Altered gait patterns follow ing anterior cruciate ligament reconstruction (ACLR) may be associated with long-term impairments and post-traumatic osteoarthritis.
This systematic review and ...meta-analysis compared lower limb kinematics and kinetics of the ACL reconstructed knee with (1) the contralateral limb and (2) healthy age-matched participants during walking, stair climbing, and running. The secondary aim was to describe the differences over time following ACLR for these biomechanical variables.
Database searches were conducted from inception to July 2014 and updated in August 2015 for studies exploring peak knee angles and moments following ACLR during walking, stair negotiation, and running. Risk of bias was assessed with a modified Downs and Black quality index for all included studies, and meta-analyses were performed. Forest plots were explored qualitatively for recovery of gait variables over time after surgery.
A total of 40 studies were included in the review; 26 of these were rated as low risk and 14 as high risk of bias. The meta-analysis included 27 studies. Strong to moderate evidence indicated no significant difference in peak flexion angles between ACLR and control groups during walking and stair ascent. Strong evidence was found for lower peak flexion moments in participants with ACLR compared with control groups and contralateral limb during walking and stair activities. Strong to moderate evidence was found for lower peak adduction moment in ACLR participants for the injured compared with the contralateral limbs during walking and stair descent. The qualitative assessment for recovery over time indicated a pattern towards restoration of peak knee flexion angle with increasing time from post-surgery. Peak knee adduction moments were lower within the first year following surgery and higher than controls during later phases (5 years).
Joint kinematics are restored, on average, 6 years following reconstruction, while knee external flexion moments remain lower than controls. Knee adduction moments are lower during early phases following reconstruction, but are higher than controls, on average, 5 years post-surgery. Findings indicate that knee function is not fully restored following reconstruction, and long-term maintenance programs may be needed.
ObjectivesThe aim of this clustered, randomised controlled trial was to assess the effectiveness of a lumbopelvic postural feedback device for changing postural behaviour in a group of healthcare ...workers. We hypothesised that workers exposed to auditory postural feedback would reduce the number of times forward bending posture is adopted at work.MethodsThis was a participant and assessor blinded, randomised, sham-controlled trial with blocked cluster random allocation. We recruited healthcare workers from aged care institutions. Healthcare sites were randomly allocated to the feedback or sham group (SG). A postural monitoring and feedback device was used to monitor and record lumbopelvic forward bending posture, and provided audio feedback whenever the user sustained lumbopelvic forward bending posture that exceeded predefined thresholds. The primary outcome measure was postural behaviour (exceeding thresholds). We used a robust variant of repeated measures mixed-effect model for assessing within-group and between-group differences in postural behaviour.ResultsWe recruited 19 sites, and 130 healthcare workers participated. There were no within-group changes on the number of times postural threshold was exceeded at 1-week follow-up (feedback group: −0.7, 95% CI −2.61 to 0.72; SG −0.3, −1.65 to 0.98), and no differences (0.05, 95% CI −1.83 to 1.94) between SG and feedback group.ConclusionsFindings from this trial indicate that audio feedback provided by a postural monitor device did not reduce the number of times healthcare workers exceeded the postural threshold.Trial registration numberACTRN12616000449437.
Neck and shoulder disorders may be linked to the presence of myofascial trigger points (MTrPs). These disorders can significantly impact a person's activities of daily living and ability to work. ...MTrPs can be involved with pain sensitization, contributing to acute or chronic neck and shoulder musculoskeletal disorders. The aim of this review was to synthesise evidence on the prevalence of active and latent MTrPs in subjects with neck and shoulder disorders.
We conducted an electronic search in five databases. Five independent reviewers selected observational studies assessing the prevalence of MTrPs (active or latent) in participants with neck or shoulder disorders. Two reviewers assessed risk of bias using a modified Downs and Black checklist. Subject characteristics and prevalence of active and latent MTrPs in relevant muscles was extracted from included studies.
Seven articles studying different conditions met the inclusion criteria. The prevalence of MTrPs was compared and analysed. All studies had low methodologic quality due to small sample sizes, lack of control groups and blinding. Findings revealed that active and latent MTrPs were prevalent throughout all disorders, however, latent MTrPs did not consistently have a higher prevalence compared to healthy controls.
We found limited evidence supporting the high prevalence of active and latent MTrPs in patients with neck or shoulder disorders. Point prevalence estimates of MTrPs were based on a small number of studies with very low sample sizes and with design limitations that increased risk of bias within included studies. Future studies, with low risk of bias and large sample sizes may impact on current evidence.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•Clinicians typically evaluate the inherent musculoskeletal or biomechanical anomalies.•Clinicians could benefit from objective and systematic footwear.•A larger national/international survey is ...warranted.•These findings could reflect the shared experiences among other practitioners.
Altered knee joint mechanics may be related to quadriceps muscle strength, time since surgery, and sex following anterior cruciate ligament reconstruction (ACLR). The aim of this study was to ...investigate the association between knee moments, with participant-related factors during stair navigation post-ACLR.
Cross-sectional study.
A total of 30 participants (14 women) with ACLR, on average 7.0 (SD 4.4) years postsurgery were tested during stair ascent and descent in a gait laboratory. Motion capture was conducted using a floor-embedded force plate and 11 infrared cameras. Quadriceps concentric and eccentric muscle strength was measured with an isokinetic dynamometer at 60°/s, and peak torques recorded. Multiple regression analyses were performed between external knee flexion and adduction moments, respectively, and quadriceps peak torque, sex, and time since ACLR.
Higher concentric quadriceps strength and female sex accounted for 55.7% of the total variance for peak knee flexion moment during stair ascent (P < .001). None of the independent variables accounted for variance in knee adduction moment (P = .698). No significant associations were found for knee flexion and adduction moments during for stair descent.
Higher quadriceps concentric strength and sex explains major variance in knee flexion moments during stair ascent. The strong association between muscle strength and external knee flexion moments during stair ascent indicate rehabilitation tailored for quadriceps may optimize knee mechanics, particularly for women.
To compare knee angles and moments between the injured and contralateral knee in participants with anterior cruciate ligament reconstruction, and compared with uninjured controls while navigating ...steps.
Cross-sectional study.
University laboratory-based study.
Twenty-five participants (30.8 ± 9.7 years; 13 women) with anterior cruciate ligament reconstruction (2–10 years post-surgery), and 24 controls (31.0 ± 10 years, 13 women).
Three-dimensional motion analysis was used to record peak knee angles and external moments during step ascent and descent in three planes, along with spatiotemporal variables.
During step ascent, the reconstructed knee exhibited significantly: (1) lower peak flexion angles compared to the controls (P = 0.005); (2) lower flexion moments (P < 0.001) compared to contralateral side and controls. No significant differences were found in the frontal and transverse planes between groups and sides. During step descent, no significant differences in angles and moments were found.
Side-to-side asymmetries and lower knee flexion angles and external knee flexion moments were evident in participants with anterior cruciate ligament reconstruction and compared to controls. These findings suggest that incomplete recovery and compensatory or protective changes in neuromuscular control and joint function may persist 2–10 years post-surgery.
•ACL reconstructed knees had lower flexion moments than contralateral sides during ascent.•ACL reconstructed knees had lower flexion moments than Controls.•Lower flexion moments and angles indicate persistent altered neuromuscular control.•Lower flexion moments and angles may indicate unloading of the reconstructed knees.
Abstract
Background
Scapular dyskinesis is reported as one of the potential factors contributing to the presentation of pain in subacromial shoulder pain. In clinical practice, the evaluation and ...control of scapular dyskinesis is considered important for managing the subacromial shoulder pain. The aim is to determine the association between changes in pain or function and changes in scapular rotations in participants with subacromial shoulder pain.
Method
Pain, function and scapular rotations were measured in 25 participants with subacromial shoulder pain at baseline and after 8 weeks. Pain was measured with Numeric Pain Rating Scale (NPRS) and function was measured with Patient Specific Functional Scale (PSFS). Scapular rotations were measured with a scapular locator at 60°, 90° and 120° of scapular arm elevation. Spearman rank correlations (r
s
) were used to assess the association between variables.
Findings
No association was observed between changes in pain or function scores with changes in scapular upward/downward rotations (r
s
= 0.03 to 0.27 for pain and − 0.13 to 0.23 for function) and scapular anterior/posterior tilt (r
s
= − 0.01 to 0.23 for pain and − 0.13 to 0.08 for function) of arm at 60°, 90° and 120° elevation. Data associated with scapular internal/external rotation was not reported due to low reliability.
Conclusion
These findings reject associations between changes in pain or function scores and scapular rotations. Future observational study is warranted using a multifactorial approach to understand potential factors that contribute to the presentation of subacromial shoulder pain.
To compare self-report and functional outcomes between participants with anterior cruciate ligament reconstruction (ACLR) with age and activity matched controls.
Cross-sectional study.
University ...laboratory-based study.
Twenty-five participants (30.8 ± 9.7 years; 13 women), two to ten years post anterior cruciate ligament reconstruction; 24 controls (31.0 ± 10 years, 13 women).
Knee Osteoarthritis and Injury Outcome Score (KOOS), Tegner, Marx Activity and Fear of Re-injury scales, and SF-12; isokinetic quadriceps and hamstring peak torque and single-leg hop distance.
There were no between-groups differences for the Tegner and the Marx Activity Scales. The ACLR group had lower KOOS dimensions (p < 0.001), SF-12 Physical Component Scores (p = 0.008), and higher Fear of Reinjury Scores (<0.001) than the controls. No significant differences were found for physical performance measures between the ACLR and the control groups. Significant between-side differences for the ACLR group were evident for concentric quadriceps (p < 0.001) and concentric hamstring peak torque (p = 0.002), and hop distance (p < 0.001).
Knee-specific symptoms and function, activity and quality of life were lower, and fear of re-injury was higher for participants with ACLR than controls. Side-to-side thigh muscle strength and hop distance deficits were evident for the ACLR group.
•18 of 25 participants, 2–10 years post ACL reconstruction had ‘symptomatic’ knees.•The ACLR group had lower symptoms, function, and quality of life scores than Controls.•The ACLR group had higher Fear of Re-injury scores than Controls.•Long-term muscle strength and hop distance asymmetries were evident in the ACL group.
Abstract
Objective
Patients with neck pain commonly have altered activity of the neck muscles. The craniocervical flexion test (CCFT) is used to assess the function of the deep neck flexor muscles in ...patients with musculoskeletal neck disorders. Systematic reviews summarizing the measurement properties of the CCFT are outdated. The objective of this study was to systematically review the measurement properties of the CCFT for assessing the deep neck flexor muscles.
Methods
The data sources MEDLINE, EMBASE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, Scopus, and Science Direct were searched in April 2019. Studies of any design that reported at least 1 measurement property of the CCFT for assessing the deep neck flexor muscles were selected. Two reviewers independently extracted data and rated the risk of bias of individual studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk-of-bias checklist. The overall rating for each measurement property was classified as “positive,” “indeterminate,” or “negative.” The overall rating was accompanied with a level of evidence.
Results
Fourteen studies were included in the data synthesis. The ratings were positive, and the level of evidence was moderate for interrater and intrarater reliability and convergent validity. There was conflicting rating and level of evidence for discriminative validity. Measurement error was indeterminate, with an unknown level of evidence. Responsiveness was negative, with a limited level of evidence. A limitation of this study was that only papers published in English were included.
Conclusions
The CCFT is a valid and reliable test that can be used in clinical practice as an assessment test. Because of the conflicting and low-quality evidence, caution is advised when using the CCFT as a discriminative test and as an outcome measure. Future better-designed studies are warranted.
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