Utility of an obstacle-crossing test to classify future fallers and non-fallers at hospital discharge after stroke: A pilot study

BackgroundExisting clinical assessments of balance and functional mobility have poor predictive accuracy for prospectively identifying post-stroke fallers, which may be due to a lack of ecological complexity that is typical of community-based fall incidents.Research questionDoes an obstacle-crossing test at hospital discharge predict fall status of ambulatory stroke survivors 3 months after discharge?MethodsAmbulatory stroke survivors being discharged home completed an obstacle-crossing test at hospital discharge. Falls were tracked prospectively for 3 months after discharge. Logistic regression examined the relationship between obstacle-crossing at discharge (pass/fail) and fall status (faller/non-faller) at 3 months post discharge.Results45 participants had discharge obstacle test and 3-month fall data. 21 (47 %) participants experienced at least one fall during follow-up, with 52 % of the falls occurring within the first month after discharge. Of the 21 fallers, 14 failed the obstacle-crossing test (67 % sensitivity). Among the 24 non-fallers, 20 passed the obstacle-crossing test (83 % specificity). The area under the receiver operating characteristic curve was 0.75 (95 % CI 0.60–0.90). Individuals who failed the obstacle-crossing test were 10.00 (95 % CI: 2.45–40.78) times more likely to fall in the first 3 months after discharge. The unadjusted logistic regression model correctly classified 76 % of the subjects. After adjusting for age, sex, days post stroke, and post-stroke disability, the odds ratio remained significant at 6.93 (95 % CI: 1.01–47.52) and correctly classified 79.5% of the participants.SignificanceThe obstacle-crossing test may be a useful discharge assessment to identify ambulatory stroke survivors being discharged home who are likely to fall in the first 3 months post discharge. Modifications to improve the obstacle-crossing test sensitivity should be explored further.     

Temporal and spatial gait parameters in patients dependent on walking assistance after stroke: Reliability and agreement between simple and advanced methods of assessment

The aim of this study was to investigate the reliability of temporal and spatial gait parameters in patients dependent on walking assistance after severe stroke, and to examine agreement between simple and advanced methods. Twenty-one patients, admitted for in-patient multidisciplinary rehabilitation, were assessed repeatedly for walking function, both in a test corridor and a gait laboratory (3D camera system) before and after 11 weeks of rehabilitation. The test–retest reliability was examined using intraclass correlation (ICC_1.1), and measurement error was reported by within-subject standard deviation (S_w). The agreement between different methods for assessing walking speed, cadence and step length was explored by Bland–Altman plots. High to excellent test–retest reliability was found between trials, both when assessed in the corridor (ICC: 0.93–0.99) and in the laboratory (ICC: 0.88–0.99). Agreement between methods was satisfactory at baseline and was higher after the rehabilitation period. Agreement was found to be slightly better at lower walking speeds and for shorter step lengths. The results implicate that temporal–spatial gait parameters may be measured reliably by both simple and advanced methods in dependent walkers after stroke. A high level of agreement was found between the two methods for walking speed, cadence and average step length at both test points.     

Inter- and intra-rater reliability of the GAITRite system among individuals with sub-acute stroke

Technology-based assessment tools with semi-automated processing, such as pressure-sensitive mats used for gait assessment, may be considered to be objective; therefore it may be assumed that rater reliability is not a concern. However, user input is often required and rater reliability must be determined. The purpose of this study was to assess the inter- and intra-rater reliability of spatial and temporal characteristics of gait in stroke patients using the GAITRite system. Forty-six individuals with stroke attending in-patient rehabilitation walked across the pressure-sensitive mat 2–4 times at preferred walking speeds, with or without a gait aid. Five raters independently processed gait data. Three raters re-processed the data after a delay of at least one month. The intraclass correlation coefficients (ICC) and 95% confidence intervals of the ICC were determined for velocity, step time, step length, and step width. Inter-rater reliability for velocity, step time, and step length were high (ICC > 0.90). Intra-rater reliability was generally greater than inter-rater reliability (from 0.81 to >0.99 for inter-rater versus 0.77 to >0.99 for intra-rater reliability). Overall, this study suggests that GAITRite is a reliable assessment tool; however, there still remains subjectivity in processing the data, resulting in no patients with perfect agreement between raters. Additional logic checking within the processing software or standardization of training could help to reduce potential errors in processing.     

Anxiety-mediated gait adaptations reduce errors of obstacle negotiation among younger and older adults: implications for fall risk

The purpose of this study was to determine if anxiety-mediated gait adaptations can reduce the risk for falling among younger and older adults. Fourteen younger adults (23.14 ± 3.08 years) and 14 older adults (69.28 ± 5.41 years) participated in this study. Participants were asked to walk the length of a 7.20 m walkway and avoid contact with an obstacle that appeared suddenly underfoot at either 25% or 75% of the gait cycle duration. Testing was conducted in four conditions of postural threat. The obstacle was presented as a light beam and did not jeopardize balance when contacted. Fall risk was inferred from the frequency of obstacle contacts. Our findings indicated that obstacle contact frequency decreased when conservative gait patterns emerged. These findings imply that anxiety-mediated gait adaptations are beneficial in reducing the risk for falling among older adults and present the possibility that fear of falling may offer protective benefits for postural control. One possibility is that the beneficial effects of anxiety can only be realized among older adults who do not fear falling.     

Association of carotid atherosclerotic plaque features with acute ischemic stroke: A magnetic resonance imaging study

Background and purpose

It remains unclear whether direct vessel wall imaging can identify carotid high-risk lesions in symptomatic subjects and whether carotid plaque characteristics are more effective indicators for cerebral infarct severity than stenosis. This study sought to determine the associations of carotid plaque characteristics by MR imaging with stenosis and acute cerebral infarct (ACI) sizes on diffusion weighted imaging (DWI).

Materials and methods

One hundred and fourteen symptomatic patients underwent carotid and brain MRI. ACI volume was determined from symptomatic internal carotid artery territory on DWI images. Ipsilateral carotid plaque morphological and compositional characteristics, and stenosis were also determined. The relationships between carotid plaque characteristics, stenosis and ACIs size were then evaluated.

Results

In carotid arteries with 30–49% stenosis, 86.7% and 26.7% were found to have lipid-rich necrotic core (LRNC) and intraplaque hemorrhage, respectively. Furthermore, 45.8% of carotid arteries with 0–29% stenosis developed LRNCs. Carotid morphological measurements, such as % wall volume, and the LRNC size were significantly associated with ipsilateral ACIs volume before and after adjustment for significant demographic factors (age and LDL) or stenosis in patients with carotid plaque (all p < 0.05).

Conclusions

A substantial number of high-risk plaques characterized by vessel wall imaging exist in carotid arteries with lower grade stenosis. In addition, carotid plaque characteristics, particularly the % wall volume and LRNC size, are independently associated with cerebral infarction as measured by DWI lesions. Our findings indicate that characterizing atherosclerotic plaque by MR vessel wall imaging might be useful for stratification of plaque risk and infarction severity.     

Gait characteristics under single-/dual-task walking conditions in elderly patients with cerebral small vessel disease: Analysis of gait variability,gait asymmetry and bilateral coordination of gait

BackgroundDual-task walking (DTW) is common in daily life and represents an ideal paradigm for elucidating gait irregularity. Under single-task walking (STW) and DTW conditions, the symmetric and bilaterally coordinated human gait pattern found in healthy individuals is absent in individuals with neurological ailments such as Parkinson’s disease, Alzheimer’s disease and post-stroke issues. Cerebral small vessel disease (CSVD) is a neuropathological and radiological issue that has been reported to be associated with cognitive and motor disorders. However, few gait analyses have focused on elderly individuals with CSVD under DTW conditions.Research questionAre parameters of gait analysis helpful in elucidating gait abnormalities in elderly patients with CSVD under DTW conditions?MethodsA total of 46 elderly patients with CSVD (CSVD group) and 22 healthy, age-matched individuals (HE group) were recruited. Gait data were collected from both groups under STW and DTW conditions. Direct parameters and metrics reflecting gait variability, gait asymmetry, and bilateral coordination of gait in the two groups were compared.ResultsUnder STW conditions, elderly individuals with CSVD showed markedly shorter stride length, were slower, and had higher gait asymmetry (GA) and phase coordination index (PCI) than healthy controls after adjusting for age, sex and level of education. Under DTW conditions, there were statistically significant differences between the two groups in stride time, stride length, cadence, stride time variability, GA and PCI after adjusting for age, sex, and level of education.SignificanceReanalysis-generated parameters, such as gait variability, GA, and PCI, are biomarkers for gait dysfunction in elderly patients with CSVD. In this study, elderly individuals with CVSD showed abnormal gait features under both STW and DTW conditions.     

Association of fluid balance trajectories with clinical outcomes in patients with septic shock:A prospective multicenter cohort study

Background:Septic shock has a high incidence and mortality rate in Intensive Care Units (ICUs).Earlier intravenous fluid resuscitation can significantly improve outcomes in septic patients but easily leads to fluid overload (FO),which is associated with poor clinical outcomes.A single point value of fluid cannot provide enough fluid information.The aim of this study was to investigate the impact of fluid balance (FB) latent trajectories on clinical outcomes in septic patients.Methods:Patients were diagnosed with septic shock during the first 48h,and sequential fluid data for the first 3 days of ICU admission were included.A group-based trajectory model (GBTM) which is designed to identify groups of individuals following similar developmental trajectories was used to identify latent subgroups of individuals following a similar progression of FB.The primary outcomes were hospital mortality,organ dysfunction,major adverse kidney events (MAKE) and severe respiratory adverse events (SRAE).We used multivariable Cox or logistic regression analysis to assess the association between FB traJectories and clinical outcomes.Results:Nine hundred eighty-six patients met the inclusion criteria and were assigned to GBTM analysis,and three latent FB trajectories were detected.64 (6.5％),841 (85.3％),and 81 (8.2％) patients were identified to have decreased,low,and high FB,respectively.Compared with low FB,high FB was associated with increased hospital mortality[hazard ratio (HR)=1.63,95％CI 1.22-2.:17],organ dysfunction[odds ratio (OR)=2.18,95％CI 1.22-3.42],MAKE (OR=1.80,95％CI 1.04-2.63) and SRAE (OR=2.33,95％CI 1.46-3.71),and decreasing FB was significantly associated with decreased MAKE(OR=0.46,95％CI 0.29-0.79) after adjustment for potential covariates.Conclusion:Latent subgroups of septic patients followed a similar FB progression.These latent fluid trajectories were associated with clinical outcomes.The decreasing FB trajectory was associated with a decreased risk of hospital mortality and MAKE.     

Shoulder pain in swimmers: A 12-month prospective cohort study of incidence and risk factors

ObjectiveTo investigate shoulder pain incidence rates and selected risk factors for shoulder pain in competitive swimmers.Design12-month prospective cohort study.SettingFive swimming clubs in Melbourne, Australia.Participants74 (37 M, 37 F) competitive swimmers ranging in age from 11 to 27 years and performing at least five swim sessions per week.Assessment of risk factorsSwimmers completed a baseline questionnaire regarding demographics, anthropometric features, swimming characteristics and training and injury history. Active shoulder internal (IR) and external rotation (ER) range of motion and passive joint laxity were measured.Main outcome measurementsShoulder pain was self-reported over 12 months with significant interfering shoulder pain (SIP) defined as pain interfering (causing cessation or modification) with training or competition, or progression in training. A significant shoulder injury (SSI) was any SIP episode lasting for at least 2 weeks.Results28/74 (38%) participants reported SIP while 17/74 (23%) reported SSI. Exposure-adjusted incidence rates were 0.3 injuries and 0.2 injuries per 1000 swim km for SIP and SSI, respectively. Swimmers with both high and low ER range were at 8.1 (1.5, 42.0) and 12.5 (2.5, 62.4) times greater risk of sustaining a subsequent SIP, respectively and 35.4 (2.8, 441.4) and 32.5 (2.7, 389.6) times greater risk of sustaining a SSI, respectively than those with mid-range ER. Similarly swimmers with a history of shoulder pain were 4.1 (95% CI: 1.3, 13.3) and 11.3 (95% CI: 2.6, 48. 4) times more likely to sustain a SIP and SSI, respectively.ConclusionShoulder pain is common in competitive swimmers. Preventative programs should be particularly directed at those swimmers identified as being at risk of shoulder pain.     

Relationship between ankle function and walking ability for children and young adults with cerebral palsy: A systematic review of deficits and targeted interventions

BackgroundA primary goal of treatment for children with cerebral palsy is improved walking ability to allow for a more active and independent lifestyle. With the importance of ankle function to walking ability, and the deficits in ankle function associated with cerebral palsy, there is good rationale for targeting this joint in an effort to improve walking ability for this population.Research QuestionHow do deficits and targeted interventions of the ankle joint influence walking ability in children with cerebral palsy?MethodsA specific search criteria was used to identify articles that either (1) provided information on the relationship between ankle function and walking ability or (2) investigated the effect of a targeted ankle intervention on walking ability in cerebral palsy. PubMed, Embase, CINAHL, and Web of Science databases were searched from 1980–April, 2020. Resulting citations were compared against a prospective set of inclusion and exclusion criteria. Data relevant to the original research question was extracted, and the level of evidence for each intervention study was scored. Interpretation was focused on specific, pre-determined mobility measures.ResultsSixty-one citations met all criteria for data extraction, six of which were observational, and fifty-five of which were interventional. Level of evidence ranged from 2 to 4. Self-selected walking speed was the most common measure of walking ability, while physical activity level was the least common.SignificanceAnkle function is an important contributor to the walking ability of children with cerebral palsy, and most interventions targeting the ankle seem to demonstrate a benefit on walking ability, but future higher-powered and/or controlled studies are necessary to confirm these findings.     

The association of padded headgear with concussion and injury risk in junior Australian football: A prospective cohort study

ObjectivesTo assess whether padded headgear was associated with incidence of suspected sports-related concussion, non-sports-related concussion head injury, and injuries to other body regions in junior Australian football.DesignProspective cohort injury surveillance.MethodsThere were 400 junior players (42.5% female) enrolled across two seasons. Suspected sports-related concussion was defined by detection of observable signs on the field and medical assessment or missed match(es) due to suspected sports-related concussion. Non-sports-related concussion head injury and injuries to other body regions were defined as those that received medical assessment or resulted in a missed match.ResultsThere were 20 teams monitored over 258 matches. 204 players (2484 player hours) wore mandated headgear throughout the season and 196 (2246 player hours) did not. The incidence rate of suspected sports-related concussion was 3.17 (95% confidence interval: 3.04–3.30) per 1000 player-hours and no differences were observed between males and females (risk ratio 1.11; 95% confidence interval: 0.40–3.06). Headgear use was not associated with suspected sports-related concussion (risk ratio 1.09; 95% confidence interval: 0.41–2.97), non-sports-related concussion head injury (risk ratio 0.27; 95% confidence interval: 0.06–1.31), or injuries to other body regions (risk ratio 1.41; 95% confidence interval: 0.79–2.53).ConclusionsHeadgear use was not associated with reduced risk of suspected sports-related concussion, non-sports-related concussion head injury or injuries to other body regions. There was no difference in the rate of suspected sports-related concussion in female compared to male players, however, rates of non-sports-related concussion head injury and injuries to other body regions were higher in male players.     

Differences in kinetic asymmetry between injured and noninjured novice runners: A prospective cohort study

PurposeThe purpose of this prospective study was to describe natural levels of asymmetry in running, compare levels of asymmetry between injured and noninjured novice runners and compare kinetic variables between the injured and noninjured lower limb within the novice runners with an injury.MethodsAt baseline vertical ground reaction forces and symmetry angles (SA) were assessed with an instrumented treadmill equipped with three force measuring transducers. Female participants ran at 8 and 9 km h^?1 and male runners ran at 9 and 10 km h^?1. Participants were novice female and male recreational runners and were followed during a 9-week running program.ResultsTwo hundred and ten novice runners enrolled this study, 133 (63.3%) female and 77 (36.7%) male runners. Thirty-four runners reported an RRI. At baseline SA values varied widely for all spatio-temporal and kinetic variables. The inter-individual differences in SA were also high. No significant differences in SA were found between female and male runners running at 9 km h^?1. In injured runners the SA of the impact peak was significantly lower compared to noninjured runners.ConclusionsNatural levels of asymmetry in running were high. The SA of impact peak in injured runners was lower compared to noninjured runners and no differences were seen between the injured and noninjured lower limbs.     

乳腺癌患者全麻术后残余肌松的发生率及危险因素:前瞻性队列研究

目的 观察全凭静脉麻醉时使用维库溴铵的乳腺癌患者术后残余肌松(PORC)的发生率,并分析其危险因素.方法 采用前瞻性队列研究设计,纳入择期全麻乳腺癌手术女性患者257例.采用丙泊酚和瑞芬太尼全凭静脉麻醉,术中维持脑电双频指数(BIS)值40～60,肌松药采用维库溴铵(0.1mg/kg).术毕不给予肌松拮抗药,由麻醉医生根据临床拔管指征拔除气管导管,同时由恢复室护士使用Veryark-TOF肌松监测仪,采用4个成串刺激(TOF)方式检测拇内收肌的收缩反应,记录拔除喉罩时患者的TOF比值(TOFr).结果 以TOFr＜0.7为标准,乳腺癌患者在手术后拔除喉罩即刻PORC的发生率为60.3％(155/257),而以TOFr＜0.9为标准时,PORC的发生率为93.8％(241/257).Logistic回归分析显示,年龄、新辅助化疗、术中多次追加肌松剂与PORC风险增加无显著相关性(P＞0.05),而患者手术中末次追加肌松剂到拔除喉罩时间与术后PORC风险增加相关(OR=1.031,95％CI 1.017～1.046,P＜0.001).结论 对于乳腺癌全麻手术患者,术毕不给予肌松拮抗药可使PORC发生率明显增高,末次给予肌松剂到拔除喉罩时间缩短是发生PORC的危险因素.     

Incidence of acute volleyball injuries: a prospective cohort study of injury mechanisms and risk factors

The purpose of the study was to examine the incidence and mechanisms of acute volleyball injuries, with particular reference to possible risk factors for ankle injuries. Coaches and players in the top two divisions of the Norwegian Volleyball Federation were asked to keep records of exposure time and all acute volleyball injuries causing a player to miss at least one playing day during one season. We found 89 injuries among 272 players during 51 588 players hours, 45 837 h of training and 5751 h of match play. The total injury incidence was 1.7 ± 0.2 per 1000 h of play, 1.5 ± 0.2 during training and 3.5 ± 0.8 during match play. The ankle (54%) was the most commonly injured region, followed by the lower back (11%), knee (8%) shoulder (8%) and fingers (7%). Of the ankle injuries, 79% were recurrences, and the relative risk of injury was 3.8 ( P < 0.0001) for previously injured ankles (38 of 232) vs. non-injured ankles (10 of the 234). Moreover, a reinjury was observed in 21 of the 50 ankles that had suffered an ankle ankle sprain within the last 6 months (42.0 ± 7.0%; risk ratio: 9.8 vs. uninjured ankles; P < 0.000001). The data indicate that external supports should be worn for 6–12 months after an ankle sprain and that specific injury prevention programs may be developed for ankle sprains in volleyball.     

Effectiveness of gait retraining interventions in individuals with hip or knee osteoarthritis: A systematic review and meta-analysis

BackgroundOsteoarthritis is a chronic synovial joint disease leading to pain, stiffness, and gait dysfunction, resulting in a significant health and economic burden. Gait retraining strategies and tools are used to address biomechanical gait dysfunction and symptoms in individuals with osteoarthritis. However, there is limited evidence relating to their effectiveness.QuestionDo gait retraining strategies and tools improve gait biomechanics and symptoms in individuals with hip or knee osteoarthritis compared to control or alternate intervention?MethodsSeven databases were searched using key words relating to osteoarthritis, gait retraining, and biomechanics. A best evidence synthesis was conducted on included studies. Where available, a meta-analysis was performed, and the standardised mean difference (SMD) and 95% confidence internals (CI) were reported.ResultsEighteen studies were included. One study investigated gait retraining in participants with hip osteoarthritis and demonstrated limited evidence for improving gait biomechanics. Seventeen studies on knee osteoarthritis were included in the best evidence synthesis with six included in the meta-analysis. Gait retraining strategies which incorporated a real-time biofeedback tool, appear to have strong evidence for effectively modifying walking biomechanics. Moderate evidence was identified to support kinesiology taping improving pain scores. The meta-analysis pooled effect demonstrated significant improvements for knee adduction moment [SMD, −1.10; 95% CI. −1.85, −0.35] and the Western Ontario and McMaster Osteoarthritis Index in favour of gait retraining than a control intervention [SMD, −0.86; 95% CI. −1.33, −0.39]. All other interventions demonstrated evidence that was conflicting, limited, or not in favour of gait retraining.ConclusionGait retraining may be beneficial for improving biomechanics and symptoms in knee osteoarthritis, however due to the high heterogeneity and limited studies in the analysis, further research is required. Further high quality randomised controlled trials for knee and especially hip osteoarthritis investigating the effects of gait retraining on biomechanics and symptoms are required.     

Relationship between gait biomechanics and inversion sprains: a prospective study of risk factors

This prospective study determined gait related risk factors for inversion sprains in 223 physical education students. Static lower leg alignment was determined, and 3D-kinematics combined with plantar pressure profiles were collected. After evaluation, the same sports physician registered all sports injuries during the next 6–18 months. During this period, 21 subjects had an inversion sprain, one of whom had a bilateral sprain. Twenty-two ankles, 12 left and 10 right comprised the inversion sprain group and both feet of 36 non-injured subjects acted as controls. Comparison of the two groups revealed that the gait of subjects who are at risk of sustaining an inversion sprain had a laterally situated centre of pressure at initial contact. These subjects also showed a mobile foot type at first metatarsal contact, forefoot flat and heel off. In this type the foot is more pronated over a prolonged period and accompanied by more pressure underneath the medial side of the foot and a delayed maximal knee flexion. Resupination is delayed and roll off does not occur across the hallux, but more laterally, probably because of the diminished support at the first metatarsophalangeal joint. Total foot contact time was also longer in the inversion sprain group compared with controls. The findings of this study suggest that effective prevention and rehabilitation of inversion sprains should include attention to gait patterns and adjustments of foot biomechanics.     

ProjectRun21: Do running experience and running pace influence the risk of running injury—A 14-week prospective cohort study

Objectives

The health benefits from participation in half-marathon is challenged by a yearly running-related injury (RRI) incidence proportion exceeding 30%. Research in injury etiology is needed to successfully prevent injuries. The body’s load capacity is believed to play an essential role for injury development. Therefore, the purpose of ProjectRun21 was to investigate the association between load capacity defined as running experience and running pace, and RRI when following a specific half-marathon running schedule.

Prognosis and prognostic factors of running-related injuries in novice runners: A prospective cohort study

Objectives

To investigate the prognosis and possible prognostic factors of running-related injuries (RRIs) in novice runners.

Cardiorespiratory fitness,incidence and mortality of lung cancer in men: A prospective cohort study

Objectives

To evaluate the association between cardiorespiratory fitness (CRF), lung cancer incidence and cancer mortality in men.

Differences in upper body posture between individuals with and without chronic idiopathic neck pain during computerised device use: A 3D motion analysis study

BackgroundComputer use is associated with poor postures and increased risk of developing neck pain. Evaluating differences in working posture of individuals with and without chronic neck pain may assist the development of strategies to lessen or prevent pain.ObjectiveTo identify if upper body kinematics differs between individuals with and without chronic idiopathic neck pain during four conditions (tablet, laptop, and desktop computer sitting and standing).MethodsThree-dimensional (3D) motion capture measured upper body kinematics in 44 individuals with chronic idiopathic neck pain > 90 days (Cases n = 22) and without pain (Control n = 22), during a typing task under four conditions: tablet, laptop, desktop computer (sitting and standing). Differences between groups were evaluated using generalised linear mixed models.ResultsAcross all conditions and compared to controls, cases had significantly less flexion between their head-neck and upper trunk segments (between group mean difference 7.15°, 2.1, 12.2, p = .006), greater upper trunk flexion relative to the laboratory (−6.15°, −10.9, −1.3, p = .012), greater shoulder flexion bilaterally (left 12.35°, 6.7, 17.9, p < .001; right 13.49°, 7.9, 19.1, p < .001) and less right elbow flexion (−6.87°, −12.1, −1.7, p = .010). Approaching significance, the case group had less left elbow flexion (between group mean difference −5.36°, −10.9, 0.1, p = .056) and a smaller mean craniocervical angle for the seated desktop condition (group x condition interaction −6.37°; 95% CI −12.7, −0.1, p = .052).SignificanceIndividuals with neck pain consistently used different upper body postures compared to individuals without pain when working on computerised devices under varying workstation conditions. This finding suggests that people with neck pain work in potentially aggravating postures that may be associated with their pain.