The aim of this study was to establish reference values for rate of torque development (RTD) and muscle torque steadiness (MTS) of knee extensors across the lifespan, and evaluate if these measures ...are independently associated with Osteoarthritis Research Society International (OARSI)-recommended performance-based measures (6-minute walk test, 30-second chair stand test, stair climb test) and other clinical variables.
In this cross-sectional observational study, knee extensor strength of 764 participants (12-89 years) from the 1000 Norms Project was assessed via fixed dynamometry. Age- and sex-stratified normative RTD (Nms-1 kg-1) and MTS (Nm kg-1) values were presented as means and 95% confidence intervals. Correlations and multiple regression analyses were calculated to identify factors (age, sex, height, weight, OARSI-recommended performance-based measures, Knee Injury and Osteoarthritis Outcome Score, vertical jump, long jump, grip strength, basic gait-related knee biomechanics) independently associated with RTD or MTS.
Age- and sex-stratified normative RTD and MTS reference values were generated. Male subjects exhibited higher RTD but poorer MTS (less steady) than female subjects across all age groups. Better performance in OARSI-recommended performance-based measures, vertical jump, long jump, and grip strength were associated with greater RTD but poorer MTS. Thirty-second chair stand test, stair climb test, vertical jump, long jump, and grip strength were independent determinants of RTD and MTS.
The RTD and MTS demonstrated associations with clinical variables relevant to knee osteoarthritis. The normative reference values generated may help identify the presence and extent of impairments in RTD and MTS associated with knee osteoarthritis and assist in developing responsive outcome measures for therapeutic trials.
Reduced muscle tone, muscle weakness, and physical fatigue can impact considerably on quality of life for children with neurofibromatosis type 1 (NF1). Human muscle biopsies and mouse models of NF1 ...deficiency in muscle show intramyocellular lipid accumulation, and preclinical data have indicated that L‐carnitine supplementation can ameliorate this phenotype. The aim of this study is to examine whether daily L‐carnitine supplementation is safe and feasible, and will improve muscle strength and reduce fatigue in children with NF1. A 12‐week Phase 2a trial was conducted using 1000 mg daily oral levocarnitine tartrate supplementation. Recruited children were between 8 and 12 years old with a clinical diagnosis of NF1, history of muscle weakness and fatigue, and naïve to L‐carnitine. Primary outcomes were safety (self‐reporting, biochemical testing) and compliance. Secondary outcomes included plasma acylcarnitine profiles, functional measures (muscle strength, long jump, handwriting speed, 6‐minute‐walk test 6MWT), and parent‐reported questionnaires (PedsQL™, CBCL/6–18). Six children completed the trial with no self‐reported adverse events. Biochemical tests for kidney and liver function were normal, and the average compliance was 95%. Plasma acylcarnitine levels were low, but within a range not clinically linked to carnitine deficiency. For strength measures, there was a mean 53% increase in dorsiflexion strength (95% confidence interval CI 8.89–60.75; p = 0.02) and mean 66% increase in plantarflexion strength (95% CI 12.99–134.1; p = 0.03). In terms of muscle performance, there was a mean 10% increase in long jump distance (95% CI 2.97–16.03; p = 0.01) and 6MWT distance (95% CI 5.88–75.45; p = 0.03). Comparison with the 1000 Norms Project data showed a significant improvement in Z‐score for all of these measures. Parent reports showed no negative impact on quality of life, and the perceived benefits led to the majority of individuals remaining on L‐carnitine after the study. Twelve weeks of L‐carnitine supplementation is safe and feasible in children with NF1, and a Phase 3 trial should confirm the efficacy of treatment.
Patient-reported outcome measures (PROMs) provide structured information on the patient’s health experience and facilitate shared clinical decision-making. Registries that collect PROMs generate ...essential information about the clinical course and efficacy of interventions. Whilst PROMs are increasingly being used in adult orthopaedic registries, their use in paediatric orthopaedic registries is not well known. The purpose of this systematic review was to identify the frequency and scope of registries that collect PROMs in paediatric orthopaedic patient groups. In July 2023, six databases were systematically searched to identify studies that collected PROMs using a registry amongst patients aged under 18 years with orthopaedic diagnoses. Of 3190 identified articles, 128 unique registries were identified. Three were exclusively paediatric, 27 were majority paediatric, and the remainder included a minority of paediatric patients. One hundred and twenty-eight registries collected 72 different PROMs, and 58% of these PROMs were not validated for a paediatric population. The largest group of orthopaedic registries collected PROMs on knee ligament injuries (21%). There are few reported dedicated orthopaedic registries collecting PROMs in paediatric populations. The majority of PROMs collected amongst paediatric populations by orthopaedic registries are not validated for patients under the age of 18 years. The use of non-validated PROMs by registries greatly impedes their utility and impact. Dedicated orthopaedic registries collecting paediatric-validated PROMs are needed to increase health knowledge, improve decision-making between patients and healthcare providers, and optimise orthopaedic management.
Background
We aim to describe 12‐mo functional and motor outcome performance in a cohort of participants with congenital myotonic dystrophy (CDM).
Methods
CDM participants performed the 6 Minute Walk ...Test (6MWT), 10 Meter Run, 4 Stair Climb, Grip Strength, and Lip Force at baseline and 12‐mo visits. Parents completed the Vineland Adaptive Behavior Scale.
Results
Forty‐seven participants, aged 0 to 13 y old, with CDM were enrolled. 6MWT, 10 Meter Run, and 4 Stair Climb were completed in >85% of eligible participants. The only significant difference between mean baseline and 12‐mo performance was an improvement in 6MWT in children 3‐6 y old (P = .008). This age group also had the largest mean % improvement in performance in all other timed functional testing. In children >7 y, the slope of change on timed functional tests decreased or plateaued, with further reductions in performance in children ≥10 y. Participants with CTG repeat lengths <500 did not perform differently than those with repeat lengths >1000.
Conclusions
The 6MWT, 10 Meter Run, and 4 Stair Climb were the most feasible measures. Our findings are consistent with the clinical profile and prior cross‐sectional data, helping to establish reasonable expectations of functional trajectories in this population as well as identifying points in which therapeutic interventions may be best studied. Further study of outcomes in children >10 y old and <3 y is warranted, but this new information will assist planning of clinical trials in the CDM population.
This study examined the association between body mass index (BMI) and disability in children with Charcot-Marie-Tooth disease (CMT).
We conducted a cross-sectional analysis of 477 patients with CMT ...who were 3 to 20 years of age from the Inherited Neuropathy Consortium and 316 age- and sex-matched healthy children from the 1,000 Norms Project. BMI was categorized according to the International Obesity Task Force (IOTF) criteria, and BMI categorization was compared with healthy children. IOTF categories (adult equivalent BMI cut points) were severely underweight (BMI <17 kg/m
), underweight (BMI ≥17-<18.5 kg/m
), healthy weight (BMI ≥18.5-<25 kg/m
), overweight (BMI ≥25-<30 kg/m
), and obese (BMI ≥30 kg/m
). Scores on the 0 to 44-point CMT Pediatric Scale (CMTPedS), a well-validated measure of disability, were examined in relation to BMI.
There was a higher proportion of children with CMT categorized as severely underweight (5.7% vs 0.3%), underweight (10.3% vs 5.1%), and obese (7.3% vs 3.8%) (
< 0.05). Fewer children with CMT were categorized as healthy weight (61.8% vs 74.4%) (
< 0.05), and the proportion of overweight (14.9% vs 16.5%) between groups was similar. CMTPedS scores (mean ± SD) for weight categories were as follows: severely underweight 27 ± 9, underweight 20 ± 8, healthy weight 17 ± 9, overweight 17 ± 9, and obese 22 ± 10. Compared to children with a healthy weight with CMT, being severely underweight was associated with being more disabled (
< 0.001), as was being obese (
= 0.015).
The proportion of children with CMT who are underweight or obese is higher compared to age- and sex-matched healthy children. In children with CMT, being underweight or obese is associated with greater disability, when compared to children with CMT of healthy weight.
Introduction
The 6‐minute walk test (6MWT) is a well‐established clinical assessment of functional endurance, validated as a measure of walking ability in spinal muscular atrophy (SMA). The current ...availability of disease‐modifying therapies for SMA indicates a growing need for normative reference data to compare SMA patients with healthy controls.
Methods
The literature was searched in two scientific databases. Studies were evaluated and selected based on adherence to American Thoracic Society guidelines for administering the 6MWT. Reference equations from the selected studies were applied to 6MWT data collected from SMA patients to calculate and compare % predicted values.
Results
Three pediatric and six adult studies were selected for comparison. The % predicted values using the pediatric and adult equations ranged from 47.7 ± 18.2% to 67.6 ± 26.2% and 43.0 ± 17.9% to 59.5 ± 26.2%, respectively, and were significantly different (P < 0.001).
Discussion
Results suggest significant variability between % predicted values derived from published reference equations in children and adults, despite adherence to 6MWT standardization.
Background
Foot muscle weakness can produce foot deformity, pain and disability. Toe flexor and foot arch exercises focused on intrinsic foot muscle strength and functional control may mitigate the ...progression of foot deformity and disability. Ensuring correct exercise technique is challenging due to the specificity of muscle activation required to complete some foot exercises. Biofeedback has been used to improve adherence, muscle activity and movement patterns. We investigated the feasibility of using a novel medical device, known as “Archercise”, to provide real‐time biofeedback of correct arch movement via pressure change in an inflatable bladder, and foot location adherence via sensors embedded in a footplate during four‐foot exercises.
Methods
Thirty adults (63% female, aged 23–68 years) performed four‐foot exercises twice on the Archercise sensor footplate alone and then with biofeedback. One‐way repeated measures ANOVA with pairwise comparisons were computed to assess the consistency of the exercise protocol between trial 1 and trial 2 (prior to biofeedback), and the effectiveness of the Archercise biofeedback device between trial 2 and trial 3 (with biofeedback). Outcome measures were: Arch movement exercises of arch elevation and lowering speed, controlled arch elevation, controlled arch lowering, endurance of arch elevation; Foot location adherence was determined by percentage of time the great toe, fifth toe and heel contacted footplate sensors during testing and were analysed with paired sample t‐tests. Participant survey comments on the use of Archercise with biofeedback were reported thematically.
Results
Seventeen (89%) arch movement and foot location variables were collected consistently with Archercise during the foot exercises. Archercise with biofeedback improved foot location adherence for all exercises (p = 0.003–0.008), coefficient of determination for controlled arch elevation (p < 0.0001) and endurance area ratio (p = 0.001). Twenty‐nine (97%) participants reported Archercise with biofeedback, helped correct exercise performance.
Conclusions
Archercise is a feasible biofeedback device to assist healthy participants without foot pathologies perform foot doming exercises.
Trial registration
Australian New Zealand Clinical Trials Registry (ANZCTR): 12616001559404. Registered 11 November 2016, http://www.ANZCTR.org.au/ACTRN12616001559404p.aspx
The onset of the COVID-19 pandemic in March 2020 resulted in a rapid shift to online learning for physiotherapy education in Australia and around the world. This Sydney-based qualitative study ...explored the reflections of physiotherapy educators and leaders involved in delivering physiotherapy programs with the aim of gaining insight into what happened to physiotherapy education during the initial stages of the pandemic and what lessons were learnt that will inform future physiotherapy education. Many pedagogical challenges were identified including the need to rapidly shift content online whilst still meeting competency requirements, how to effectively engage students, and the challenges of teaching and assessing practical psychomotor skills. The benefits of the rapid shift were the upskilling of educators, innovations in teaching and resources, and recognising that some aspects of physiotherapy education were improved by the change. Overall educators and leaders felt time was needed to effectively design physiotherapy content to fit different delivery modes and it was important some aspects of physiotherapy education should continue to be taught in-person. Future physiotherapy education is likely to be a combination of in-person and online delivery and lessons learnt from this time need to be incorporated into physiotherapy programs to achieve the best educational outcomes.
Aim
The primary aim of this study was to determine the association between generalized joint hypermobility (GJH), knee‐specific hypermobility (KSH) and self‐reported knee health in an Australian ...population. Secondary aims included elucidating ethnic/gender differences in GJH/KSH prevalence and knee health, and identifying KSH using a novel knee extension range of motion cut‐off method.
Method
Knee extension range, Beighton score, and 5 domains of the Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected from adults aged 18‐101 years self‐identifying as healthy, and were grouped by ethnicity and gender. Two established Beighton score criteria and 1 novel knee extension range cut‐off method were used to determine GJH and KSH respectively. Point‐biserial correlation tested the associations between GJH/KSH and KOOS. Differences in GJH/KSH prevalence and knee health between ethnic/gender groups were determined with the Chi‐squared test.
Results
Of 732 participants (50% male), 80.3% were Caucasian. No correlations were found between GJH and KOOS while a very weak correlation was found between KSH and 1 KOOS domain (r > −.30; P = .04). Prevalence of GJH was higher in non‐Caucasians (17.4% vs 5.6%, P < .001) and females (4.4% vs 1.1%, P = .007). Prevalence of KSH between ethnic and gender groups was not significantly different (P = .50 and P = .69 respectively). Non‐Caucasians scored higher (better) in all KOOS domains than Caucasians (all P < .05).
Conclusion
Those who met the age‐ and gender‐specific criteria for GJH/KSH did not report worse knee health than their non‐hypermobile counterparts. Clinicians can assure individuals who exhibit GJH/KSH that these are not associated with lower knee health and function.
Pedobarography software calculates the centre-of-pressure trajectory in relation to the foot to quantify foot contact patterns. This study presents two new pedobarography measures using the ...centre-of-pressure trajectory to assess heel rocker.
To validate these pedobarography measures against 3D gait analysis, emed®-x and Vicon Nexus gait analysis data were captured from 25 children aged 8–16 years (11 male) with unilateral (n = 18) and bilateral (n = 7) cerebral palsy or acquired brain injury. 3D gait analysis identified whether heel rocker was intact (n = 22 feet) or absent (n = 28 feet) based on centre-of-pressure at initial contact and the ankle kinematic curve between 0 and 2% of the gait cycle. Pedobarography measures calculated from the initial centre-of-pressure point were the distance to the heel (point of initial contact) and to the most posterior point of the trajectory (rollback), reported as a percentage of foot length.
The median point of initial contact in limbs with an intact heel rocker was 9% (range 7–12%) and median rollback was 0% (range 0–0.2%), whereas the median point of initial contact in limbs with an absent heel rocker was 58% (range 8–78%) and rollback was 18% (range 0–40%). Point of initial contact is the more accurate method for predicting heel rocker, with a threshold of 14% of foot length identifying the correct heel rocker status in 94% of cases.
Point of initial contact can assess heel rocker with high accuracy. Both point of initial contact and rollback provide sensitive information on foot strike pattern, enhancing the utility of pedobarography.
•We present new pedobarography measures to quantify the centre-of-pressure trajectory.•Point of initial contact and rollback were validated against three-dimensional gait analysis.•Point of initial contact and rollback predict heel rocker with high accuracy.•Point of initial contact and rollback provide a sensitive measure of foot contact pattern.
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