Variation In Range Of Motion Research Articles

The Influence of Weather Conditions on the Diurnal Variation in Range of Motion in Older Adults with Knee Osteoarthritis.

(1) Background: This study investigated the relationship between weather conditions, diurnal patterns, and total knee range of motion (ROM), as well as the severity of symptoms (pain and stiffness) in older adults with knee osteoarthritis. (2) Methods: An exploratory longitudinal study was conducted on 28 older adults with knee osteoarthritis (mean age 71.86 ± 4.49 years; 46.4% men, 53.6% women). We used as assessment tools the Visual Analog Scales (VAS) for self-reported local knee pain and stiffness, and goniometry for ROM. Measurements were taken twice, six months apart, in winter and summer, in the morning and evening of each selected day. Recorded weather factors comprised temperature, relative humidity, barometric pressure, and maximum wind speed. (3) Results: The study revealed significant effects of season and time of day on pain and stiffness, respectively (p < 0.001). Additionally, a significant interaction between season and time influenced total knee ROM (p < 0.001). Moreover, there was a statistically significant relationship between time and total knee ROM (p < 0.001). (4) Conclusions: This research underscores the complex link between seasonal fluctuations and daily variations in some symptomatic and functional aspects of knee osteoarthritis in older adults.

Cervical disc arthroplasty combined with two-level ACDF for the treatment of contiguous three-level cervical degenerative disc disease: A comparative study.

To compare the differences among constructs with one-level cervical disc arthroplasty (CDA) and two-level anterior cervical discectomy and fusion (ACDF).A retrospective study was conducted involving patients who underwent one-level CDA and two-level ACDF between June 2012 and July 2020. According to the different locations of CDA and ACDF, we divided the constructs into three types: type Ⅰa: CDA-ACDF-ACDF; type Ⅰb: ACDF-CDA-ACDF; type Ⅰc: ACDF-ACDF-CDA. The differences of clinical and radiological outcomes were evaluated.Fifty-three patients were included with 29 in type Ⅰa group, 11 in type Ⅰb group, and 13 in type Ⅰc group. After surgery, all groups showed significant improvement in apanese Orthopedic Association, Neck Disability Index, and Visual Analog Scale scores (p < 0.001). Range of motion(ROM) of the total cervical spine in type Ⅰc group decreased significantly compared with those in type Ⅰa and type Ⅰb groups (p < 0.05). No significant differences in ROM of the arthroplasty segment and the variations in ROM of the superior adjacent segment were observed among thethree groups. The fusion rates of the superior ACDF segments were significantly higher at 6 and 12 months postoperatively than those of the inferior ACDF segments (p < 0.05).The clinical outcomes were similar among constructs concerning different locations of CDA and ACDF in three-level hybrid surgery. ROM of the cervical spine in type Ⅰc group decreased significantly compared with that in type Ⅰa and type Ⅰb groups. The fusion rates of superior ACDF segments were higher at early time points after surgery than those of inferior ACDF segments.

A comparison of intervertebral ligament properties utilized in a thoracic spine functional unit through kinematic evaluation

Ligament properties in the literature are variable, yet scarce, but needed to calibrate computational models for spine clinical research applications. A comparison of ligament stiffness properties and their effect on the kinematic behavior of a thoracic functional spinal unit (FSU) is examined in this paper. Six unique ligament property sets were utilized within a volumetric T7–T8 finite element (FE) model developed using computer-aided design (CAD) spinal geometry. A 7.5 Nm moment was applied along three anatomical planes both with and without costovertebral (CV) joints present. Range of Motion (RoM) was assessed for each property set and compared to published experimental data. Intact and serial ligament removal procedures were implemented in accordance with experimental protocol. The variance in both kinematic behavior and comparability with experimental data among property sets emphasizes the role nonlinear characterization plays in determining proper kinematic behavior in spinal FE models. Additionally, a decrease in RoM variation among property sets was exhibited when the model setup incorporated the CV joint. With proper assessment of the source and size of each ligament, the material properties considered here could be expanded and justified for implementation into thoracic spine clinical studies.

Differences in Glenohumeral Range of Motion and Humeral Torsion Between Right-Handed and Left-Handed Professional Baseball Pitchers

Background: Elite pitchers have demonstrated significant differences in glenohumeral range of motion and humeral torsion compared with the nonthrowing population. Furthermore, abnormal shoulder range of motion measurements have been associated with different injury risks and challenges in assessing rehabilitation progress. Variations in range of motion and torsion due to handedness in the asymptomatic professional population have yet to be investigated in the literature. Hypothesis: No significant differences in glenohumeral range of motion and humeral torsion would exist between asymptomatic right- and left-handed professional pitchers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: 217 Major League Baseball pitchers from a single organization were evaluated over a 7-year period between 2013 and 2020. Range of motion was measured with a standard goniometer. Ultrasound scanning was used to determine neutral position of the shoulder, and the degree of humeral torsion was measured with a goniometer. Results: Right-handed pitchers demonstrated significantly greater values of glenohumeral external rotation (118.5° vs 112.7°; P < .001) in their throwing arms compared with their left-handed counterparts. Right-handed pitchers also showed greater values of glenohumeral internal rotation deficit (13.9° vs 4.8°; P < .001) and side-to-side differences in humeral retrotorsion (−23.1° vs −2.2°; P < .001). Left-handed pitchers demonstrated significantly greater flexion deficits in the throwing arm compared with their right-handed counterparts (7.5° vs 0.0°; P < .001). Conclusion: In the throwing arm, right-handed pitchers demonstrated significantly greater measures of external rotation, glenohumeral internal rotation deficit, and humeral retrotorsion compared with left-handed counterparts. Furthermore, right-handed pitchers demonstrated a significant side-to-side difference in retrotorsion, whereas left-handed pitchers did not. However, left-handed pitchers demonstrated a side-to-side shoulder flexion deficit that was not present in the cohort of right-handed pitchers. The correlation between humeral retrotorsion and increased external rotation indicates that osseous adaptations may play a role in range of motion differences associated with handedness. Additionally, these findings may explain observed differences in several throwing metrics between right- and left-handed pitchers. Knowledge of these differences can inform rehabilitation programs and shoulder maintenance regimens.

Randomized controlled trial on Dryland And Thermal Aquatic standardized exercise protocol for chronic venous disease (DATA study)

ObjectiveThe present investigation aims to compare the effect of a standardized exercise protocol in thermal aquatic immersion vs dryland (DL) on patients with chronic venous disease (CVD). MethodsThirty-four patients with CVD (C3,Ep,As,Pr) were included in the study and randomly assigned to perform a standardized exercise protocol in a DL environment (DL group) or in a thermal water (TW group) from a natural hot spring at 33°C with a high mineral content. Leg volumetry, ankle range of motion (ROM), ultrasound-detected subcutaneous tissue and great saphenous vein (GSV) diameter were assessed. Quality of life was measured by VVSymQ and CIVIQ-20. ResultsAfter five TW sessions the average volume decrease was –432.4 ± 122.4 mL (P < .0001) in the right leg and –358.8 ± 109.3 mL (P < .0001) in the left. No significant volume change was reported at the end of the five sessions in DL. In TW, the subcutaneous tissue thickness significantly decreased (all assessment points P < .0001 right and P < .0001 left). In contrast, no significant changes were found in the DL group. The TW group showed a significant great saphenous vein caliber reduction, both in the right and left legs (6.2 ± 5.9%, P < .002; 6.1 ± 2.2%, P < .0001), whereas in the DL group no significant differences were found. After five sessions, ankle ROM significantly increased in both groups, both in dorsiflexion and in plantarflexion (right leg: TWdorsiflexionP < .0001, TWplantarflexionP < .0001; DLdorsiflexionP < .003, DLplantarflexionP < .007) (left leg: TWdorsiflexionP < .0001, TWplantarflexionP < .0001; DLdorsiflexionP < .006, DLplantarflexionP < .001). Only the TW group showed a linear correlation between volume and ankle ROM variation (right leg: R2 = 0.80, R2 = 0.75, P < .0001; left leg: R2 = 0.82, R2 = 0.81, P < .0001). The VVSymQ and CIVQ20 scores significantly improved in TW (P < .0001 and P < .0001, respectively), whereas DL showed a significant improvement only in CIVQ20 score (P < .02). ConclusionsThermal aquatic immersion enhances the clinical benefits of a standardized exercise protocol for patients with CVD. Compared with the data available in the literature on non-TW, the present investigation shows a potential role of higher density types of water in lower limb volume control. Intense and rigorous data collection is needed to move from empirical evidence to evidence-based science in TW, a potentially very useful treatment modality for CVD.

Effects of range of motion on muscle development during resistance training interventions: A systematic review.

The purpose of this study was to systematically review the literature as to the effects of performing exercise with a full versus partial range of motion (ROM) during dynamic, longitudinal resistance training (RT) programs on changes in muscle hypertrophy. Based on the available literature, we aimed to draw evidence-based recommendations for RT prescription. Six studies were identified as meeting inclusion criteria: four of these studies involved RT for the lower limbs while the other two focused on the upper extremities. The total combined sample of the studies was n = 135, which comprised 127 men and 8 women. The methodological quality of all included studies was deemed to be “excellent” based on the modified PEDro scale. When assessing the current body of literature, it can be inferred that performing RT through a full ROM confers beneficial effects on hypertrophy of the lower body musculature versus training with a partial ROM. Alternatively, research on the effects of ROM for the upper limbs is limited and conflicting, precluding the ability to draw strong practical inferences. No study to date has investigated how ROM influences muscle growth of the trunk musculature. Finally, some evidence indicates that the response to variations in ROM may be muscle-specific; however, this hypothesis also warrants further study.

Rehabilitation variability following medial patellofemoral ligament reconstruction

ABSTRACTBackground: Medial patellofemoral ligament (MPFL) reconstruction is an increasingly utilized surgical option for recurrent patellar instability. Recent studies have highlighted the potential benefits of accelerated functional rehabilitation; however, no validated MPFL rehabilitation guidelines currently exist.Objective: To assess the variability of MPFL reconstruction rehabilitation protocols published online by academic orthopaedic programs.Methods: Online MPFL rehabilitation protocols from U.S. teaching orthopaedic programs were reviewed. A comprehensive scoring rubric was developed to assess each protocol for both the presence of various rehabilitation components and the timing of their introduction.Results: Thirty-one protocols (20%) were identified from 155 U.S. academic orthopaedic programs. Thirty protocols (97%) recommended immediate postoperative knee bracing. Twenty protocols (65%) allowed for weight-bearing as tolerated using crutches immediately postoperatively, whereas seven protocols (23%) recommended partial weight-bearing and four protocols (13%) recommended toe-touch weight-bearing. For those protocols advising partial and toe-touch weight-bearing, advancement to full weight-bearing was achieved at averages of 4.7 (range, 3–8) weeks and 6.3 (range, 6–7) weeks, respectively. There was considerable variation in range of motion (ROM) goals; however, most protocols (97%) recommended achieving 90 degrees of knee flexion at an average of 1.4 (range, 0–6) weeks. Significant diversity was found in the inclusion and timing of strengthening, stretching, proprioception, and basic cardiovascular exercises. Twenty-five protocols (81%) recommended return to training after completing specific athletic criteria.Conclusions: A minority of U.S. teaching orthopaedic institutions publish MPFL reconstruction rehabilitation protocols online. Furthermore, there is a high degree of variability in both the composition and timing of rehabilitation modalities across these protocols.

Quality and Variability of Online Physical Therapy Protocols for Isolated Meniscal Repairs.

The ideal meniscal repair postoperative rehabilitation protocol has yet to be determined. Further, patients are attempting to access health care content online at a precipitously increasing rate given the efficiency of modern search engines. The purpose of this investigation was to assess the quality and variability of meniscal repair rehabilitation protocols published online with the hypothesis that there would be a high degree of variability found across available protocols. To this end, Web-based meniscal repair physical therapy protocols from U.S. academic orthopaedic programs as well as the first 10 protocols identified by the Google search engine for the term "meniscal repair physical therapy protocol" were reviewed and assessed via a custom scoring rubric. Twenty protocols were identified from 155 U.S. academic orthopaedic programs for a total of 30 protocols. Twenty-six protocols (86.6%) recommended immediate postoperative bracing. Twelve (40.0%) protocols permitted immediate weight-bearing as tolerated (WBAT) postoperatively, while the remaining protocols permitted WBAT at an average of 4.0 (range, 1-7) weeks. There was considerable variation in range of motion (ROM) goals, with most protocols (73.3%) initiating immediate passive ROM to 90°. The types and timing of strength, proprioception, agility, and pivoting exercises advised were extremely diverse. Only five protocols (16.7%) employed functional testing as a marker for return to athletics. The results of this study indicate that only a minority of academic orthopaedic programs publish meniscal repair physical therapy protocols online and that within the most readily available online protocols there are significant disparities in regards to brace use, ROM, weight-bearing, and strengthening and proprioception exercises. These discrepancies reflect the fact that the best rehabilitation practices after a meniscal repair have yet to be elucidated. This represents a significant area for improved patient care through standardization.

Effect of AmLexin (Acacia catechu &amp; Morus alba) on Redox Balance and Subjective Pain in Healthy Runners

IntroductionIntense exercise is known to increase both oxidative stress and post‐exercise pain. Muscle soreness and soft tissue pain is a frequent complaint among recreational exercisers and a significant obstacle to continued participation in regular physical activity.ObjectiveOur study examined the effects of an herbal dietary supplement (AmLexin; combination of Acacia catechu heartwood extract and Morus alba root bark extract) versus a look‐alike placebo on redox balance (plasma oxidative stress and oxidative capacity) and subjective pain levels following intense exercise.Subjects &amp; MethodsTwenty‐four (N=24) healthy men and women were recruited to participate in a progressive 8‐week running program followed by a 13.1‐mile timed run (half‐marathon). Subjects were randomly divided in double‐blind fashion to receive either the supplement at 200 mg b.i.d. (N=12) or placebo (N=12) for 9 weeks (8 weeks pre‐race during training and 1‐week post‐race). We measured range of motion (ROM) and pain/stiffness (WOMAC &amp; VAS) weekly during 8‐weeks of training and daily for 6‐days post‐race, and plasma redox status on days 1 and 6 post‐race.ResultsDue to large variations in ROM between and within subjects, there were no significant differences in ROM between supplementation groups. However, multiple measures of pain and stiffness were significantly lower for days 1–3 post‐race in the AmLexin group compared to the Placebo group, including WOMAC scores for overall pain at day 1 and 3 post run and a clear trend of less stiffness and better activities of daily living in the AmLexin group. The AmLexin group also showed statistically significant less pain/stiffness than Placebo based on VAS scores for multiple body parts (quadriceps, calves, hamstrings, and knees) at several time points after the race. Redox balance assessment indicated the AmLexin group to show a strong trend toward improved status at day 1, that reached statistical significance for lower oxidative stress and higher oxidative capacity at day 6 post‐race compared to the Placebo group.ConclusionAmLexin has previously been reported to protect joint cartilage from damage, reducing the amount of glycosaminoglycan released by articular cartilage (1 &amp;2), and to be an effective quencher of super oxide anion, a free radical generated by tissue wear and tear (3). These clinical results further demonstrate AmLexin's effectiveness to reduce oxidative stress, improve oxidative capacity, and prevent the development of post‐exercise subjective pain and stiffness in a population of healthy non‐arthritic adults. Therefore, AmLexin may be viewed as an effective dietary supplement to facilitate healthy pain‐free participation in regular physical activity.Support or Funding InformationFunding provided by UnigenThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Quality and Variability of Online Physical Therapy Protocols for Isolated Meniscal Repairs

Objectives:Patients are attempting to access healthcare content online at a precipitously increasing rate given the efficiency and ease of modern search engines. The purpose of this study was to assess the quality and variability found across isolated meniscal repair rehabilitation protocols published online.Methods:Web-based meniscal repair physical therapy protocols from U.S. academic orthopaedic programs available online were included for review. The first 10 protocols identified by the Google search engine for the term “meniscal repair physical therapy protocol” were also included as these will be the most commonly encountered by patient searches. Exclusion criteria comprised treatment of concomitant injuries and protocols aimed at pediatric patients. A comprehensive custom scoring rubric was created to assess each protocol for presence or absence of various rehabilitation components, as well as their timing.Results:Twenty protocols were included from 155 U.S. academic orthopaedic programs for a total of 30 protocols. Only one protocol (5%) recommended a pre-operative rehabilitation program and no protocol recommended continuous passive motion post-operatively. Twenty-six protocols (86.6%) recommended immediate post-operative bracing with an average 5.0 (range 3 to 8) weeks of brace use. Twenty-three of these protocols (88.5%) specifically mentioned locking of the brace during ambulation. Twelve (40.0%) protocols permitted immediate weight bearing as tolerated (WBAT) post-operatively, while the remaining protocols permitted WBAT at an average 4.0 (range 1 to 7) weeks post-operatively. There was considerable variation in range of motion (ROM) goals with most protocols (73.3%) initiating immediate PROM to 90°. Full ROM was mentioned in 22 (73.3%) protocols and permitted at an average of 5.2 (range 1 to 7) weeks. The types of strength and proprioception exercises specifically recommended in each protocol were extremely diverse. In regard to modalities recommended for return to basic activity, stationary biking was the most commonly employed (90.0%) at an average 4.6 (range 1 to 7) weeks post-operatively. Agility and pivot training were permitted at an average of 12.5 (range 7 to 28) and 19.3 (range 11 to 28) weeks, respectively. Only five protocols (16.7%) employed functional testing during the rehabilitation process as a marker for return to athletic activities, with 14 (46.7%) protocols failing to mention return to practice or competition as a goal for meniscal repair rehabilitation.Conclusion:There is a paucity of evidence-based treatment modalities employed during physical therapy following isolated meniscal repair. The results of this study indicate that only a minority of academic orthopaedic programs publish meniscal repair physical therapy protocols online and that within these protocols there are significant disparities. These variations reflect the lack of consensus regarding the best-practice components of meniscal repair rehabilitation which can lead to confusion among patients, therapists and surgeons resulting in longer recovery times and inferior results. This inconsistency represents an opportunity for improvement through standardization.

What are we measuring? A critique of range of motion methods currently in use for Dupuytren's disease and recommendations for practice.

BackgroundRange of motion is the most frequently reported measure used in practice to evaluate outcomes. A goniometer is the most reliable tool to assess range of motion yet, the lack of consistency in reporting prevents comparison between studies. The aim of this study is to identify how range of motion is currently assessed and reported in Dupuytren’s disease literature. Following analysis recommendations for practice will be made to enable consistency in future studies for comparability. This paper highlights the variation in range of motion reporting in Dupuytren’s disease.MethodsA Participants, Intervention, Comparison, Outcomes and Study design format was used for the search strategy and search terms. Surgery, needle fasciotomy or collagenase injection for primary or recurrent Dupuytren’s disease in adults were included if outcomes were monitored using range of motion to record change. A literature search was performed in May 2013 using subject heading and free-text terms to also capture electronic publications ahead of print. In total 638 publications were identified and following screening 90 articles met the inclusion criteria. Data was extracted and entered onto a spreadsheet for analysis. A thematic analysis was carried out to establish any duplication, resulting in the final range of motion measures identified.ResultsRange of motion measurement lacked clarity, with goniometry reportedly used in only 43 of the 90 studies, 16 stated the use of a range of motion protocol. A total of 24 different descriptors were identified describing range of motion in the 90 studies. While some studies reported active range of motion, others reported passive or were unclear. Eight of the 24 categories were identified through thematic analysis as possibly describing the same measure, ‘lack of joint extension’ and accounted for the most frequently used.ConclusionsPublished studies lacked clarity in reporting range of motion, preventing data comparison and meta-analysis. Percentage change lacks context and without access to raw data, does not allow direct comparison of baseline characteristics. A clear description of what is being measured within each study was required. It is recommended that range of motion measuring and reporting for Dupuytren’s disease requires consistency to address issues that fall into 3 main categories:-Definition of termsProtocol statementOutcome reportingElectronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0884-3) contains supplementary material, which is available to authorized users.

Theoretical relationships between component design, patient bone geometry and range-of-motion post hip resurfacing

Clinical studies indicate that range of motion until prosthetic impingement is important in understanding unexplained failures of hip resurfacings, yet the underlying biomechanical principles have received little attention. This study investigates the mathematical relationships between component design, position, patient bone geometry and range of motion in hip resurfaced prostheses. Variations in range of motion and impingement-free safe-zones for cup position were calculated using an established method of vector analysis that facilitated parametric analysis in a time efficient manner. The alpha angle, defined as the angle between the centreline of the femoral neck and the waist of the femoral head/neck junction, was used to represent the natural femoral neck. Range of motion and impingement-free safe-zones were inversely proportional to the alpha angle and cup inclusion angle. The size of the safe-zone was most sensitive to the alpha angle with a 6 degrees reduction, decreasing the range of cup positions without impingement by 80-100%. Lowering the upper limit of cup inclination from 55 degrees to 45 degrees reduced the range of cup positions that allow impingement-free motion by 47-94%. No common safe-zone was observed for the range of component sizes and positions investigated. This offers an explanation to why clinic studies have failed to associate outcome with standardised positioning criteria.

RELATIONSHIP BETWEEN PATELLAR HEIGHT AND RANGE OF MOTION AFTER TOTAL KNEE ARTHROPLASTY

To evaluate whether, after total knee arthroplasty, there is any correlation between patellar height and range of motion (ROM) achieved by patients six months after the operation. Methods: Forty-five patients who underwent total knee arthroplasty were assessed at least 12 months after the operation (total of 54 knees). The maximum and minimum ROM of all the knees was recorded under fluoroscopy, along with patellar height according to the Blackburne and Peel ratio. Two possible correlations were evaluated: patellar height and ROM; and patellar height and ROM variation from before to after the operation. Results: A correlation was found between patellar height and postoperative ROM (p = 0.04). There was no correlation between patellar height and ROM variation (p = 0.182). Conclusion: After total knee arthroplasty, the lower the patella is, the worse the ROM is.

The COL5A1 Genotype is Associated with Range of Motion Measurements in Older Healthy Active Participants

PURPOSE: COL5A1 encodes for the alpha 1 chain of type V collagen, which forms heterotypic fibres with type I collagen - the most prominent protein in connective tissue - and plays an important role in regulating fibre assembly and diameter. Certain heritable disorders of connective tissue, which have a unifying symptom of joint hypermobility, are caused by mutations within COL5A1. In addition, a C/T single nucleotide polymorphism (SNP) (rs12722) within the 3'-untranslated region (3'-UTR) of the CO5A1 gene is associated with chronic Achilles tendinopathy, female ACL ruptures and running endurance performance. Furthermore, this sequence variant is associated with range of motion (ROM) measurements in a mixed injured/uninjured cohort. The aim of this study was to investigate the association between COL5A1 rs12722 and sit and reach (SR) ROM in an apparently healthy and physically active cohort. METHODS: The SR test was performed on 204 male and 121 female white participants, who were genotyped for COL5A1 SNP rs12722 (C/T). RESULTS: The COL5A1 genotype frequency (33.1% TT, 47.4% TC and 19.5% CC) was in HWE (p=0.555). The genotype groups were matched for sex, age, height, weight and the amount of self-reported flexibility or exercise training per week at the time of testing. There was a significant (p=0.007) interaction effect between SR ROM and age, when the T allele (TT and TC genotypes) group was compared to the CC genotype group. When divided into the younger (35 years) participants, the COL5A1 genotype was only associated with SR ROM in older participants (TT: 23 ± 10 cm, N=26; TC: 25 ± 10 cm, N=22; CC: 32 ± 11 cm, N=22; p=0.017). Of all the factors considered to be influencing SR ROM (age, sex, weight, exercise in the 24 hours prior to testing, primary sport participation associated with lower body ROM, self-reported current flexibility and current training, and COL5A1 genotype) only sex (p<0.001) and COL5A1 genotype (p<0.001) were significant independent determinants of SR ROM in the older group (22.8% of the variance). CONCLUSIONS: SNP rs12722 within COL5A1 3'-UTR is associated with SR ROM, particularly with increasing age and is an important contributing factor to ROM variation, particularly in older, apparently healthy and physically active individuals.

Range of motion measurements diverge with increasing age for COL5A1 genotypes

Increased and decreased joint range of motion (ROM) are modifiable risk factors for musculoskeletal soft-tissue injuries. Certain heritable disorders of connective tissue, which have a unifying symptom of joint hypermobility, are caused by mutations within the COL5A1 gene. Furthermore, the COL5A1 BstUI restriction fragment length polymorphism (RFLP) sequence variant is associated with ROM measurements in a mixed injured/uninjured cohort. The association between COL5A1 BstUI RFLP and sit and reach (SR) ROM in an apparently healthy and physically active cohort was investigated. The SR test was performed on 325 white subjects (204 males). Subjects were also genotyped for the BstUI RFLP (C/T) within the 3'-untranslated region of the COL5A1 gene. The COL5A1 BstUI RFLP genotype was associated with SR ROM in older (≥35 years) subjects (TT: 225 ± 96 mm, TC: 245 ± 100 mm, CC: 32 ± 108 mm, N=96, P=0.017). Age and COL5A1 BstUI genotype interacted significantly for SR ROM. Sex and COL5A1 genotype accounted for 22.8% of the variance in SR ROM in the older group. The COL5A1 BstUI RFLP is associated with SR ROM, particularly with increasing age and is an important contributing factor to ROM variation, particularly in older, apparently healthy and physically active individuals.

WE‐C‐BRC‐09: Targeting Accuracy in Real‐Time Tumor Tracking Via External Surrogates: A Retrospective Clinical Study

Purpose: To quantify the accuracy of real‐time tumor tracking via external surrogates in a large patient population. Method and Materials: A database of 339 fractions in 86 patients, who received hypofractionated stereotactic body radiotherapy with a robotic linear accelerator (CyberKnife®) between July 2005 and June 2007, was analyzed. The system tracks the tumor in real‐time by using a correspondence model between external marker motion and implanted fiducials. Such model is updated during treatment by intermittent stereoscopic X‐ray imaging, providing ground truth tumor position. The corresponding model includes prediction in the future in order to account for the time lag due to data processing and robot motion (∼115 ms). Predicted tumor positions were compared to ground truth data acquired during treatment to quantify the achieved targeting accuracy. Results: Intermittent imaging provided a statistically robust description of tumor motion 89% of the fractions. Clinical data show that the mean error contribution due to the need for prediction is approximately 0.5 mm. The overall average accuracy in tumor tracking, expressed as the 95% confidence interval of targeting errors, is ∼3.4 mm. We proved that the targeting error increases as a function of the tumor range of motion and treatment site. Larger effects were measured in the superior‐inferior direction, with a 3 mm error increase per 1 cm range of motion variation. Also, unevenly spaced model updating was found to significantly reduce the accuracy in tumor tracking. Conclusion: The accuracy of a state of the art solution for tumor tracking, developed for high precision radiotherapy with a robotic linear accelerator, has been analyzed. Adequate accuracy can be achieved, with caveats when the range of motion is large and the model updating scheme is irregular. Future work will include detailed analysis on progressive upgrades in the correlation model.

Convergent Validity of the Constant-Murley Outcome Measure in Patients with Rotator Cuff Disease

Despite the popularity of the Constant-Murley score (CMS), a combined patient-report and objective (health professional administered) shoulder outcome measure, minimal information exists on its reliability or validity. The purpose of this study was to examine (1) internal consistency and convergent validity of the CMS and (2) the degree to which other shoulder measures explain variation in range of motion and strength components of the CMS. In this cross-sectional study of outcome measures, 45 patients undergoing conservative or surgical treatment for rotator cuff disease participated. Two disease-specific outcome measures, one shoulder-specific measure, and one upper extremity outcome measure were compared to the CMS. Correlations between competing measures and relative total CMS were moderate (0.56 to 0.75). The American Shoulder & Elbow Score, the Upper Extremity Functional Index, the Western Ontario Rotator Cuff Index, and the Rotator Cuff Quality of Life index explained 38%, 28%, 26%, and 10% of variance of the objective component of the CMS respectively. The patient-report component of the CMS measures a multidimensional concept. The strength component had moderate correlations with isometric strength measures of the shoulder external rotators and abductors. The total CMS appears to measure a construct that is not totally captured by competing measures. The unexplained variance may be due, in part, to the lack of importance of the patient's physical impairment to symptoms or activity limitations as measured by other instruments.

Importance of Pelvic Compensation in Posture and Motion After Posterior Spinal Fusion Using CD Instrumentation for Idiopathic Scoliosis

Posture and motion analysis after a Cotrel-Dubousset instrumentation. To investigate the compensation role of pelvis. Few existing studies found no compensation at the lower unfused level but did not investigate the pelvis. Thirty patients were analyzed before surgery then at short-, medium-, and long-term postoperative follow-up. Calibrated x-rays with three-dimensional reconstruction yielded quantification of pelvic parameters. Noninvasive optoelectronic system allowed analyzing subjects first in standing position, then during flexion-extension, lateral bending, and axial rotation. Skin markers were used to quantify three-dimensional orientation of the shoulders, trunk and pelvis, and their range of motion (ROM). Ten patients among 21 had after surgery more than 5 degrees change of pelvic incidence. In flexion, global ROM decreased from preoperative to postoperative phase (P < 0.05). Global ROM variation was not correlated to that of lower unfused segment, while it was highly correlated to pelvic ROM variation (r = 0.78 at medium follow-up). This study underlines the central role of pelvis in balance and motion of the patients before and after surgery.

Use of the flexion test of the distal forelimb in the sound horse: repeatability and effect of age, gender, weight, height and fetlock joint range of motion.

The flexion test of the distal limb is a commonly used clinical tool in both lame and sound horses. In the latter use it is given some predictive value. In recent studies it has been shown that examiner-related factors (force, time) may strongly influence the outcome of the test. In the present study, the possible influences of a number of horse-related factors and short- and long-term repeatability were investigated. Flexion tests were performed by the same researcher in 100 clinically sound horses under standardized conditions. The outcome of the test was scored on a 9-point semiquantitative scale. The maximum flexion angles of the fetlock joints were measured and the range of motion (ROM) of the fetlock joint was calculated. In the second part of the study, flexion tests were repeated, at intervals of 10 min, 30 min, 48 h and 6 months in 23 horses to assess repeatability. Over 60% of the 100 sound horses had a positive flexion test. Of these, about 50% showed a slight lameness, 35% a mild lameness, and 15% a distinct lameness. There was no influence of weight, height or ROM on the score of the flexion test. The outcome of the flexion test increased significantly with age and was significantly higher in mares than in geldings. When repeating the flexion test with short intervals of 10 and 30 min, the score increased significantly after the second test. Repeated flexion after 48 h did not result in a significantly different outcome. Over a 6-month period, the outcome of the test decreased significantly and the ROM increased significantly. It is concluded that most clinically sound horses have a (slightly) positive flexion test of the distal limb. This and the lack of long-term consistency of the test cast doubt on the presumption that a positive flexion test may be an indication for subclinical joint disorders and question the possible value of the test as a predictor of future joint-related problems. There exists a wide individual variation in ROM of the fetlock joint with, in sound horses, no relationship between ROM and the outcome of the flexion test. The factors age and gender should be taken into account when interpreting the results of a flexion test.

Diurnal Variation in Trunk Kinematics During a Typical Work Shift

Diurnal variation in trunk flexibility, defined as changes in range of motion, has been previously observed and quantified. Prior studies have shown that decreased disk height occurs as the day progresses and allows the spinal ligaments to slacken, resulting in an increase in the range of motion (flexibility) and a possible reduction in the risk of injury. This risk may be accentuated under dynamic motions of the spine. This study was conducted to observe the change in dynamic trunk mobility as a function of time of the day. Trunk motions of 21 men were observed at three specific times of the day using a triaxial electrogoniometer. No variation in trunk range of motion in any of the cardinal planes was observed. However, velocity and acceleration in the sagittal plane showed significant variations, suggesting the reexamination of the "slack ligaments" hypothesis. This study asserts that identifying flexibility by only its static component, range of motion, gives only partial information about the diurnal variation experienced by the spine. Industrial injuries occurring in the early morning hours may be a result of insufficient trunk mobility. This study indicates that risk associated with diurnal variation is far more complex than originally thought.