Self-reported Functional Scores Research Articles

Viability of Structured Gait Retraining for Improving Clinical Outcomes Following Running-related Injury in Active Duty Service Members.

All branches of the U.S. Military have a running component of their physical readiness testing battery. Running-related musculoskeletal injuries affect 20 to 40% of DoD Service Members each year. Running form has not historically been addressed with military running-related injuries. To assess the utility of a structured gait retaining protocol designed to treat the onset of running-related pain and/or injury by correcting identified biomechanical risk factors for injury and improve clinical outcomes. Case series. A total of 160 Active Duty Service Members (ADSMs) with running-related lower-body musculoskeletal injuries were referred by a physical therapist for a multisession gait retraining program termed "Run with CLASS" (Cadence, Lean, Alignment, Soft-landing, Strike). Run with CLASS utilized various drills to emphasize impact progression, proximal strengthening, and proprioception and spatial awareness. Results revealed that the implemented gait retraining protocol significantly improved running parameters following lower-body injury as evidenced by increased cadence, improved functional assessment scores, and a marked transition from predominantly heel strike to forefoot strike patterns during running. A 3-week supervised gait retraining program focused on the gait retraining program termed "Run with CLASS" (Cadence, Lean, Alignment, Soft-landing, Strike) was successful in altering biomechanics of self-selected running gait by increasing cadence and transitioning ADSMs to a forefoot foot strike. Additionally, ADSMs reported significant improvements on the self-reported functional scores on the University of Wisconsin Running Injury and Recovery Index and Single Assessment Numerical Evaluation. 4.

The association between kinesiophobia and functional limitations in service members with knee pain

BackgroundKnee diagnoses account for more than 50% of lower extremity musculoskeletal conditions in non-deployed US Service members. However, there is limited information regarding kinesiophobia in Service members with non-operative knee diagnoses. HypothesesThe objectives of this study were to determine the prevalence of high levels of kinesiophobia in US military Service members with knee pain across different knee diagnoses, and to determine the relationships between kinesiophobia and lower extremity function and/or specific functional limitations in Service members with knee pain. It was hypothesized Service members with knee pain would exhibit high levels of kinesiophobia across all knee diagnoses examined, and higher levels of both kinesiophobia and pain would be associated with worse self-reported function in this population. It was also hypothesized higher levels of kinesiophobia would be associated with functional activities with high knee loading. DesignRetrospective cohort study. Level of evidenceIV. MethodsSixty-five US Service members presenting to an outpatient physical therapy clinic were included in this study (20 females; age = 30.8 ± 7.7 years; height = 1.74 ± 0.9 m; mass = 80.7 ± 16.2 kg). Inclusion criterion was the presence of knee pain (duration = 50 ± 59 months); exclusion criterion was knee pain as a sequela of knee surgery. Data regarding demographic, pain chronicity, pain by Numeric Rating Scale (NRS), Tampa Scale of Kinesiophobia (TSK), and Lower Extremity Functional Scale (LEFS) were retrospectively obtained from patients’ medical records. A high level of kinesiophobia was defined as a TSK score of greater than 37 points. Patient diagnoses included: osteoarthritis (n = 16); patellofemoral pain syndrome (n = 23); and other non-operative knee diagnoses (n = 26). Commonality analysis was utilized to determine the effects of age, height, mass, NRS, and TSK on LEFS score. Predictor values were interpreted as <1% = negligible, >1% = small; >9% = moderate, >25% = large. Additionally, exploratory item-specific analyses examined the strength of the relationships between kinesiophobia and LEFS item responses. Binary logistic regression determined if difficulty with an individual LEFS item could be predicted from either NRS or TSK score. Statistical significance was set at P < 0.05. ResultsHigh levels of kinesiophobia were identified in 43 individuals (66%). NRS and TSK explained 19.4% and 8.6% of the unique variance in LEFS, and 38.5% and 20.5% of total variance, respectively. Age, height, and mass explained negligible to small proportions of the unique variance in LEFS. TSK and NRS were independent predictors for 13/20 individual LEFS items, with odds ratios ranging from 1.12 to 3.05 (P < 0.05). ConclusionThe majority of US Service members in this study exhibited high levels of kinesiophobia. Kinesiophobia was significantly related to self-reported functional scores and performance on individual functional tasks in Service members with knee pain. Clinical relevanceTreatment strategies addressing both fear of movement and pain reduction in patients with knee pain may help optimize functional outcomes.

Comparing Pain and Pain Coping Mechanisms in Patients Undergoing Total Joint Arthroplasty as Part of a Mission Trip to Those in the United States

BackgroundAccess to total joint arthroplasty can be difficult in low-resource settings. Service trips are conducted to provide arthroplasty care to populations in need around the world. This study aimed to compare the pain, function, surgical expectations, and coping mechanisms of patients from one such service trip to the United States. MethodsIn 2019, the Operation Walk program conducted a service trip in Guyana during which 50 patients had hip or knee arthroplasties. Patient demographics, patient-reported outcome measures, questionnaires assessing pain attitudes and coping, and pain visual analog scales were collected preoperatively and at 3 months postoperatively. These outcomes were compared with a matched cohort of elective total joint arthroplasty at a US tertiary care medical center. There were 37 patients matched between the 2 cohorts. ResultsThe mission cohort had significantly lower preoperative self-reported function scores than the US cohort (38.3 versus 47.5, P = .003), as well as a significantly larger improvement at 3 months (42.4 versus 26.4, P = .014). The mission cohort had significantly higher initial pain (8.0 versus 7.0, P = .015), but there were no differences with regard to pain at 3 months (P = .420) or change in pain (P = .175). The mission cohort had significantly greater preoperative scores in pain attitude and coping responses. ConclusionPatients in low-resource settings were more likely to have preoperative functional limitations and pain, and they coped with pain through prayer. Understanding the key differences between these 2 types of populations and how they approach pain and functional limitations may help improve care for each group. Level of EvidenceII, prospective study.

Postmarketing Follow-Up of a Digital Home Exercise Program for Back, Hip, and Knee Pain: Retrospective Observational Study With a Time-Series and Matched-Pair Analysis.

Musculoskeletal conditions are the main drivers of global disease burden and cause significant direct and indirect health care costs. Digital health applications improve the availability of and access to adequate care. The German health care system established a pathway for the approval of "Digitale Gesundheitsanwendungen" (DiGAs; Digital Health Applications) as collectively funded medical services through the "Digitale-Versorgung-Gesetz" (Digital Health Care Act) in 2019. This article presents real-world prescription data collected through the smartphone-based home exercise program "Vivira," a fully approved DiGA, regarding its effect on self-reported pain intensity and physical inability in patients with unspecific and degenerative pain in the back, hip, and knee. This study included 3629 patients (71.8% [2607/3629] female; mean age 47 years, SD 14.2 years). The primary outcome was the self-reported pain score, which was assessed with a verbal numerical rating scale. The secondary outcomes were self-reported function scores. To analyze the primary outcome, we used a 2-sided Skillings-Mack test. For function scores, a time analysis was not feasible; therefore, we calculated matched pairs using the Wilcoxon signed-rank test. Our results showed significant reductions in self-reported pain intensity after 2, 4, 8, and 12 weeks in the Skillings-Mack test (T3628=5308;P<.001). The changes were within the range of a clinically relevant improvement. Function scores showed a generally positive yet more variable response across the pain areas (back, hip, and knee). This study presents postmarketing observational data from one of the first DiGAs for unspecific and degenerative musculoskeletal pain. We noted significant improvements in self-reported pain intensity throughout the observation period of 12 weeks, which reached clinical relevance. Additionally, we identified a complex response pattern of the function scores assessed. Lastly, we highlighted the challenges of relevant attrition at follow-up and the potential opportunities for evaluating digital health applications. Although our findings do not have confirmatory power, they illustrate the potential benefits of digital health applications to improve the availability of and access to medical care. German Clinical Trials Register DRKS00024051; https://drks.de/search/en/trial/DRKS00024051.

The effectiveness and sustainability of supervised balance training in chronic ankle instability with grade III ligament injury: a one-year prospective study

BackgroundTo determine the effectiveness and sustainability of supervised balance training in people with chronic ankle instability (CAI) with grade III ligament injury.MethodsTwenty young adults (12 males and 8 females) diagnosed with CAI with grade III ligament injury underwent 3 months of supervised balance training. The self-reported functional questionnaire, plantar pressure (walking and single leg standing), and isokinetic ankle strength were consecutively evaluated at pre-training, 3 months, 6 months and one year. Paired T tests were used to explore changes in muscle strength and plantar pressures following the supervised balance training. According to whether the patient had sprain recurrence, the patients were divided into sprain recurrence group and control group. The risk factors of sprain recurrence were explored with univariate analysis and multivariable logistic regression.ResultsThe self-reported functional scores, the plantar pressure distribution and the muscle strength showed significant immediate improvements after 3 months of supervised balance training. At 6 months post-training, peak force under 2nd metatarsal, time to peak force under the medial hindfoot, time to boundary measurements and dorsiflexion, and eversion strength were partly declined to the pre-training level. 16 patients (80%) resumed the daily life and sports without sprain recurrence during the follow-up. Four patients (20%) reported ankle sprain during the follow-up, and the sprain recurrence group showed significantly higher Beighton scores (p = 0.012) and weaker initial inversion strength (p = 0.022) than the control group.ConclusionsThree months’ of supervised balance training could effectively improve postural control and muscle strength of CAI cases with grade III ligament injury, although these improvements would partially deceased over time. Additional strength exercises for dorsiflexion and eversion should be supplemented from 6 months. Higher Beighton score and initial inversion muscle strength weakness might increase the risk of sprain recurrence.Trial registrationChiCTR, ChiCTR1900023999, Registered 21 June 2019, https://www.chictr.org.cn/edit.aspx?pid=39984&htm=4

Patient-reported outcomes after primary rotating hinge total knee arthroplasty: a multi-centre clinical cohort study.

Rotating hinge prostheses for total knee arthroplasty (TKA) are mostly used in revision setting; however, evidence on the use of these constrained devices in primary setting is scarce and inconsistent. Therefore, we aimed to evaluate the functional outcomes after third-generation rotating hinge implants in primary TKA with a minimal follow-up of twoyears in a large dual-centre observational retrospective clinical trial. The hospital databases of two centres were searched for primary rotating hinge arthroplasty from January 2007 to January 2015. A minimum follow-up of at least twoyears was assured. Patients meeting the inclusion criteria were asked to fill out two self-reported functional scores, the Oxford Knee Score (OKS) and Forgotten Joint Score (FJS), to measure the functional status of the knee. In total, 267 primary rotating hinge knee arthroplasties in 242 patients were performed in two centres. The three major indications were axial malalignment (valgus/varus > 15°), 87/267 (33%), persistent ligamentous instability (28%) and neuromuscular disorders (12%). 184 patients with 202 primary rotating hinge knee arthroplasties could be included that provided data of the self-reported outcome measures (OKS and FJS). A mean OKS score of 37.71 (± 9.23) and a mean FJS score of 63.65 (± 31.01) could be obtained. This large clinical study suggests that constrained devices provide the best results when treating bone-on-bone tricompartimental osteoarthritis of the knee with severe axial deviation (valgus/varus > 15°) and/or persistent ligamentous instability.

Donor site morbidity following radial forearm free flap reconstruction with split thickness skin grafts using negative pressure wound therapy

BackgroundDonor site complications secondary to radial forearm free flap (RFFF) reconstruction can limit recovery. Optimizing hand and wrist function in the post-operative period may allow more efficient self-care and return to activities of daily living. Negative pressure wound dressings (NPD) may increase blood flow and perfusion as compared to static pressure dressings (SPD) designed to minimize shear forces during the healing period. This study aims to compare subjective and objective hand and wrist functional outcomes following RFFF reconstruction with split thickness skin grafts (STSG) in patients treated with NPD and SPD.MethodsAdult patients undergoing RFFF with STSG were identified preoperatively and randomized to receive NPD or SPD following their RFFF reconstruction. NPD involved a single-use, portable device capable of applying 80 mmHg of negative pressure to the forearm donor site. SPD involved a volar splint. Dressings were left in place for seven days with subjective and objective function assessed at seven days, one month and three months postoperatively. The primary outcome was self-reported hand function as measured with the function subscale of the Michigan Hand Questionnaire (MHQ). Secondary outcomes included hand and wrist strength, range of motion, sensation, scar aesthetics, and skin graft complications.ResultsTwenty-four patients undergoing RFFF were randomized to NPD or SPD. Patients treated with NPD had improved MHQ self-reported functional scores as compared to those treated with SPD at seven days postoperatively (P = 0.016). Flexion at seven days was improved in NPD group (P = 0.031); however, all other strength and range of motion outcomes were similar between groups. There were no differences in rates of graft complications, scar aesthetics, or sensation.ConclusionsIn the immediate post-operative period, NPD was associated with improved patient-reported hand and wrist function. Wound care to optimize hand and wrist function could allow for improved patient outcomes in the immediate postoperative period.

Correlation between preoperative imaging parameters and postoperative basic kinematics-based functional outcome in patients with tibial plateau fractures

BackgroundFunctional scores and radiographs are often used to assess function and predict development of osteoarthritis in patients with multi-fragmentary tibial plateau fractures (TPFs). Locomotion, which is the primary goal of fracture treatment, is rarely assessed. The objective of this study was to assess functional ability of patients after TPF fixation using spatio-temporal gait analysis (STGA), and to compare STGA variables with self-reported functional scores and preoperative fracture characteristics. MethodsPreoperative CT scans of 21 patients with complete articular multi-fragmentary TPFs were evaluated for number of fragments, maximum gap between the fragments and maximum articular depression. All patients underwent STGA (velocity, cadence, step length of the affected and the unaffected leg, single-limb support by the affected and the unaffected leg, and double-leg support) and filled the Knee Society Score and the Short Form-12 questionnaires on average 3 years (SD = 1.56, range, 2–5.8) post-injury. FindingsStep length and single-limb support time of the affected leg were shorter compared to the unaffected leg (p = 0.02 and p = 0.007, respectively). Number of fracture fragments correlated with cadence (R = −0.461, p = 0.04) and velocity (R = −0.447, p = 0.04). InterpretationGiven that both higher fracture comminution and deformity on the one hand and the above gait parameter alterations on the other hand are associated with knee osteoarthritis, STGA may be used for routine postoperative evaluation of patients after TPF fixation.

More than pain: pre-operative indicators of patients who progress from unilateral to bilateral total knee arthroplasty within 10 years

Purpose: Up to 40% of patients who seek knee arthroplasty (TKA) in the management osteoarthritis will progress to a second, contralateral TKA within 5-10 years of the index surgery. The aim of this study was to investigate whether the assessment of pain and function prior to and 12 months following the index TKA can be used to predict which patients will progress to contralateral TKA and those who do not. Methods: Five hundred and one patients were included and assessed (i) immediately prior to their first knee arthroplasty, (ii) 12 months following TKA, and (iii) 10 years (minimum 5 years) following TKA. Participant demographics (age, sex, BMI), pre-operative and 12 month post-operative self-reported pain and function scores (Knee Society Scores, Oxford-12, SF-12) and walking speed at 12 months were treated as factors that might be associated with progression to a subsequent contralateral knee arthroplasty. Factors with an association in univariate analyses (p<0.01) were entered into a binomial logistic regression using a hierarchical procedure in an order based on the strength of the association. Results: Three hundred and forty-nine participants were assessed at all three timepoints (70.0%). On average, at the time of their first TKA participants were 66.3 years old (SD=8.2) and had a BMI of 31.5 (SD=5.1). One hundred and ninety-nine participants (57.2%) were female. One hundred and forty participants reported the presence of pain in the contralateral knee at the time of TKA, and 162 participants (46.4%) progressed to contralateral TKA. Of the participants with contralateral knee pain at the time of TKA, only 84 (60.2%) progressed to contralateral TKA. Higher BMI, younger age, worse pre-operative Oxford-12 score, less knee flexion range, lower post-operative SF-12 Physical Component Score, and the post-operative presence of pain were all significantly associated with having a subsequent contralateral TKA. A binomial logistic regression model that included these factors explained between 24% and 32% of the variance in the progression to a contralateral TKA. Participants with worse pre-operative self-reported function scores were 1.2 times more likely to progress to contralateral TKA. Of the participants with no contralateral knee pain at the time of TKA, 60 (28.7%) progressed to contralateral TKA. Females in this cohort were 2.5 times more likely to progress to contralateral TKA than males, but this explained less than 8% of the variance in outcome. There was no difference in self-reported quality of life, pain or function at the latest assessment between participants who did not have a contralateral TKA (KOOS Quality of Life Average=99.7, SD=0.3; Oxford-12 score Average=37.93, SD=10.0, WOMAC Function Average 85.8, SD=17.6) and those who did (KOOS QOL Average=99.7, SD=0.3; p=0.562, Oxford-12 Average=38.3, SD=10.1; p=0.811, WOMAC Function Average = 85.9, SD=18.7; p=0.988). Conclusions: Forty-six percent of patients with TKA progressed to a second (or contralateral) TKA within 10 years. Patients with higher BMI and poorer self-reported function prior to an initial TKA are more likely to progress to the second TKA within 10 years. Females without pain in the contralateral knee at the time of the initial TKA are 2.5 times more likely to progress to the second TKA within 10 years than males with a similar presentation of pain. This information supports the need to maximise pre-operative function prior to TKA, and suggests that there are additional opportunities to tailor interventions towards preventing a second TKA surgery.

Improvement of self-reported functional scores and thickening of quadriceps and femoral intercondylar cartilage under ultrasonography after single intra-articular injection of a novel cross-linked hyaluronic acid in the treatment of knee osteoarthritis.

Most studies used hyaluronic acid (HA) requiring 3-5 intra-articular injections (IAJ) for knee osteoarthritis (KOA). We evaluated the efficacy of a single IAJ of a novel HA by measuring the thickness of quadriceps and femoral intercondylar cartilage (FIC) under ultrasonography (US) in addition to subjective self-reported measures. Forty-nine patients with KOA (Kellgren-Lawrence grades 2-3) received unilateral IAJ of HYAJOINT Plus to the worse knee and were assessed at baseline and 1, 3 and 6-months after IAJ. Outcome measures were the (1) Visual Analog Scale for pain (VAS), (2) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), (3) Lequesne's Index, (4)single-leg-stance duration (5) thigh circumference, and (6) thickness of quadriceps and FIC under US. Forty-six patients completed the 6-month-follow-up study. All outcome measures improved significantly after HA injection (p< 0.001). Both VAS and WOMAC-pain subscale scores improved significantly at 1, 3, and 6 months (p< 0.01). The US thickness of the quadriceps and FIC improved significantly at both 3 and 6 months (p< 0.05). The Lequesne's index, single-leg-stance and thigh circumference improved significantly at 6 months (p< 0.01). HYAJOINT Plus is effective both subjectively and objectively for 6 months and is safe as a treatment for KOA.

Association of wrist and forearm range of motion measures with self-reported functional scores amongst patients with distal radius fractures: a longitudinal study

BackgroundPatients with distal radius fractures (DRF) often have limited range-of-motion (ROM) in multiple planes of movement. No studies have comprehensively examined the impact of various ROM limitations on physical function.MethodsWe performed a multi-center, longitudinal study of 138 patients with conservatively managed DRF. ROM measures were taken at initial evaluation, and at 4 and 8 weeks later. Self-reported physical function was indexed by the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH).ResultsWrist extension, active thumb opposition and a full composite grip were amongst the strongest ROM measures associated with functional scores over time. However, wrist radial deviation and forearm pronation were non-significantly associated with functional scores.ConclusionGiven that ROM is potentially modifiable, the identification of important ROM measures associated with QuickDASH scores can potentially facilitate patient education and refine interventions to optimize functional recovery. Well-designed randomized intervention studies are however needed to confirm these association findings.

Depression Symptomatology and Anterior Cruciate Ligament Injury

Background: Recent literature has recognized a correlation with depression and poor self-reported functional outcome after orthopaedic procedures. However, the effect of depression on anterior cruciate ligament reconstruction (ACLR) outcome has never been studied. Purpose: To quantify the incidence of major depressive disorder (MDD) and correlate depression symptoms with patient-rated knee function in patients undergoing ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: In this multicenter prospective cohort study, 64 consecutive adult patients undergoing primary ACLR were given the 16-item self-report Quick Inventory of Depressive Symptomatology (QIDS) to assess MDD symptoms preoperatively and at 6 weeks, 12 weeks, 24 weeks, and 1 year postoperatively. Lysholm and International Knee Documentation Committee (IKDC) subjective scores were obtained at the same time points to assess self-reported knee function. A QIDS score ≥6 served as a validated threshold for diagnosis of MDD. MDD and non-MDD group assignment was based on preoperative QIDS score. Student t test analysis was performed to compare ACLR outcomes between MDD and non-MDD patients. Correlation among QIDS, Lysholm, and IKDC scores was determined with Spearman r value. Results: A total of 27 patients (42%) were categorized in the MDD group. At baseline, the MDD group reported mean Lysholm (50.8) and IKDC (43.7) scores that were significantly lower than those (64.9 and 57.0, respectively) reported by the non-MDD group (P < .05). Both cohorts showed similar and significant absolute improvement from baseline to 1 year postoperatively (MDD vs non-MDD, increase in mean Lysholm: +24.4 vs +23.5 [P = .63]; MDD vs non-MDD, increase in mean IKDC: +28.1 vs +32.3 [P = .21]). While Lysholm and IKDC scores improved in both groups, at 1-year follow-up, MDD patients reported significantly lower mean Lysholm (75.2 vs 88.4; P = .04) and mean IKDC (71.8 vs 89.3; P = .001) scores as compared with their non-MDD counterparts. In addition, a moderate inverse correlation was found between QIDS and Lysholm scores (r = −0.50) and between QIDS and IKDC scores (r = −0.54). Interestingly, 4 patients experienced complications in the MDD cohort (15%), while there were no complications in the non-MDD group. Conclusion: This study suggests that ACLR may be an equally effective intervention for MDD and non-MDD patients, given their similar significant absolute improvements in functional scores from baseline to 1 year after ACLR. However, MDD patients still reported significantly lower self-reported functional scores at baseline and 1 year postoperatively.

Preoperative psychological findings in adolescents undergoing hip preservation surgery.

Chronic pain is associated with increased anxiety, depression, and maladaptive behaviors, especially in adolescents. We hypothesized that adolescents with chronic hip pain selected for hip preservation surgery (HPS) would demonstrate increased anxiety and depression compared with same-age peers. We designed a study to assess the psychological state of adolescents before HPS. We prospectively evaluated 58 patients (23 males, 35 females), average age 16.5 years (range, 11 to 19 y) before HPS. Their diagnoses included: femoroacetabular impingement (n=25), acetabular dysplasia (16), Perthes disease (11), and slipped capital femoral epiphysis (6). Psychological questionnaires included patient-completed and parent-completed Behavioral Assessment System for Children, Second Edition (BASC-2), Beck Youth Inventory, Second Edition (BYI-II), and Resiliency Scales. Self-reported functional questionnaires included the modified Harris hip score (mHHS, max 100) and the UCLA activity score. Psychological scores were compared between diagnoses, procedures performed, and self-reported functional scores with a Student t test and ANOVA. All patients reported pain, 52 (90%) reported pain >6 months with 28 (54%) >1 year. A total of 44 patients (76%) reported moderate or severe pain. All reported decreased function: average UCLA 7.25 (range, 2 to 10), average HHS 65.5 (range, 27.5 to 97.9). At presentation, 10 patients (17.2%) were receiving psychological intervention and 30% had a family history of mental illness. On the basis of the BYI-II scales, 10% and 31% of patients reported at-risk or clinically significant symptoms of anxiety and depression, respectively. Similarly, using the BASC-2 measure, 28% and 14% reported at-risk or clinically significant anxiety and depression, respectively. Resiliency scales demonstrated that 21% to 36% of patients report maladaptive behavior. There were no significant correlations between any psychological score and diagnosis, procedure, or preoperative functional score. Preoperative evaluation identified patients who reported at-risk or clinically significant symptoms of anxiety and/or depression, with up to one third of patients reporting maladaptive behavior that may significantly influence their postoperative outcomes. Preoperative psychological evaluation, with appropriate intervention and follow-up, if needed, should be considered before surgery selection as mental health conditions may be undiagnosed and will likely influence functional outcomes.

Relationships Between Biomechanics, Tendon Pathology, and Function in Individuals With Lateral Epicondylosis

Single-cohort descriptive and correlational study. To investigate the relationships between tendon pathology, biomechanical measures, and self-reported pain and function in individuals with chronic lateral epicondylosis. Lateral epicondylosis has a multifactorial etiology and its pathophysiology is not well understood. Consequently, treatment remains challenging, and lateral epicondylosis is prone to recurrence. While tendon pathology, pain system changes, and motor impairments due to lateral epicondylosis are considered related, their relationships have not been thoroughly investigated. Twenty-six participants with either unilateral (n = 11) or bilateral (n = 15) chronic lateral epicondylosis participated in this study. Biomechanical measures (grip strength, rate of force development, and electromechanical delay) and measures of tendon pathology (magnetic resonance imaging and ultrasound) and self-reported pain and function (Patient-Rated Tennis Elbow Evaluation) were performed. Partial Spearman correlations, adjusting for covariates (age, gender, weight, and height), were used to evaluate the relationship between self-reported pain, function, and biomechanical and tendon pathology measures. Statistically significant correlations between biomechanical measures and the Patient-Rated Tennis Elbow Evaluation ranged in magnitude from 0.44 to 0.68 (P<.05); however, no significant correlation was observed between tendon pathology (magnetic resonance imaging and ultrasound) measures and the Patient-Rated Tennis Elbow Evaluation (r = -0.02 to 0.31, P>.05). Rate of force development had a stronger correlation (r = 0.54-0.68, P<.05) with self-reported function score than with grip strength (r = 0.35-0.47, P<.05) or electromechanical delay (r = 0.5, P<.05). Biomechanical measures (pain-free grip strength, rate of force development, electromechanical delay) have the potential to be used as outcome measures to monitor progress in lateral epicondylosis. In comparison, the imaging measures (magnetic resonance imaging and ultrasound) were useful for visualizing the pathophysiology of lateral epicondylosis. However, the severity of the pathophysiology was not related to pain and function, indicating that imaging measures may not provide the best clinical assessment.

Quadriceps neuromuscular function and self-reported functional ability in knee osteoarthritis

The purposes of this study were to determine 1) the relationships of self-reported function scores in patients with knee osteoarthritis (OA) to both maximal isometric torque and to isotonic power at a variety of loads, and 2) the degree to which muscle volume (MV) or voluntary activation (VA) are associated with torque and power measures in this population. Isometric maximal voluntary contraction (MVC) torque and isotonic power [performed at loads corresponding to 10, 20, 30, 40, and 50% MVC, and a minimal load ("Zero Load")] were measured in 40 participants with knee OA. Functional ability was measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) function subscale. MV was determined with magnetic resonance imaging, and VA was measured with the interpolated twitch technique. In general, power measured at lower loads (Zero Load and 10-30% MVC, r(2) = 0.21-0.28, P < 0.05) predicted a greater proportion of the variance in function than MVC torque (r(2) = 0.18, P < 0.05), with power measured at Zero Load showing the strongest association (r(2) = 0. 28, P < 0.05). MV was the strongest predictor of MVC torque and power measures in multiple regression models (r(2) = 0.42-0.72). VA explained only 6% of the variance in MVC torque and was not significantly associated with power at any load (P > 0.05). Quadriceps MVC torque and power are associated with self-reported function in knee OA, but muscle power at lower loads is more predictive of function than MVC torque. The variance in MVC torque and power between participants is due predominantly to differences in MV and has little to do with deficits in VA.

RT3 accelerometer shoulder activity: Discrimination of activity levels by the RT3 accelerometer for the assessment of shoulder physical activity (SPA)

We investigated whether the RT3 accelerometer can be used to discriminate and characterize the different levels of shoulder physical activity (SPA) in both patients and healthy adults. Twenty healthy adults and 20 patients with shoulder disorders (SDs) performed activities at 5 levels of difficulty (easy, easy–moderate, moderate, hard–moderate, hard) with the same RT3 accelerometer fixed on the arm. The Vector Magnitude (VM) is the square root of the sum of squares from each axis to determine the overall magnitude of activity. The SPA counts of healthy group were significantly higher than the patient group in every level except easy (31–38 VM counts difference, p < 0.01). For both groups, the hard task demonstrated higher counts as compared to the other tasks. The easy task showed lower counts as compared to the other tasks. In the patient group, significant correlation between FLEX-SF scores and counts from the RT3 ( R = −0.72, p < 0.05) was found in the moderate tasks. The results of this study showed that RT3 can be a potential measurement tool to (1) characterize the difference of SPA between two groups; and (2) partially discriminate the different levels of SPA. The correlations between self-reported function scores and SPA RT3 counts are dependent on self-reported task difficulty.

Geographic information system-based decision support for soil conservation planning in Tajikistan

<h3>Aim:</h3> The safety and potential efficacy of a chimaeric anti-tumour necrosis factor alpha monoclonal antibody (infliximab) were examined in diffuse cutaneous systemic sclerosis (dcSSc). <h3>Methods:</h3> A 26-week open-label pilot study in which 16 cases of dcSSc received five infusions of infliximab (5 mg/kg). Clinical assessment included skin sclerosis score, scleroderma health assessment questionnaire, self-reported functional score and physician global visual analogue scale. Collagen turnover, skin biopsy analysis and full safety evaluation were performed. <h3>Results:</h3> There was no significant change in skin score at 26 weeks but a trend for lower modified Rodnan skin score at 22 weeks (OR 17, 95% CI 6 to 46) compared with peak value (OR 29, 95% CI 11 to 44; p = 0.10). Serum aminoterminal propeptide of type III collagen level was significantly lower at week 26 compared with baseline (p = 0.03). Secretion of type I collagen by dermal fibroblasts was reduced at 26 weeks compared with baseline (p = 0.02). There were no deaths during the study and no suspected unexpected serious adverse reactions. 21 serious adverse events (AE) occurred in seven subjects, mostly attributable to dcSSc. 127 distinct AE occurred in 16 subjects. Of these, 19 AE (15%) were probably or definitely related to infliximab treatment. Eight (50%) patients prematurely discontinued infliximab. Anti-infliximab antibodies developed during the study in five subjects and were significantly associated with suspected infusion reactions (p = 0.025). <h3>Conclusion:</h3> In dcSSc infliximab did not show clear benefit at 26 weeks but was associated with clinical stabilisation and a fall in two laboratory markers of collagen synthesis. The frequency of suspected infusion reactions may warrant additional immunosuppression in any future studies in systemic sclerosis.

Self-Reported Functional Status as Predictor of Observed Functional Capacity in Subjects with Early Osteoarthritis of the Hip and Knee: A Diagnostic Study in the CHECK Cohort

Objectives Patients with hip or knee osteoarthritis (OA) may experience functional limitations in work settings. In the Cohort Hip and Cohort Knee study (CHECK) physical function was both self-reported and measured performance-based, using Functional Capacity Evaluation (FCE). Relations between self-reported scores on SF-36 and WOMAC (Western Ontario and McMaster Arthritis Index, function scales) and FCE performance were studied, and their diagnostic value for clinicians in predicting observed physical work limitations was assessed. Methods Ninety-two subjects scored physical function on SF-36 (scale 0–100, 100 indicating the best health level) and WOMAC (scale 0–68, 68 indicates maximum restriction) and performed the FCE. Correlations were calculated between all scores. Cross-tables were constructed using both questionnaires as diagnostic tests to identify work limitations. Subjects lifting <22.5 kg on the FCE-test ‘lifting-low’ were labeled as having physical work limitations. Diagnostic aspects at different cut-off scores for both questionnaires were analysed. Results Statistically significant correlations (Spearman’s ρ 0.34–0.49) were found between questionnaire scores and lifting and carrying tests. Results of a diagnostic cross-table with cut-off point <60 on SF-36 ‘physical functioning’ were: sensitivity 0.34, specificity 0.97 and positive predictive value (PV+) 0.95. Cut-off point ≥21 on WOMAC ‘function’ resulted in sensitivity 0.51, specificity 0.88 and PV+ 0.88. Conclusion Low self-reported function scores on SF-36 and WOMAC diagnosed subjects with limitations on the FCE. However, high scores did not guarantee performance without physical work limitations. These results are specific to the tested persons with early OA, in populations with a different prevalence of limitations, different diagnostic values will be found. FCE may be indicated to help clinicians to assess actual work capacity.

Response shift in self-reported functional scores after knee microfracture for full thickness cartilage lesions

Our aim was to determine whether response shift (RS), a change in the internal standards of a patient, occurs in patients treated for full thickness knee cartilage defects. We have also evaluated the effect of functional scores on patient satisfaction after surgery. Self-administered questionnaires were used to evaluate pre- and post-operative and retrospective post-operative scores of 53 patients following knee microfracture. Patient satisfaction, Lysholm, Visual Analogue Scale (VAS) for pain and modified International Knee Documentation Committee (IKDC) scores were evaluated. RS (pre-test-then-test), unadjusted and adjusted treatment effects (UTE and ATE) and their effect sizes were calculated. All four functional outcome measures had a positive RS. The effect size of the RS ranged from around 0.35 for the Lysholm and IKDC2 score to over 0.9 for the VAS pain score. Gender, age, smoking status and time since follow-up did not significantly affect the RS. RS did not differ significantly between the three patient satisfaction groups (P>0.05). Post-operative Lysholm and IKDC1 scores differed most significantly between the satisfaction groups. All four scores had a significant shift, implying that patients thought they felt worse before the operation in retrospect than they did at the time. The traditional way of assessing treatment effect, difference between post-intervention and pre-intervention functional scores, may be confounded by change in the internal standards of the patient and should take this into account. RS did not affect the clinical interpretation in this case series. Patient-reported satisfaction after surgery is only related to post-operative scores.

Secondary motions of the shoulder during arm elevation in patients with shoulder tightness

An analysis of secondary shoulder motions (humeral rotation, humeral head anterior/posterior translation, scapular tipping, and scapular upward/downward rotation) in subjects with anterior/posterior shoulder tightness provides the opportunity to examine the role of tightness as a means of affecting shoulder motions. Subjects with shoulder tightness (anterior, n = 12; posterior, n = 12) elevated their arms in the scapular plane. Three replicated movements were performed to the maximum motions. Kinematics data were collected by FASTRAK 3D electromagnetic system. To determine if a significant difference of the secondary motions existed between anterior/posterior shoulder tightness, two-factor mixed ANOVA models with the repeated factor of elevation angle (five elevation angles) and the independent factor of group were calculated. The relationships between the self-reported functional scores (Flexilevel Scale of Shoulder Function, FLEX-SF) and abnormal shoulder kinematics were assessed. For humeral head anterior/posterior translation, the subjects with posterior tightness demonstrated anterior humeral head translation (10 mm, p = 0.019) compared to subjects with anterior tightness. The subjects with anterior tightness demonstrated less posterior tipping (2.2°, p = 0.045) compared to subjects with posterior tightness. The humeral anterior translation had moderate relationships with FLEX-SF scores ( r = −0.535) in subjects with posterior tightness. The scapular tipping had moderate relationships with FLEX-SF scores ( r = 0.432) in subjects with anterior tightness. In conclusion, the secondary motions were different between subjects with anterior and posterior shoulder tightness. During arm elevation, less scapular posterior tipping and less posterior humeral head translation in subjects with anterior and posterior shoulder tightness, respectively, are significantly related to self-reported functional disability in these subjects.