Stair Test Research Articles

Feasibility of an eight-week telerehabilitation intervention for patients with unresectable thoracic neoplasia receiving chemotherapy: A pilot study

BACKGROUND: Exercise-based rehabilitation improves physical function, fatigue and quality of life in patients with thoracic neoplasia. However, the implementation of this intervention is limited because of poor accessibility and adherence. Consequently, telerehabilitation is a promising strategy to improve access and adherence to rehabilitation.OBJECTIVES: To investigate the feasibility, adherence and satisfaction of a home-based telerehabilitation program (TELERP) with real-time physiological parameters acquisition in patients with unresectable thoracic neoplasia receiving chemotherapy and to explore its effects on patients’ functional capacity.METHODS: Five patients receiving chemotherapy followed an 8-week TELERP using real-time monitoring combined with interactive exercises. The TELERP included supervised and unsupervised exercise sessions (3 sessions/week). The feasibility of the TELERP, adverse outcomes and adherence were analyzed. Six-minute walking test (6MWT) and timed stair test (TST) were done to assess functional capacity.RESULTS: Five patients with lung cancer (mean age of 62 ± 7 yr; BMI of 24 ± 3 Kg/m2) completed the TELERP. Patients completed 15 supervised and 8.6 ± 2.97 unsupervised exercise sessions, representing 100 and 96% of the prescribed sessions, respectively. Patients trained at moderate and high intensity ≥50% of the time of the cardiopulmonary exercise session. No adverse event occurred. Following the TELERP, TST and 6MWT improved significantly (Δ −3.0 ± 0.19 s, p = 0.05 and Δ 39.8 ± 19.7 m, p = 0.01, respectively).CONCLUSION: These results support the feasibility of a TELERP and suggest that such intervention may contribute to maintain or improve functional capacity for patients with thoracic neoplasia receiving chemotherapy.

Relationship Between Strength Parameters and Functional Performance Tests in Patients With Severe Knee Osteoarthritis.

Decreased leg muscle strength is a major determinant of reduced function in patients with knee osteoarthritis (OA). The identification of a strength parameter that is best correlated with functional performance is important for monitoring rehabilitation results. To determine which muscle strength measurements show the highest correlation with functional capacity in patients with severe knee OA shortly before total knee arthroplasty (TKA). Cross-sectional exploratory study. Outpatient rehabilitation department at a university teaching hospital. The sample included 75 patients (51 female) scheduled for primary TKA, recruited through multistage sampling. Independent variables were peak isometric, isokinetic concentric, and eccentric leg extensor strength measured on the leg press, as well as peak isometric knee extensor strength measured on the strength chair. Two multiple regression analyses were performed, one including all strength measures and the other including all of the strength ratios. Pearson correlation coefficients were calculated between the strength measures and functional test scores. Dependent variables were the Timed Up and Go Test (TUG) and the Stair Test (ST). The regression analysis including all strength measures could explain 11.9% of the variance of the TUG (P = .068, not significant [NS]) and 21.5% of the variance of the ST (P = .009, significant). The regression model for the strength ratios explained 11.8% of the variance of the TUG (P = .090, NS) and 6.3% of the ST (P = .217, NS). Although univariate analysis confirmed significant correlations between strength measurements and functional tests, multiple regression analysis revealed a higher predictive value for the ST than for the TUG. The use of both muscle strength tests and performance-based function tests is advisable to evaluate functional impairments of patients with knee OA. III.

The effects of Pilates vs. aerobic training on cardiorespiratory fitness, isokinetic muscular strength, body composition, and functional tasks outcomes for individuals who are overweight/obese: a clinical trial

BackgroundSome studies have been conducted to verify the effects of Pilates for individuals who are obese, but conclusive results are not yet available due to methodological concerns. The present study aims to verify and compare the effects of Pilates and aerobic training on cardiorespiratory fitness, isokinetic muscular strength, body composition, and functional task outcomes for individuals who are overweight/obese.MethodsOf the sixty participants, seventeen were allocated to the control group, since the intervention protocol (Pilates or walking sessions) was during their working hours. The remaining 44 participants were randomly allocated to one of two experimental groups (Pilates (n = 22)) or aerobic groups (n = 21).The Pilates and aerobic groups attended 60-min exercise sessions, three times per week for 8 weeks. The aerobic group performed walking training at a heart rate corresponding to the ventilatory threshold. The Pilates group performed exercises on the floor, resistance apparatus, and 1-kg dumbbells. The control group received no intervention. All volunteers were evaluated at the beginning and end of the intervention. The following assessments were conducted: food intake, cardiorespiratory maximal treadmill test, isokinetic strength testing, body composition and anthropometry, abdominal endurance test, trunk extensor endurance test, flexibility test and functional (stair and chair) tests.ResultsThere was no significant difference pre- and post-intervention in calorie intake [F(2, 57) = 0.02744, p = 0.97)]. A significant improvement in oxygen uptake at ventilatory threshold (p = 0.001; d = 0.60), respiratory compensation point (p = 0.01; d = 0.48), and maximum effort (p = 0.01; d = 0.33) was observed only in the Pilates group. Isokinetic peak torque for knee flexor and extensor muscles did not change for any groups. Lean mass (p = 0.0005; d = 0.19) and fat mass (p = 0.0001; d = 0.19) improved only in the Pilates group. Waist and hip circumference measurements decreased similarly in both experimental groups. Abdominal test performance improved more in the Pilates group (p = 0.0001; d = 1.69) than in the aerobic group (p = 0.003; d = 0.95). Trunk extensor endurance and flexibility improved only in the Pilates group (p = 0.0003; d = 0.80 and p = 0.0001; d = 0.41, respectively). The Pilates group showed greater improvement on the chair and stair tests (p = 0.0001; d = 1.48 and p = 0.003; d = 0.78, respectively) than the aerobic group (p = 0.005; d = 0.75 and p = 0.05; d = 0.41, respectively).ConclusionPilates can be used as an alternative physical training method for individuals who are overweight or obese since it promotes significant effects in cardiorespiratory fitness, body composition, and performance on functional tests.

Feasibility and preliminary effects of a tele-prehabilitation program and an in-person prehablitation program compared to usual care for total hip or knee arthroplasty candidates: a pilot randomized controlled trial

Purpose: Prolonged wait times for total hip and knee arthroplasty have deleterious effects on functional status for the awaiting patients. Telerehabilitation interventions can optimize the delivery of perioperative care. This pilot single-blind randomized controlled trial evaluates the feasibility and the potential impact on pain and disability of a telerehabilitation prehabilitation program, compared to in-person prehabilitation or usual care.Material and methods: Thirty-four patients awaiting a total hip or knee arthroplasty were randomly assigned to (1) an in-person 12-week prehabilitation program, (2) a tele-prehabilitation program or (3) usual care. Outcomes were feasibility, patients’ acceptance and compliance to the program, the LEFS, the WOMAC, SF-36, the Self-Pace Walk, the Stair Test, the Timed Up and Go, and a Global Rating of Change scale. Outcomes were collected at baseline and after 12 weeks.Results: Participants reported excellent satisfaction toward tele-prehabilitation. Compliance with the programs was high. No significant differences between groups were found for self-reported outcomes after the prehabilitation program (p ≥ 0.05).Conclusion: This pilot study suggests that tele-prehabilitation can be feasible using commercially available mobile technologies with patients awaiting total hip or knee arthroplasty, and can generate good satisfaction with this population. Further evaluation is warranted through a formal fully powered randomized controlled trial.Trial registration: ClinicalTrials.gov #NCT02636751Implications for RehabilitationProlonged wait times have deleterious effects on patients awaiting a total hip or knee arthroplasty.Prehabilitation interventions can optimize the delivery of perioperative care, but accessibility to such interventions can be limited by geographic situation, lack of transportation and financial issues.Using video conferencing mobile technologies can help overcome those obstacles.Tele-prehabilitation using mobile technology appears safe, feasible and generates good satisfaction with subjects awaiting a total hip or knee arthroplasty.

The effect of Tai Chi on balance and functional mobility in children with congenital sensorineural hearing loss

Background: The aim of the study was to examine the effect of Tai Chi on balance and functional mobility in children with congenital sensorineural hearing loss.Methods: The study included 39 children, aged 10–14 years, with congenital sensorineural hearing loss. The participants were divided into three groups as the Tai Chi group, conventional exercise group, and control group. The Tai Chi group and the conventional exercise group received a 1-h exercise program twice a week for 10 weeks. The balance function of the children was assessed using the Pediatric Balance Scale, the balance subtest of Bruininks-Oseretsky Test 2-Short Form, and the Functional Reach Test. The Timed Up and Go Test and the Timed Up and Down Stairs Test were used to assess functional mobility. The Wilcoxon rank, Kruskal–Wallis. and Mann–Whitney U-tests were used for statistical analyses.Results: When the pre-training values of the groups were compared, with the exception of the Timed Up and Go test, there was no statistically significant difference with respect to demographic data, balance, and functional mobility parameters (p > 0.05). After training, the overall balance and functional mobility tests improved compared to pre-training values in both the Tai Chi and conventional exercise groups (p < 0.05). When the post-training values were compared between the groups, with the exception of the Functional Reach Test and the Timed Up and Down Stairs Test, the results of both exercise groups were superior to those of the control group (p < 0.05).Conclusions: The results of this study indicate that Tai Chi and conventional exercise programs have positive effects on balance and functional mobility in children with congenital sensorineural hearing loss. However, no superiority of Tai Chi or the conventional exercise programs was determined over the other. Both Tai Chi and conventional exercise programs could be used to improve balance and functional mobility in children with congenital sensorineural hearing loss.Implications for rehabilitationTai Chi and conventional exercises are effective on balance in children with congenital sensorineural hearing loss.Tai Chi and conventional exercises are effective on functional mobility in children with congenital sensorineural hearing loss.Tai Chi may be added to the rehabilitation program for children with congenital sensorineural hearing loss.

Treadmill training and kinesiotherapy versus conventional physiotherapy in Parkinson’s disease: a pragmatic study

Abstract Introduction: Physiotherapy has been identified in the literature as an important treatment for individuals with Parkinson’s disease (PD) to improve functional capacity. Little is discussed about the physiotherapy practice environment for this population. Objective: To assess pragmatically the effects of two physiotherapy protocols: Conventional Physiotherapy (CP) and Treadmill Training and Kinesiotherapy (TTK) in PD patients. Method: Twenty-four PD patients classified from 1 to 3 on the Hoehn and Yahr scale were randomly distributed into two groups. In CP group (12 patients), exercises aimed to improve range of motion, bradykinesia, postural adjustments and gait. In TTK group (12 patients), exercises aimed to improve physical fitness, mobility and functional independence. The treatments were performed for 50 minutes, twice a week for 14 weeks. The following evaluations were performed before and after the interventions: Unified Parkinson’s Disease Rating Scale (UPDRS); gait speed (GS); up stairs (US) and down stairs (DS) tests; timed get-up-and-go test (TUG) and 6-Minute Walk Distance Test (6-MWDT). Sociodemographic and clinical data were presented as descriptive analysis. Variables with normal and non-normal distributions were analyzed by specific statistical tests. Results: Intragroup analysis showed significant results for the TTK group (TUG, US, DS, GS, UPDRS total and UPDRS II) and for the CP group only UPDRS total. Intergroup analysis was favorable for the TTK group (TUG, US, DS, 6-MWDT). Conclusion: CP group improved the patients’ general clinical status, while treadmill and kinesiotherapy improved the physical-functional and clinical aspects.

Grape Seed Extract Exerts an Anti-Apoptotic Effect and Attenuates the Decrease in Striatal Tyrosine Hydroxylase in Rotenone-Treated Mice

The potential neuroprotective effect of grape seed extract (GSE) was evaluated in the rotenone-induced Parkinson’s disease in mice. Rotenone was administered at the dose of 1.5 mg/kg subcutaneously (sc) three times per week for 2 weeks alone or in combination with GSE at doses of 13.5 and 27 mg/kg, sc, daily. The control group received the vehicle. The brain levels of the lipid peroxidation product malondialdehyde (MDA), reduced glutathione (GSH), nitric oxide (nitrite), and paraoxonase-1 (PON-1) were determined. Histopathology, caspase-9 immunohistochemistry in different brain regions, and tyrosine hydroxylase immunoreactivity (TH-ir) in the substantia nigra were performed. Behavioral testing included rearing activity, locomotor activity, and stair test paradigms. Results indicated significantly increased lipid peroxidation and nitric oxide contents along with a significant decrease in GSH level and marked inhibition of PON-1 activity in the striatum and in the rest of the brain tissue in rotenone-treated mice. Rotenone caused significant decreases in rearing and locomotor activities and impaired motor strength. Treatment with GSE at 27 mg/kg resulted in decreased MDA and nitric oxide by 22.8%/17.9% and 38.5%/45.5%, respectively, in the striatum and the rest of the brain. GSH was increased by 20.8% and 26%, while PON-1 activity increased by 204% and 142.9% after GSE treatment in the striatum and in the rest of the brain tissue, respectively, compared with the corresponding rotenone control values. GSE given at 27 mg/kg almost completely corrected the decrease in motor activity and motor strength caused by rotenone. Neuronal degeneration and the increase in caspase-9 expression caused by rotenone in different brain regions as well as the loss of substantia nigra TH-ir were markedly reduced by GSE. These data indicate that GSE was effective in improving brain oxidative stress and in preventing the behavioral deficits and neurodegeneration induced by rotenone in the mouse brain. It is suggested that GSE might be useful as an adjunctive treatment in patients with Parkinson’s disease.

Impact of adding a cognitive task while performing physical fitness tests in women with fibromyalgia: A cross-sectional descriptive study.

Fibromyalgia symptoms cause a significant reduction in the ability to perform daily life activities. These activities often require the ability to perform more than 1 task at the same time.The aim was to investigate how the addition of a cognitive task modifies the performance in physical fitness tests in fibromyalgia and healthy controls.A total of 61 women participated in this study, 31 of them diagnosed with fibromyalgia by a rheumatologist. They performed 3 physical fitness tests (arm curl, handgrip, and 10-steps stair tests) in 2 conditions:a) regular (single task [ST]) andb) while thinking in 3 words that were given before each test and had to be recalled and verbalized after the execution of each test (dual task).The dual task cost was calculated as the difference between the performances in the regular and dual-task (DT) conditions.Healthy controls obtained significantly better results than fibromyalgia in both, dual and single-task conditions. Women with fibromyalgia significantly decreased the performance in the 10-steps stair test when a cognitive task was added. Between-group differences in the dual-task costs (DTC) were not found.Women with fibromyalgia showed lower physical performance than healthy controls in both, single and dual task conditions. In addition, differences between single and dual task conditions were observed in the 10-steps stair test in women with fibromyalgia. This could be related with a reduction in the ability to perform daily life activities. However, results regarding DTC indicate that both groups may be similarly influenced by the addition of a secondary cognitive. Thus, further research with different difficulty levels of DT conditions is needed in fibromyalgia.

Evaluation of the Keeogo exoskeleton for assisting ambulatory activities in people with multiple sclerosis: an open-label, randomized, cross-over trial

BackgroundAlthough physical activity and exercise is known to benefit people with multiple sclerosis (MS), the ability of these individuals to participate in such interventions is difficult due to the mobility impairments caused by the disease. Keeogo is a lower-extremity powered exoskeleton that may be a potential solution for enabling people with MS to benefit from physical activity and exercise.MethodsAn open-label, randomized, cross-over trial was used to examine the immediate performance effects when using the device, and the potential benefits of using the device in a home setting for 2 weeks. Clinical performance tests with and without the device included the 6 min walk test, timed up and go test and the 10-step stair test (up and down). An activity monitor was also used to measure physical activity at home, and a patient-reported questionnaire was used to determine the amount and extent of home use. Generalized linear models were used to test for trial effects, and correlation analysis used to examine relationships between trial effects and usage.ResultsTwenty-nine patients with MS participated. All measures showed small decrements in performance while wearing the device compared to not wearing the device. However, significant improvements in unassisted (Rehab effect) performance were found after using the device at home for 2 weeks, compared to 2 weeks at home without the device, and participants improved their ability to use the device over the trial period (Training effect). Rehab and Training effects were related to the self-reported extent that participants used Keeogo at home.ConclusionsKeeogo appears to deliver an exercise-mediated benefit to individuals with MS that improved their unassisted gait endurance and stair climbing ability. Keeogo might be a useful tool for delivering physical activity interventions to individuals with mobility impairment due to MS.Trial registrationClinicalTrials.gov: NCT02904382. Registered 19 September 2016 - Retrospectively registered.

Effect of a 12-week mixed power training on physical function in dynapenic-obese older men: does severity of dynapenia matter?

Mobility disability affects nearly 15% of people aged 65 or over worldwide. Excess weight or obesity (OB), along with an accentuated loss of muscle strength (dynapenia), is recognized to be one of the most common risk factors for mobility impairment among the elderly. To investigate the effect of a 12-week mixed power training (MPT high-velocity resistance training mixed with functional exercises) on physical function in obese older men exhibiting different severities of dynapenia. Community-dwelling older men (69 ± 6 years) were assigned to the study if they were considered obese (OB, fat mass ≥ 25% body weight, BW) and to one of the two groups according to severity of dynapenia [(handgrip strength-HS)/BW]: type 1(OB-DY1) or type 2(OB-DY2), < 1 or 2SD from a young reference group. Participants followed a 12-week MPT, three times/week, 75min/session. Main outcomes included the performance on the 4-m and 6-min walking tests, Timed Up and Go, stair and balance tests. At baseline, OB-DY1 performed better than OB-DY2 in all functional tests (p < 0.05). Following the intervention, medium-to-large training effect size (ES) were observed for fat (ES = 0.21) and lean (ES = 0.32, p < 0.001) masses, functional performance (ES 0.11-0.54, p < 0.05), HS (ES = 0.10, p < 0.05) and lower limb muscle strength (ES = 0.67, p < 0.001) and power (ES = 0.60, p < 0.05). Training-by-group interaction showed that OB-DY1 lost more FM (ES = 0.11, p = 0.03) and OB-DY2 improved more HS (ES = 0.19, p = 0.006) than their counterparts. Seniors with obesity and severe dynapenia have poorer physical function than those in the early stage of dynapenia. Both seem to benefit from a high-velocity resistance training mixed with functional exercises, although by slightly different pathways.

Does Home-Based Progressive Resistance or High-Intensity Circuit Training Improve Strength, Function, Activity or Participation in Children With Cerebral Palsy?

ObjectiveDoes home-based progressive resistance or high-intensity circuit training improve strength, function, activity, or participation in children with cerebral palsy (CP)? DesignThis was the first study on high-intensity circuit training for children with CP. This study was conducted as a randomized prospective controlled pilot study. SettingEvaluation took place at the gait laboratory of the university hospital, training sessions were performed at home. ParticipantsChildren (N=22) with CP (average age: 12y, 10mo, 19 Gross Motor Function Classification System level I, 3 level II) were randomly assigned either to progressive resistance training (PRT) or high-intensity circuit training (HICT). InterventionsThe PRT group trained with progressive overload, while the HICT group performed as many repetitions as possible within 30-second intervals (8wk, 3 times weekly in both groups). Main Outcome MeasuresOutcome measures stretched over all domains of the International Classification of Functioning, Disability and Health and included muscle strength, muscle power sprint test (MPST), timed stairs test (TST), 6-minute walking test, Gait Profile Score (GPS), timed Up and Go test (TUGT) and participation questionnaires. ResultsOnly the HICT group was able to improve strength. Furthermore, the HICT group scored better in the MPST, while PRT participants improved in the TST and TUGT. The HICT-group was able to show improvement in the subscores of the parent-reported participation questionnaire. Other measures of mobility or participation did not change. ConclusionsBoth programs improved function specific to intervention. However, only the HICT group showed significant strength and participation improvements. Compliance was decent in both groups, but the average training unit was shorter in the HICT group. Both exercise programs showed functional benefits, but HICT might be the preferable option for strengthening in highly functional children with CP.

Relationship between self-reported and performance-based tests in assessment of patients with total hip arthroplasty.

The aim of our study was to investigate the relationship between self-reported and performance-based tests in the assessment of patients with total hip arthroplasty (THA). Ninety four patients (35 males, 59 females) were included in the study with mean age 57.1 ± 14.6 years. Patients performed four performance tests (Timed "Up & Go" Test, Sit to Stand Test, Self-paced Walk Test and Stair Test) and two self-reported measurements (Harris Hip Score [HHS] and SF-36 [36-Item Short Form Health Survey]) were preferred to assess patients. There were varying correlations between performance tests and subscales of the SF-36 including physical function, energy/fatigue, pain, general health. Strong correlation was found between HHS and Timed "Up and Go"( r = -0.59, p < 0.001), self-paced walk test ( r = -0.58, p < 0.001). Moderate correlation was found between HHS and sit to stand test ( r = -0.406, p < 0.001), stair test ( r = 0.32, p < 0.001). There were especially moderate-to-strong correlations between self-reported measurements and performance-based tests in the evaluation of patients with THA. Therefore, outcomes assessment after THA may include self-reported measurements or performance-based tests.

Mismatch Between Perception of Disability and Functional Outcomes in Individuals with Large Burn Injuries

Functional limitation can be a serious problem in burn survivors. Such individuals report physical limitations following a burn injury which leads to a perceived reduction in health-related quality of life that persists years after the initial injury. PURPOSE: We tested the hypothesis that well-healed burn survivors having prior burn injuries covering a large body surface area will have greater subjective and objective functional limitations compared to those with prior injuries covering a small body surface area. METHODS: Subjective information was collected through the SF-36 questionnaire, with a focus on the physical function domain. Objective measurements of functional ability included a maximal aerobic capacity test, timed-up-and-go, five times sit-to-stand, and timed stairs test. These variables were collected in three experimental groups: 8 individuals (2 female) with burn injuries greater than 50% (high burn, HB) of their total body surface area (TBSA); 9 individuals (5 female) with burn injuries covering less than 50% (low burn, LB) of their TBSA; and 7 (3 female) non-injured control subjects (CON). RESULTS: Analysis of the perception of limitations in Physical Function from the SF-36 revealed a statistically significant difference between groups (P=0.0014). Further post hoc pairwise testing revealed that SF-36 Physical Function scores were higher in the CON group (99±2, p=0.002) and LB group (93±9, p=0.02) when compared to the HB group (71±19). No difference was found in the SF-36 Physical Function scores between the LB and control groups (p>0.99). Of note, this pattern of differences in the perception of physical limitations between the experimental groups was not reflected in the functional measurements. Specifically, no significant differences were identified in maximum aerobic capacity (CON:32±10, LB:27±5, HB:29±5 ml/kg/min, p=0.65), five times sit-to- stand (CON:9±2, LB10±2, HB:10±1 s, p=0.26), timed up-and-go (CON:13±3, LB:13±2, HB:14±2 s, p=0.51), and timed stairs test (CON:11±2, LB:11±1, HB:11±2 s, p=0.85). CONCLUSION: Collectively, these data suggest that in burn survivors with injuries covering greater than 50% of their TBSA, perceived physical limitations do not reflect objective measures of functional ability. Supported by NIH Grant GM068865

Preliminary concurrent validity of the Fitbit-Zip and ActiGraph activity monitors for measuring steps in people with polymyalgia rheumatica

BackgroundActivity monitors provide objective measurements of physical activity, however, the accuracy of these devices in people with polymyalgia rheumatica (PMR) is unknown. Therefore, this study aimed to obtain preliminary evidence of the accuracy of two activity monitors and explore if clinical and gait-related factors altered device accuracy in people with PMR. MethodsThe ActiGraph with low frequency extension (+LFE) and standard (−LFE) algorithms, Fitbit-Zip (waist) and Fitbit-Zip (shirt) were concurrently tested using a two-minute walk test (2MWT) and stairs test in 27 people with PMR currently treated with prednisolone. To determine accuracy, activity monitor step-count was compared to a gold-standard step-count (GSSC; calculated from video recording) using Bland-Altman plots. ResultsThe Fitbit-Zip (waist) achieved closest agreement to the GSSC for the 2MWT (mean bias (95%CI): 10 (−3, 23); 95%LOA: −55, 74). The ActiGraph (+LFE) achieved closest agreement to the GSSC for the stairs test (mean bias (95%CI): 0 (−1, 1); 95%LOA: −5, 5). The ActiGraph (−LFE) performed poorly in both tests. All devices demonstrated reduced accuracy in participants with lower gait velocity, reduced stride length, longer double-limb support phase and greater self-reported functional impairment. ConclusionOur preliminary results suggest that in controlled conditions, the Fitbit-Zip fairly accurately measures step-count during walking in people with PMR receiving treatment. However, device error was greater than data published in healthy people. The ActiGraph may not be recommended without activation of the LFE. We identified clinical and gait-related factors associated with higher levels of functional impairment that reduced device accuracy. Further work is required to evaluate the validity of the activity monitors in field conditions.

Evaluation of Patients with Lower Extremity Peripheral Artery Disease by Walking Tests: A Pilot Study

Peripheral arterial disease (PAD) directly affects the quality of life, patients experimenting limited walking ability and disability. The purpose of the current study was to investigate the walking and climbing patterns of patients with lower extremity PAD in relation with several risk factors, applied on Romanian population. A cohort non-randomized design was conducted and all eligible subjects who self-referred for medical care since March 2016 until February 2017 at the Second Surgery Department, County Clinical Emergency Hospital of Cluj-Napoca were included. The eligible patients were older than 18 years, with leg pain and Rutherford grade from I to IV. The following tests were applied to each subject included in the study to investigate the capacity to walk as far as possible in six minute (6 minute walking test), the capacity to climb stairs (climbing stairs test) and the capacity to walk on a treadmill (treadmill test) until the pain occurred. Twenty-four patients with mean age of 65.08±8.53 years were investigated. Almost 81% of patients were with chronic pain, 46% were overweight, and 79% were smokers. The results on applied walking tests were as follows: 279.17±70.58 meters to 6-minutes walking test, 77.50±21.80 stairs and 182.50±73.34 meters on treadmill test. The results of the walking tests significantly correlate with each other (ρ&gt;0.93, p&lt;0.0001), and all applied tests significantly correlate with toe gangrene (ρ&gt;|0.52|, p&lt;0.01) and toe disarticulation (ρ&gt;0.62, p&lt;0.002). It can be concluded that any of the applied walking test proved reliable instrument, able to identify the patients with most severe PAD.

Demonstration of an anti-hyperalgesic effect of a novel pan-Trk inhibitor PF-06273340 in a battery of human evoked pain models.

Inhibitors of nerve growth factor (NGF) reduce pain in several chronic pain indications. NGF signals through tyrosine kinase receptors of the tropomyosin-related kinase (Trk) family and the unrelated p75 receptor. PF-06273340 is a small molecule inhibitor of Trks A, B and C that reduces pain in nonclinical models, and the present study aimed to investigate the pharmacodynamics of this first-in-class molecule in humans. A randomized, double-blind, single-dose, placebo- and active-controlled five-period crossover study was conducted in healthy human subjects (NCT02260947). Subjects received five treatments: PF-06273340 50mg, PF-06273340 400mg, pregabalin 300mg, ibuprofen 600mg and placebo. The five primary endpoints were the pain detection threshold for the thermal pain tests and the pain tolerance threshold for the cold pressor, electrical stair and pressure pain tests. The trial had predefined decision rules based on 95% confidence that the PF-06273340 effect was better than that of placebo. Twenty subjects entered the study, with 18 completing all five periods. The high dose of PF-06273340 met the decision rules on the ultraviolet (UV) B skin thermal pain endpoint [least squares (LS) mean vs. placebo: 1.13, 95% confidence interval: 0.64-1.61], but not on the other four primary endpoints. The low dose did not meet the decision criteria for any of the five primary endpoints. Pregabalin (cold pressor and electrical stair tests) and ibuprofen (UVB thermal pain) showed significant analgesic effects on expected endpoints. The study demonstrated, for the first time, the translation of nonclinical effects into man in an inflammatory pain analgesic pharmacodynamic endpoint using a pan-Trk inhibitor.

Physical function and health-related quality of life in young adults with unilateral congenital lower-limb deficiencies.

PurposeThe primary aim was to examine if there were differences in physical function and health-related quality of life (HRQoL) between young adults (18 to 35 years) with unilateral congenital lower-limb deficiency (CLLD) who had been surgically lengthened (Surg) and those using lengthening prostheses (Pros). Second, we wanted to compare their health status with an age- and gender-matched reference group (Ref) without CLLD.MethodsCross-sectional study including a study-specific questionnaire, clinical examination, two field tests evaluating physical function (the six-minute walk test and the Stair test) and HRQoL questionnaires (Short Form (SF)-36 and EuroQol (EQ)-5D-3L).ResultsPhysical function and HRQoL did not differ between the two treatment groups. The odds for having painful or disfiguring scars were 18 times higher in the Surg group (n = 16) compared with the Pros group (n = 14). The CLLD group showed significantly reduced physical function compared with the Ref group. HRQoL, measured by the EQ-5D-3L visual rating scale, was significantly reduced in the CLLD group compared with the Ref group, as was the SF-36 physical function domain in both genders. Men with CLLD also showed increased bodily pain and reduced general health (SF-36), while we found a reduction in the emotional role domain in women compared with Ref.ConclusionThere were no significant differences in physical function and quality of life in young adults with CLLD treated with surgical lengthening compared with those using lengthening prostheses. Compared with the general Norwegian population, young adults with CLLD had significantly lower physical function and reduced HRQoL in some domains.

Falls, Muscle Strength, and Functional Abilities in Community-Dwelling Elderly Women

Introduction: Falls are among the most common and serious problems facing elderly women. Falling is associated with increased mortality, morbidity, reduced functioning, loss of independence and hospitalization. Objective: The aim of this study was to investigate the association among fear of falling, muscle strength, and functional abilities in community-dwelling elderly women. Methods: Forty-nine elderly women (70.57 ± 5.59 years) participated in this study. Records of falls, self-efficacy associated with falls (FES-I Brazil), functional abilities (the Timed Up and Down Stairs test [TUDS] and the Timed Up and Go test [TUG]), lower limb muscle strength (knee extensors and ankle plantar flexors), and hand grip strength were investigated as variables of interest. Descriptive statistics, the one-way ANOVA, and linear regression tests were used to analyze the association between fear of falling and falls with other variables (α = 0.05). Results: Elderly women who presented records of falls within the last year had lesser strength of knee extensors and plantar flexors (p ≤. 05). Those who had low self-efficacy associated with falls presented lower strength of knee extensors (p ≤. 01). Variables associated with functional abilities (r = 0.70) and lower limb strength (r = 0.53) showed a positive correlation (p ≤. 01). Conclusion: The concern with the fear of falling and falls may be negative effects caused by lower limb muscle weakness.

Individuals at four months post total knee arthroplasty (TKA) still prefer to perform asymmetrically during sit-to-stand tasks

Objective Rising from a chair, a demanding task for the lower limbs, is essential to independent living. Biomechanical data collected after knee surgery is relevant for determining the level of residual deficits and compensations during functional tasks and could be used to optimize rehabilitation. The aim of this study was to quantify the kinematics and kinetic differences between the operated and non-operated lower limbs in individuals at 4 months from TKA surgery during sit-to-stand (STS) tasks executed under three foot positions. Material/patients and methods Eighty-one individuals [mean age (standard deviation): 66 (7.5) years] who had received 8 weeks of physiotherapy were assessed 4 months after undergoing knee arthroplasty. Pain, ROM and strength were assessed. Walking endurance (6MWT), stair capacity (timed stair test) and the knee and hip osteoarthritis condition (WOMAC Questionnaire) were also evaluated to determine the participants’ clinical status. For the STS, participants got up from a chair at natural speed under three conditions: spontaneous (SP), symmetrical (SYM) and asymmetrical (ASYM) foot positions (the foot back). 3D lower limb joint angles and moments were obtained using force platforms and a motion analysis system combined with an inverse dynamic approach. Statistical analyses (ANOVAs and paired t-tests) were used to assess the effects of sides and foot positions on the biomechanical data at seat-off. Results Mean values in the WOMAC, 6MWT and stair capacity were 84.7 (14.4), 411.4 m (93.9) and 19.2 (23.5), respectively. Participants had moderate pain at activity and ROM and strength at the knee were inferior on the operated side. The duration of the task was longer for ASYM condition than the two others. Kinematics and kinetic lower limb data generally differed between foot conditions and sides (mainly for joint moments) towards maximizing the use of the non-operated side except for the ASYM condition where the participants increased their weight-bearing on the operated side, resulting in higher knee moments of that side at the knee. Discussion – conclusion These results reveal that the asymmetrical behavior during STS is a preference rather than an inability to perform symmetrically. Further analyses of the data will allow identification of the predicting factors of STS performance at four months post-TKA. The study was financed by the Canadian Institutes of Health Research (CIHR, Trial Number ISRCTN66285945).

Determinants of physical functioning in women with knee osteoarthritis.

Knee osteoarthritis (OA) is an important health problem with its high prevalence and association with pain and functional disability in physical tasks and activities especially in women. To explore the impacts of widely seen demographic, pathological, psychological, and impairment factors on physical functioning in women with knee OA using the performance-based and self-reported measures. One hundred and ten women with knee OA participated in this study. Performance-based measures included the 10-m walk test, timed up and go (TUG) test, and a stair test. Self-reported physical functioning was measured using the Western Ontario and McMasters Universities OA Index. Knee muscle strength, pain intensity, flexion range of motion (ROM), body mass index (BMI), radiographic severity, and anxious and depressive symptoms were measured. Age, disease duration, and comorbidities were recorded. Correlation and linear regression analyses were used to assess the associations. In the linear regression models, knee muscle weakness, limited knee flexion ROM, pain intensity, and older age contributed to 65% of variance in physical performance measures mostly explained by knee muscle weakness. Knee pain intensity, BMI, anxiety, and knee muscle weakness contributed to 60% of variance in WOMAC physical function score mostly explained by pain. Radiologic severity, depression, comorbidities, and disease duration did not have a significant association (P < 0.05). Performance-based measures had significant but moderate correlations with WOMAC physical function score (r range 0.51-0.57, P < 0.05). In women with knee OA, knee muscle strength was the main determinant of performance-based physical functioning together with knee flexion ROM, knee pain, and age. Knee pain was the main determinant of self-reported physical functioning. BMI, anxiety, and knee muscle strength had some contributions as well. Performance-based and self-reported measures had moderate relations and evaluate different aspects of physical functioning. In the management of women with knee OA strengthening of weak knee muscles, improving limited flexion ROM, pain management, weight loss, and improving anxiety should be considered as a priority and performance-based and self-reported measures should be used together for a comprehensive evaluation of physical functioning.