCTs have been conducted on its effectiveness. The aim of this comprehensive meta-analysis was to evaluate the effectiveness of LLLT on MNP. Electronic databases were searched for identifying eligible studies comparing the effectiveness of LLLT using any wavelength with placebo or active control in myofascial neck pain up to June 2022. Data related to pain intensity, pain pressure threshold (PPT), range of motion (ROM), and disability was analyzed as a pooled estimate of mean difference or standard mean difference (SMD) with 95% confidence intervals (CIs) using random/fixed-effect model. Funnel plot and Egger's linear regression test were also conducted to examine the risk of publication bias. A total of 13 randomized controlled trials were included in this systematic review and meta-analysis. The data assessing laser effectiveness on different outcomes of 556 patients were considered for meta-analysis. Pooled results revealed that LLLT was significantly effective in pain reduction (MD = - 1.29, 95% CI = - 2.36; - 0.23, P < 0.001). Also, secondary outcomes including PPT (SMD of 2.63, 95% CI = 0.96; 4.30, P < 0.01) and right bending ROM (SMD of 3.44, 95% CI = 0.64; 6.24, P < 0.01) were improved, while disability (MD of - 7.83, 95% CI = - 17.1; 0.08, P = 1.34) did not improve significantly after LLLT. Our meta-data revealed that LLLT may reduce myofascial neck pain and its related outcomes. LLLT is suggested to be used by clinicians along with other therapies such as manual and exercise therapy.

Integrating wearables and modelling for monitoring rehabilitation following total knee joint replacement

Background and objectiveWearable inertial devices integrated with modelling and cloud computing have been widely adopted in the sports sector, however, their use in the health and medical field has yet to be fully realised. To date, there have been no reported studies concerning the use of wearables as a surrogate tool to monitor knee joint loading during recovery following a total knee joint replacement. The objective of this study is to firstly evaluate if peak tibial acceleration from wearables during gait is a good surrogate metric for computer modelling predicted functional knee loading; and secondly evaluate if traditional clinical patient related outcomes measures are consistent with wearable predictions. MethodsFollowing ethical approval, four healthy participants were used to establish the relationship between computer modelling predicted knee joint loading and wearable measured tibial acceleration. Following this, ten patients who had total knee joint replacements were then followed during their 6-week rehabilitation. Gait analysis, wearable acceleration, computer models of knee joint loading, and patient related outcomes measures including the Oxford knee score and range of motion were recorded. ResultsA linear correlation (R2 of 0.7–0.97) was observed between peak tibial acceleration (from wearables) and musculoskeletal model predicted knee joint loading during gait in healthy participants first. Whilst patient related outcome measures (Oxford knee score and patient range of motion) were observed to improve consistently during rehabilitation, this was not consistent with all patient's tibial acceleration. Only those patients that exhibited increasing peak tibial acceleration over 6-weeks rehabilitation were positively correlated with the Oxford knee score (R2 of 0.51 to 0.97). Wearable predicted tibial acceleration revealed three patients with a consistent knee loading, five patients with improving knee loading, and two patients with declining knee loading during recovery. Hence, 20% of patients did not present with satisfactory joint loading following total knee joint replacement and this was not detected with current patient related outcome measures. ConclusionsThe use of inertial measurement units or wearables in this study provided additional insight into patients who were not exhibiting functional improvements in joint loading, and offers clinicians an ‘off-site’ early warning metric to identify potential complications during recovery and provide the opportunity for early intervention. This study has important implications for improving patient outcomes, equity, and for those who live in rural regions.

Are progressive shoulder exercises feasible in patients with glenohumeral osteoarthritis or rotator cuff tear arthropathy?

BackgroundLittle is known about the feasibility of progressive shoulder exercises (PSE) for patients with glenohumeral osteoarthritis (OA) or rotator cuff tear arthropathy (CTA). The aim of this study was to investigate whether 12 weeks of PSE is feasible in patients with glenohumeral OA or CTA eligible for shoulder arthroplasty. Moreover, to report changes in shoulder function and range of motion (ROM) following the exercise program.MethodsTwenty patients were included. Eighteen patients (11 women, 15 with OA), mean age 70 years (range 57–80), performed 12 weeks of PSE with one weekly physiotherapist-supervised and two weekly home-based sessions. Feasibility was measured by dropout rate, adverse events, pain, and adherence to PSE. At baseline and end of intervention, patients completed the Western Ontario Osteoarthritis of the Shoulder (WOOS) score and Disabilities of the Arm, Shoulder and Hand (DASH). Data to assess feasibility were analyzed using descriptive statistics.ResultsTwo patients dropped out and no adverse events were observed. Sixteen of the eighteen patients (89%) had a high adherence (≥ 70%) to the physiotherapist-supervised sessions. Acceptable pain levels were reported; in 76% of all exercise sessions with no numeric rating scale (NRS) score over five for any exercise. WOOS improved with a mean of 23 points (95% CI 13;33), and DASH improved with a mean of 13 points (95% CI 6;19).ConclusionAdherence to PSE was high and dropout rates were low. PSE is feasible, safe and may relieve shoulder pain, improve function and ROM in patients with glenohumeral OA or CTA. The patient-experienced gains after PSE seem clinically relevant and should be compared to arthroplasty surgery in a RCT setting.Trial registrationAccording to Danish law, this study did not need an approval by the Central Denmark Region Committee on Health Research Ethics. Approval from The Danish Data Protection Agency (journal number 1-16-02-15-20) was obtained.