Does knee alignment influence gait in patients with severe knee osteoarthritis?

Background

Patients with knee osteoarthritis present an altered gait pattern. Amongst many factors, the lower limb alignment (varus, valgus) has been identified as an important risk factor for the progression of knee osteoarthritis. Among the large number of studies on knee osteoarthritis gait, only a few have included patients with a valgus deformity. The aims of this study were to determine how knee alignment influences full-body gait in patients with knee osteoarthritis and if knee malalignment is associated with pain and functional capacity.

Methods

Sixty patients with severe knee osteoarthritis scheduled for a total knee arthroplasty were included in this study. Twenty-six subjects were recruited as the control group. The spatio-temporal parameters, three-dimensional full-body kinematics, and lower body kinetics were evaluated during a comfortable gait and compared between the groups. Pain and function were assessed with the WOMAC questionnaire.

Findings

The full-body gait analysis demonstrated substantially different gait patterns and compensation mechanisms between the three groups. Patients with varus knee alignment significantly augmented their trunk movements in sagittal and frontal planes compared to patients with a valgus knee. In addition, patients with a valgus knee reported lower pain and lower functional deficits compared to patients with a varus knee.

Interpretation

We found that gait compensations were significantly influenced by lower limb alignment. These new insights related to different knee osteoarthritis gait patterns might help in the understanding of gait compensation behaviours prior to total knee arthroplasty and better manage the strategies of rehabilitation following surgery.     

Effect of real-time visual feedback on manual chest compression in ambulance北大核心CSCD

Objective To investigate the efficacy of real-time visual feedback on improving the quality of manual chest compression in ambulance. Methods Ten pre-hospital doctors with cardiopulmonary resuscitation experience, aged under 40 years, were recruited to this randomized, crossover, manikin research and randomly assigned into control group (n=5) and feedback group (/J=5) by the sealed envelope method. The setting place was a moving ambulance with the velocity of 25~50 km/ h. The whole process consisted of two sessions. In control group, which received feedback in the second session, chest compressions were performed without interruption during each of the three 2 min phases per session, resting for 2 min between phases and for 5 min between sessions. In feedback group, which received feedback in the first session, chest compressions were performed without interruption during each of the three 2 min phases per session, resting for 2 min between phases and for 5 min between sessions. Data of compression rate, compression depth, compression detention and compression accuracy rate were collected. Results In control group, the compressions rate was lower and compression detention was shorter during the second session compared with those during the first session [(109.84.7) r/min vs. (121.210.1) r/min, (6.52.1) r/min vs. (10.42.8) r/min, all PO.05], while the compression accuracy rate during the second session was higher than that during the first session [(28.214.3) % vs. (16.89.9) %, PO.05]. There was no significant difference in compression rate between the two sessions in control group; Compression frequency, compression depth, compression detention and compression accuracy rate did not significantly change between the two sessions in feedback group (all P>0.05). In the whole process, the compression rate was lower and compression detention was shorter in the feedback group compared with the control group [(111.1 5.1) r/min vs. (115.59.7) r/min, (6.51.8) vs. (8.44.6) r/min, all PO.05], and the compression accuracy rate in the feedback group was higher than that in the control group[(22.513.4) % vs. (26.716 ) %, PO.05]. There was no significant difference in compression rate between the two groups during whole process (P>0.05). Conclusions Although real-time visual feed back improved the quality of manual chest compression in ambulances, which demonstrated more reasonable compression rate, less compression detention and higher compression accuracy, the overall quality of reuscitation was still not enough to achieve effective treatment. This implies that more optimal methods are required to transfer the patients suffering cardiac arrest. © 2018 Chinese Medical Association. All Rights Reserved.     

Does acupuncture provide pain relief in patients with osteoarthritis knee? An overview of systematic reviews

BackgroundKnee osteoarthritis (OA) is the most common condition that causes pain and disability in adults over 50 years old. The application of acupuncture, as a method of complementary intervention, could be beneficial for pain relief and knee function in patients with knee OA.ObjectiveAnalyze the effectiveness of acupuncture versus control interventions in patients with knee OA.MethodsAn electronic search was performed in the MEDLINE (via PubMed), EMBASE, PEDro, Cochrane CENTRAL, CINAHL, Web of Science and LILACS databases. The eligibility criteria for selecting systematic reviews included clinical trials that compared acupuncture versus control interventions for pain intensity in patients with knee OA.ResultsA total of 15 systematic reviews met the eligibility criteria for the quantitative synthesis. In the short term, the mean difference (MD) for pain intensity was −0.32 cm (95% CI = −0.57 to −0.08, p = 0.01). There was a very low quality of evidence according to the GRADE rating. In the short term, the mean difference (MD) for knee function was −8.74 points (95% CI = −13.36 to −4.12, p ≤ 0.001). There was low quality of evidence according to the GRADE rating. All differences were in favor of acupuncture.ConclusionAt short-term, there was low to very low evidence and there were statistically significant differences in pain intensity and knee function in favor of acupuncture versus control interventions in patients with knee OA. However, these differences were not clinically important. For the acupuncture versus sham, in the short-term, no differences clinical neither statistically significant to favor of acupuncture in pain intensity and knee function.     

Is the Human Activity Profile a useful measure in people with knee osteoarthritis?

This study evaluated the usefulness of the Human Activity Profile (HAP) in people with knee osteoarthritis (OA). People with OA (N = 226) completed the HAP and a battery of pain and physical function measures. Healthy elderly controls (N = 33) also completed the HAP, and 20 OA participants underwent repeat testing 2 to 7 days later. Test-retest reliability was excellent (intraclass correlation coefficients 0.96 and 0.95). The HAP was sensitive enough to detect differences in physical activity between people with (N = 33) and without OA (N = 33) (p < 0.01). When OA individuals were classified as impaired, moderately active, or active based on HAP score, differences in pain and physical function were detected (p < 0.05). Correlations between HAP and commonly used pain and physical function measures were weak to moderate (r = 0.18-0.63, all p < 0.01), indicating that the HAP measures additional information not gained by other assessment tools. The HAP is a reliable measure, and it is sensitive enough to discriminate between people with and without knee OA, and within an OA cohort. The HAP appears to have greater applicability in osteoarthritic women than men.     

Efficacy of core exercises in patients with osteoarthritis of the knee: A randomized controlled clinical trial

Trial designRandomized, evaluator blinded, controlled, parallel group.MethodsThis trial was conducted between July 2011 and January 2015 at a public hospital in Argentina. Patients older than 40 years with a medical diagnosis of osteoarthritis (OA) were randomly assigned to the experimental group (EG) or control group (CG). Both groups performed conventional exercises 3 times a week for 12 weeks and core exercises were added to the EG intervention.The objective was to compare the efficacy of conventional treatment combined with core muscle strengthening exercises, with conventional treatment alone in terms of short- and medium-term pain reduction and physical function in patients with knee OA.The primary outcome was knee pain assessed using a visual analog scale and the secondary outcome was physical function assessed at baseline, week 8 and 12, and 2 follow-up visits held 1 month and 3 months after the end of treatment.Results113 patients were randomized to a CG (n = 60) or EG (n = 53). 66 patients were eliminated and 25 patients in the EG and 22 in the CG were analyzed.Both pain reduction and improved physical function were observed throughout the intervention in both groups. At the end of the treatment, a statistically and clinically significant pain reduction was observed in the EG. No adverse effects were reported.ConclusionThe combination of core muscle activation exercises and conventional treatment was more effective in short-term pain reduction in patients with knee OA.     

Are there different gait profiles in patients with advanced knee osteoarthritis? A machine learning approach

BackgroundDetermine whether knee kinematics features analyzed using machine-learning algorithms can identify different gait profiles in knee OA patients.Methods3D gait kinematic data were recorded from 42 patients (Kellgren-Lawrence stages III and IV) walking barefoot at individual maximal gait speed (0.98 ± 0.34 m/s). Principal component analysis, self-organizing maps, and k-means were applied to the data to identify the most relevant and discriminative knee kinematic features and to identify gait profiles.FindingsFour different gait profiles were identified and clinically characterized as type 1: gait with the knee in excessive varus and flexion (n = 6, 14%, increased knee adduction and increased maximum and minimum knee flexion, p < 0.01); type 2: gait with knee external rotation, either in varus or valgus (n = 11, 26%, excessive maximum and minimum external rotation, p < 0.001); type 3: gait with a stiff knee (n = 17, 40%, decreased knee flexion range of motion, p < 0.001); and type 4: gait with knee varus ‘thrust’ and decreased rotation (n = 8, 19%, increased and reduced range of motion in the coronal and transverse plane, respectively, p < 0.05).InterpretationIn a group of patients with homogeneous Kellgren-Lawrence classification of knee OA, gait kinematics data permitted to identify four different gait profiles. These gait profiles can be a valuable tool for helping surgical decisions and treatment. To allow generalization, further studies should be carried with a larger and heterogeneous population.     

Effect of early rehabilitation nursing on ability of daily living in patients with stroke

The direction of modern research on rehabilitation is to recover the function,and improve patients‘ motion,living ability,make them turn round to family and society.OBJECTIVE:To explore the effect of early rehabilitation nursing on ability of daily living of patients with stroke.     

Is there a role for CT coronary angiography in patients with symptomatic angina? Effect of coronary calcium score on identification of stenosis

Present guidelines discourage the use of CT coronary angiography (CTCA) in symptomatic angina patients. We examined the relation between coronary calcium score (CS) and the performance of CTCA in patients with stable and unstable angina in order to understand under which conditions CTCA might be a gate-keeper to conventional coronary angiography (CCA) in such patients. We included 360 patients between 50 and 70 years old with stable and unstable angina who were clinically referred for CCA irrespective of CS. Patients received CS and CCTA on 64-slice scanners in a multicenter cross-sectional trial. The institutional review board approved the study. Diagnostic performance of CTCA to detect or rule out significant coronary artery disease was calculated on a per patient level in pre-defined CS categories. The prevalence of significant coronary artery disease strongly increased with CS. Negative CTCA were associated with a negative likelihood ratio of <0.1 independent of CS. Positive CTCA was associated with a high positive likelihood ratio of 9.4 if CS was <10. However, for higher CS the positive likelihood ratio never exceeded 3.0 and for CS >400 it decreased to 1.3. In the 62 (17%) patients with CS <10, CTCA reliably identified the 42 (68%) of these patients without significant CAD, at no false negative CTCA scans. In symptomatic angina patients, a negative CTCA reliably excludes significant CAD but the additional value of CTCA decreases sharply with CS >10 and especially with CS >400. In patients with CS <10, CTCA provides excellent diagnostic performance.     

Pericardial effusion in patients with schizophrenia: are they on clozapine?

Clozapine is used in the treatment of resistant schizophrenia. It is used as a reserve drug mainly because of its adverse effect profile affecting gastrointestinal, haematological and cardiorespiratory systems. Cardiac side effects are uncommon but could be potentially life threatening, hence early recognition and active monitoring are essential to prevent serious cardiac side effects. A case of pericarditis with pericardial effusion is described in a patient who was recently started on clozapine which disappeared within 1 week after discontinuation of clozapine.     

The impact of self-efficacy on physical activity maintenance in patients with hip osteoarthritis – a mixed methods study

Purpose: Understanding motivational factors related to physical activity (PA) maintenance is essential in promoting long-term exercise benefits. This study explored the impact of self-efficacy (SE) on post-intervention PA maintenance in patients with hip osteoarthritis. Method: An SE-theory based mixed-methods sub-study of a trial investigating the effects of 4 months supervised exercise in patients with hip osteoarthritis. Questionnaire data (n?=?52; baseline and 12 months) on PA and SE (Arthritis Self-Efficacy Scale, ASES, score-range 10–100) were analysed (Mann–Whitney test) for differences in characteristics of maintainers and non-maintainers. Semi-structured individual interviews (n?=?15; at 12-months follow-up) were analysed using directed content analysis. Results: Compared to non-maintainers (n?=?9; 17%) maintainers (n?=?31; 60%) had improved (p?Conclusion: SE contributes to understanding of post-intervention PA maintenance in patients with hip osteoarthritis. However, disease-related factors and clinical trial participation appears significant too.

• Implications for Rehabilitation

• Patients’ perceived self-efficacy for physical activity contributes to the understanding of post-intervention physical activity maintenance in patients with hip osteoarthritis.

• Practitioners may benefit from incorporating the self-efficacy theory in the planning and execution of exercise interventions to promote post-intervention physical activity maintenance and long term health benefits.

• Post-intervention physical activity maintenance may be increased by focussing on the patients’ exercise self-efficacy through verbal persuasion and support, disease-specific information and information on normal physiological responses to exercise combined with an individualised training progression to support experiences of success and achievement of desired outcomes.

     

Effect of combined spa-exercise therapy on circulating TGF-β1 levels in patients with ankylosing spondylitis

BACKGROUND: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial joints with no satisfactory therapy. Reduction of joint pain has been reported after a course of therapy at a spa, Gasteiner Heilstollen, in Badgastein in Austria. The mechanism underlying this beneficial effect is not clearly understood and objective evidence for the biological response to therapy is lacking. The aim of this study was to find evidence for a biological response to speleotherapy in patients with AS and to study the involvement of the antiinflammatory cytokine TGF-beta1 in this response. PATIENTS AND METHODS: 83 patients with AS were treated in Badgastein for 3-4 weeks. Therapy included active exercises, hyperthermia and exposure to low doses of radon in a former mine. Response to therapy was assessed from measurement of morning pain and immunoassay of serum levels of TGF-beta1 before and after therapy. Ten AS patients who received conventional therapy and 10 patients with low back pain (LBP) served as controls. RESULTS: A significant increase in TGF-beta1 (total and active) was found in AS patients after spa therapy. Mean concentration of total TGF-beta1 increased from 28,715 pg/ml to 43,136 pg/ml, (P<0.01) and active TGF-beta1 increased from 77 pg/ml to 1096 pg/ml (P<0.001). When the AS patients were divided into two groups according to pain reduction, group 1 (decrease in morning pain, responders: n=46) exhibited a 17-fold increase of active TGF-beta1 levels (96 pg/ml to 1654 pg/ml, P<0.0001) whereas group 2 (no change or an increase in morning pain: nonresponders: n=37), showed only 7-fold increase (53 pg/ml to 402 pg/ml, P<0.01). There was a moderate increase in active TGF-beta1 from 31 pg/ml to 42 pg/ml (P<0.05) in patients with LBP and no significant change was observed in the patients treated with conventional therapy. CONCLUSION: These results demonstrate a significant increase in circulating TGF-beta1 in patients with AS after the combined spa-exercise therapy in Badgastein. The results also provide evidence for a biological response to speleotherapy and suggest that TGF-beta, through its antiinflammatory function, may play a role in this response.