Gait characteristics and lower limb muscle strength in women with early and established knee osteoarthritis

Background

Based on novel classification criteria using magnetic resonance imaging, a subpopulation of “early knee osteoarthritis patients” was clearly defined recently. This study assessed whether these early osteoarthritis patients already exhibit gait adaptations (knee joint loading in particular) and changes in muscle strength compared to control subjects and established knee osteoarthritis patients.

Methods

Fourteen female patients with early knee joint degeneration, defined by magnetic resonance imaging (early osteoarthritis), 12 female patients with established osteoarthritis and 14 female control subjects participated. Specific gait parameters and lower limb muscle strength were analyzed and compared between groups. Within the osteoarthritis groups, association between muscle strength and dynamic knee joint loading was also evaluated.

Findings

Early osteoarthritis patients presented no altered gait pattern, no significant increase in knee joint loading and no significant decrease in hamstring muscle strength compared to controls, while established osteoarthritis patients did. In contrast, early osteoarthritis patients experienced significant quadriceps weakness, comparable to established osteoarthritis patients. Within the osteoarthritis groups, muscle strength was not correlated with knee joint loading during gait.

Interpretation

The results suggest that gait changes reflect mechanical overload and are most likely the consequence of structural degeneration in knee osteoarthritis. Quadriceps weakness might however contribute to the onset and progression of the disease. This study supports the relevance of classification of early osteoarthritis patients and assists in identifying their functional characteristics. This helps to understand the trajectory of disease onset and progression and further develop more targeted strategies for prevention and treatment of knee osteoarthritis.     

Effectiveness and safety of electrical moxibustion for knee osteoarthritis: A multicenter,randomized, assessor-blinded,parallel-group clinical trial

BackgroundThe prevalence of knee osteoarthritis (KOA) is increasing, and it has emerged as a major health issue. Studies have been reported that moxibustion is effective for treating KOA, but conventional moxibustion is difficult to control the intensity of stimulation and causes smoke, harmful gases, or odors. An electrical moxibustion (EM) device was developed to solve these problems, so we conducted this study to evaluate the effectiveness and safety of EM as a treatment for KOA.MethodsThis is a multicenter, randomized, assessor-blinded, parallel-group clinical trial. Participants with KOA were randomly allocated into EM, traditional indirect moxibustion (TIM), or usual care groups. The moxibustion groups were received 12 sessions of moxibustion treatment at six acupuncture points (ST36, ST35, ST34, SP9, EX-LE4, SP10) over a period of 6 weeks. The usual care group was received usual treatment and self-care. The primary outcome was the degree of pain measured by numerical rating scale (NRS). The second outcomes were measured using visual analog scale, Korean version of the Western Ontario and McMaster Universities osteoarthritis index, patient global assessment, European quality of life five dimension five level scale, and warm sense threshold and heat pain threshold. For safety assessment, laboratory test and adverse events (AEs) were recorded.ResultsA total of 138 participants were assigned. While there was no significant NRS change in the usual care, EM and TIM showed significant decrease after treatment. Compared to the usual care, the mean change of NRS in the EM and TIM was significantly different, but there was no significance between two groups. Regarding secondary outcomes, EM and TIM also showed significant difference compared to the usual care, but there was no significance between two groups. Regarding safety assessment, while usual care showed significant safety among three groups, EM showed seven treatment-related AEs by four participants compared TIM’s 10 events by 10 participants. In addition, there was no blister caused by burns in the EM, which occurred four cases in the TIM.ConclusionThis study shows that EM is effective to improve the pain and function by KOA with a certain level of safety.     

Contract-relax technique compared to static stretching in treating migraine in women: A randomized pilot trial

IntroductionPhysical therapy is often used by patients with headache, including modalities such as muscle stretching exercises.ObjectivesTo evaluate the feasibility of a pilot trial aimed at determining the efficacy of the proprioceptive neuromuscular facilitation (PNF) contract-relax technique compared to static stretching for treating migraineurs.MethodsThis pilot trial allocated 30 migraineur women (23 ± 4 years) into PNF (n = 15) and static stretching groups (n = 15). The interventions were performed twice a week (16 sessions, 8 weeks). The feasibility outcomes included successful random allocation of 30 patients during a 12-month period, the proportion of eligible patients randomly assigned to each group, and the proportion of those who completed the 30-day follow-up. The outcomes of headache characteristics; medication intake; severity of migraine-related disability; neck disability; cervical mobility; pressure pain threshold; adverse effects and global perception of change were evaluated at baseline, after the end of treatment and after 30-day follow-up.ResultsThe recruitment rate was 4.66% participants/month. The proportion of eligible patients randomly assigned to each group and for those who completed the 30-day follow-up was 88.23% and 100%, respectively. Both groups improved in headache-related outcomes. The perception of change was important for 67% of the PNF group and 47% of the static stretching group. No differences were found between groups regarding the studied outcomes.ConclusionThis is a feasible pilot trial. The PNF contract-relax technique was no more effective than static stretching for treating migraine, but both techniques improved the headache, the severity of migraine-related disability and the satisfaction after treatment.     

Lateral wedge insoles for medial knee osteoarthritis: effects on lower limb frontal plane biomechanics

Background

Lateral wedges reduce the peak knee adduction moment and are advocated for knee osteoarthritis. However some patients demonstrate adverse biomechanical effects with treatment. Clinical management is hampered by lack of knowledge about their mechanism of effect. We evaluated effects of lateral wedges on frontal plane biomechanics, in order to elucidate mechanisms of effect.

Methods

Seventy three participants with knee osteoarthritis underwent gait analysis with and without 5° lateral wedges. Frontal plane parameters at the foot, knee and hip were evaluated, including peak knee adduction moment, knee adduction angular impulse, center of pressure displacement, ground reaction force, and knee-ground reaction force lever arm.

Findings

Lateral wedges reduced peak knee adduction moment and knee adduction angular impulse (− 5.8% and − 6.3% respectively, both P < 0.001). Although reductions in peak moment were correlated with more lateral center of pressure (r = 0.25, P < 0.05), less varus malalignment (r values 0.25-0.38, P < 0.05), reduced knee-ground reaction force lever arm (r = 0.69, P < 0.01), less hip adduction (r = 0.24, P < 0.05) and a more vertical frontal plane ground reaction force vector (r = 0.67, P < 0.001), only reduction in knee-ground reaction force lever arm was significantly predictive in regression analyses (B = 0.056, adjusted R² = 0.461, P < 0.001).

Interpretation

Lateral wedges significantly reduce peak knee adduction moment and knee adduction angular impulse. It seems a reduced knee-ground reaction force lever arm with lateral wedges is the central mechanism explaining their load-reducing effects. In order to understand why some patients do not respond to treatment, future evaluation of patient characteristics that mediate wedge effects on this lever arm is required.     

八段锦对膝骨性关节炎患者干预效果的Meta分析

目的系统评价八段锦对膝骨性关节炎患者的干预效果。方法计算机检索Web of Science、CINAHL、PubMed、EMbase、The Cochrane Library、CNKI、万方数据和维普数据库,搜集有关八段锦对膝骨性关节炎患者干预效果的RCT,检索时限均从建库至2019年1月23日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析,采用GRADE pro软件对结果证据质量进行评级。结果最终纳入6项RCT,328例研究对象。Meta分析结果显示,八段锦组较对照组能有效改善患者疼痛程度[SMD=-1.50,95%CI(-2.43,-0.58),P=0.001]、僵硬程度[SMD=-0.85,95%CI(-1.46,-0.23),P=0.007]、生理功能[SMD=-1.28,95%CI(-2.45,-0.10),P=0.03]、行动能力[SMD=1.04,95%CI(0.07,2.02),P=0.03]。但5项研究证据等级均为极低质量。结论当前证据显示,八段锦干预对改善膝骨性关节炎患者疼痛程度、僵硬程度及行动能力有明显的临床效果,但受纳入研究质量的限制,尚需更多高质量研究加以证实。     

膝关节骨关节炎患者等长、等速向心和等速离心测试的比较观察

目的 评价膝关节骨关节炎（OA）患者患侧及健侧膝伸肌和屈肌在等长、等速向心和等速离心收缩时的功能特性及相互间的关系。方法 应用Biodex System 3型等速测试系统对54例单侧膝OA患者进行患侧和健侧膝伸肌和屈肌的等长、等速向心及等速离心肌力测试。结果 膝OA患者患侧膝关节伸肌和屈肌在不同收缩模式下的肌力均较健侧显著下降（P＜0．05），特别是在低速向心和低速离心收缩状态时的降低幅度尤为显著；同时患者的膝关节屈／伸肌肌力（H／Q）比值和动态控制率均提示其患侧肢体存在肌力平衡异常。结论 在对膝OA患者肌肉功能进行评定时，应选用等速肌力测试并同时分析其H／Q比值及动态控制率，只有这样才能对患者的肌肉状况作出全面而客观的评定。     

Effectiveness of leech therapy in women with symptomatic arthrosis of the first carpometacarpal joint: a randomized controlled trial

Leech therapy has been shown to be effective for symptomatic treatment of osteoarthritis of the knee. We aimed to investigate the effectiveness of leech therapy in another type of osteoarthritis, osteoarthritis of the first carpometacarpal joint (thumb saddle joint). Thirty-two women with symptomatic painful osteoarthritis of the first carpometacarpal joint and who scored>40 mm on a 100mm VAS pain scale were randomized to a single treatment with 2-3 locally applied leeches (leech group) or a 30-day course with topical diclofenac twice a day. Primary outcome measure was change of overall pain (mean of VAS for pain at rest, in motion, during grip) from baseline to day 7. Secondary outcomes were functional disability (DASH-questionnaire), quality of life (QoL, SF-36) and grip strength. Patients were examined baseline and at days 7, 30 and 60 after treatment. Overall pain score at day 7 was reduced from 59.6+/-13.8 to 27.1+/-20.6 in the leech group (n=16) and from 50.6+/-13.3 to 46.9+/-18.5 with diclofenac (n=16) (group difference -26.5, 95%CI -40.3; -12.7; p=0.0003). Group differences for pain relief favoring the leech treatment increased at days 30 and 60. Significant treatment effects were also observed for the DASH score, QoL and grip. Results were not affected by outcome expectation or consumption of analgetics. A single course of leech therapy is effective in relieving pain, improving disability and QoL for at least 2 months. The potential of leech therapy for treatment of arthritic pain and underlying mechanisms should be further investigated.     

Quadriceps strengthening exercises may not change pain and function in knee osteoarthritis

It is believed that Quadriceps strength training may reduce pain and improve functional activity in patients with knee osteoarthritis (OA). This improvement is generally attributed to an increase in quadriceps strength. This study investigated whether quadriceps muscle strength increases with decreasing pain, improving functional activity in knee OA. Twenty-four patients with knee OA participated in an 8-week treatment protocol including traditional physical therapy and strength training 3 sessions per week. Measurements were conducted before and after the intervention and included the peak torque of quadriceps muscle, pain by visual analogue scale (VAS), short Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and functional activity by the 2 minute walking test (2MWT) and time up & go test (TUGT). After the intervention, analysis of data illustrated that changes in quadriceps muscle strength correlated with changes in VAS (r² = 0.310, p = 0.005), WOMAC (r² < 0.278, p < 0.008) and 2MWT (r² < 0.275, p < 0.009) significantly, although the correlation slope was negligible. No correlation was found between muscle strength and TUGT. However, the strength training significantly improved quadriceps muscle strength (p = 0.013), pain and functional activity (p = 0.000). This study showed that reduction in pain and improvement in functional activity occurs independently from an increase in quadriceps muscle strength in knee OA. It seems that increased quadriceps muscle strength may not be a cause of improvement in pain and functional activity in knee OA.     

Systemic use of antibiotics does not prevent postoperative infection in elective colorectal surgery: a randomized controlled trial

We assessed the clinical impact of the systemic use of antibiotics on postoperative infection in colorectal surgery. Perioperative administration prevents postoperative infection: a statement which is based on the results of five randomized controlled trials performed in the 1970s and 1980s. Our study design was a randomized controlled trial. We created two groups, one using the systemic antibiotic cefotiam (CTM), and the other using no antibiotic as the control. The primary end point was the overall postoperative infection rate. There were 100 patients assigned to this study. The patients were divided into two groups; the control group consisted of 51 cases and the CTM group had 49 cases. The backgrounds of the patients in the two groups were not significantly different. The overall postoperative infection rate was 28/51 (54.9%) in the control group and 25/49 (51.0%) in the CTM group. The surgical site infection (SSIs) (superficial, deep, and space/organ ) were 23/51 (45.1%) in the control group and 20/49 (40.8%) in the CTM group. No significant difference was observed between the CTM group and the control group regarding postoperative infection after elective colorectal surgery.     

Pelvic static magnetic stimulation to control urinary incontinence in older women: a randomized controlled trial

Objectives

To determine the efficacy of non-invasive static magnetic stimulation (SMS) of the pelvic floor compared to placebo in the treatment of women aged 60 years and over with urinary incontinence for 6 months or more.

Subjects and Methods

A single-blinded randomized, placebo-controlled, parallel-group trial. Subjects were excluded if they had an implanted electronic device, had experienced a symptomatic urinary tract infection, or had commenced pharmacotherapy for the same in the previous 4 weeks, or if they were booked for pelvic floor or gynecological surgery within the next 3 months. Once written consent was obtained, subjects were randomly assigned to the active SMS group (n=50) or the placebo group (n=51). Treatment was an undergarment incorporating 15 static magnets of 800–1200 Gauss anterior, posterior, and inferior to the pelvis for at least 12 hours a day for 3 months. Placebo was the same protocol with inert metal disks replacing the magnets. Primary outcome measure was cessation of incontinence as measured by a 24-hour pad test. Secondary outcomes were frequency and severity of symptoms as measured by the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS-SF), the Incontinence Severity Index, a Bothersomeness Visual Analog scale, and a 24-hour bladder diary. Data were collected at baseline and 12 weeks later.

Results

There were no statistically significant differences between groups in any of the outcome measures from baseline to 12 weeks. Initial evidence of subjective improvement in the treatment group compared to the placebo group was not sustained with sensitivity analysis.

Conclusion

This study found no evidence that static magnets cure or decrease the symptoms of urinary incontinence. Additional work into the basic physics of the product and garment design is recommended prior to further clinical trials research.     

Frontal and transverse plane hip kinematics and gluteus maximus recruitment correlate with frontal plane knee kinematics during single-leg squat tests in women

Background

Hip muscle dysfunction may be associated with knee valgus that contributes to problems like patellofemoral pain syndrome. The purpose of this study was to (1) compare knee and hip kinematics and hip muscle strength and recruitment between “good” and “poor” performers on a single-leg squat test developed to assess hip muscle dysfunction and (2) examine relationships between hip muscle strength, recruitment and frontal plane knee kinematics to see which variables correlated with knee valgus during the test.

Methods

Forty-one active women classified via visual rating as “good” or “poor” performers on the test participated. Participants completed 5-repetition single-leg squat tests. Isometric hip extension and abduction strength, gluteus maximus and gluteus medius recruitment, and 3-dimensional hip and knee kinematics during the test were compared between groups and examined for their association with frontal plane knee motion.

Findings

“Poor” performers completed the test with more hip adduction (mean difference = 7.6°) and flexion (mean difference = 6.3°) than “good” performers. No differences in knee kinematics, hip strength or hip muscle recruitment occurred. However, the secondary findings indicated that increased medial hip rotation (partial r = 0.94) and adduction (partial r = 0.42) and decreased gluteus maximus recruitment (partial r = 0.35) correlated with increased knee valgus.

Interpretation

Whereas hip muscle function and knee kinematics did not differ between groups as we'd hypothesized, frontal plane knee motion correlated with transverse and frontal plane hip motions and with gluteus maximus recruitment. Gluteus maximus recruitment may modulate frontal plane knee kinematics during single-leg squats.     

Management of acute whiplash: A randomized controlled trial of multidisciplinary stratified treatments

Acute whiplash is a heterogeneous disorder that becomes persistent in 40% to 60% of cases. Estimates of recovery have not changed in recent decades. This randomized, single-blind, controlled trial tested whether multidisciplinary individualized treatments for patients with acute whiplash (<4 weeks postinjury) could reduce the incidence of chronicity at 6 mo by 50% compared to usual care. Participants (n = 101) were recruited from accident and emergency centres and the community. It was hypothesized that better recovery rates were achievable if the heterogeneity was recognised and patients received individualised interventions. Patients randomized to pragmatic intervention (n = 49) could receive pharmaceutical management (ranging from simple medications to opioid analgesia), multimodal physiotherapy and psychology for post-traumatic stress according to their presentations. The treatment period was 10 wks with follow-up at 11 weeks and 6 and 12-months. The primary outcome was neck pain and disability (Neck Disability Index (NDI)). Analysis revealed no significant differences in frequency of recovery (NDI ?8%) between pragmatic and usual care groups at 6 months (OR 95%, CI = 0.55, 0.23–1.29), P = 0.163) or 12 mo (OR 95%, CI = 0.65, 0.28–1.47, P = 0.297). There was no improvement in current nonrecovery rates at 6 mo (63.6%, pragmatic care; 48.8%, usual care), indicating no advantage of the early multiprofessional intervention. Baseline levels of pain and disability had a significant bearing on recovery both at 6 and 12 mo in both groups, suggesting that future research focus on finding early effective pain management, particularly for the subgroup of patients with initial high levels of pain and disability, towards improving recovery rates.     

Effects of Swedish massage on gait spatiotemporal parameters in adult women with medial knee osteoarthritis: A randomized controlled trial

BackgroundPatients with knee osteoarthritis (OA) are always faced with functional limitations in daily activities due to knee pain. They are also at risk of falling because of compensatory kinetics and kinematics changes in walking, which is why they are seeking complementary therapies to deal with their problems.ObjectiveThe present research aimed to evaluate whether Swedish massage is effective in relieving the symptoms of knee OA and improving the gait spatiotemporal parameters of patients with knee OA.MethodsThirty adult women with knee OA participated in this study voluntarily. The intervention group (n = 15) received Swedish massage on their quadriceps for 20–30 min per session (12 sessions). During this period, the control group (n = 15) received their regular treatment. Osteoarthritis symptoms were evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index. The spatiotemporal parameters of gait were also captured by the motion analysis system during barefoot walking.ResultsThe intervention group demonstrated significantly more pain relief and improved function compared to the control group. A significant increase was observed in the gait speed, total support time, and single support time (P < 0.05). Moreover, there was a significant decrease in the step width and initial double support time of the patients after receiving Swedish massage (P < 0.05).ConclusionIt can be concluded that Swedish massage may positively affect pain relief and function improvement in patients with knee OA. Also, Swedish massage was found to improve the spatiotemporal parameters in the patients. This may have important clinical implications regarding the rehabilitation of patients with knee OA.     

Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait

Background

Compared to matched controls, knee osteoarthritis patients walk with altered, kinematics, kinetics and muscle activity. Studies of osteoarthritis patient gait have focused on individual measures, and findings from these studies differ due to differences in patient levels of disability and age. Therefore, aims of this study were to examine kinematic, kinetic and muscle co-contraction gait variables within a single osteoarthritis patient group, and to determine if alterations in these variables are related to pain, symptom and function measures.

Methods

Thirty asymptomatic controls and 54 patients with radiographic evidence of knee osteoarthritis participated. Self-perceived measures of pain and symptoms, and gait (knee joint angles, moments and muscle co-contraction) were analysed and compared.

Findings

Osteoarthritis patients had greater self-perceived pain and symptoms on the questionnaires. Gait differences in the knee osteoarthritis patients were greater knee flexion at heel strike and during early stance along with reductions in the peak external knee extension moment in late stance. Co-contraction ratios highlighted greater lateral muscle activation in osteoarthritis patients, which were correlated with the magnitude of their adduction moments. Larger adduction moments were related to lower self-perceived pain and symptoms.

Interpretation

Osteoarthritis patients use predominantly lateral muscle activation during stance which may aid in stabilising the external knee adduction moment. Kinematic alterations in knee osteoarthritis patient gait occur without alterations in knee joint moments. Our results also suggest that adduction moments are lowered to reduce the patients’ pain and symptoms.     

Progressive resistance strengthening exercises after stroke: a single-blind randomized controlled trial

OBJECTIVE: To determine the effectiveness of progressive resistance strengthening exercises to improve gross motor function and walking in patients receiving intensive rehabilitation after stroke. DESIGN: Randomized controlled trial. SETTING: Five inpatient rehabilitation programs affiliated with teaching hospitals. PARTICIPANTS: Inclusion criteria included less than 6 months poststroke and recovery of the leg stages 3 to 5 on the Chedoke-McMaster Stroke Assessment (CMSA). INTERVENTIONS: Both groups received conventional physical therapy programs. In addition, the experimental group performed 9 lower-extremity progressive resistance exercises 3 times a week for the duration of their stay, whereas the control group did the same exercises and for the same duration but without resistance. MAIN OUTCOME MEASURES: The Disability Inventory of the CMSA and the 2-minute walk test (2MWT) at baseline, 4 weeks, discharge, and 6 months after discharge. RESULTS: Over the length of stay, the rate of change in the Disability Inventory was.27 points per day in the experimental group and.29 points per day in the control group; the between-group difference was -.02 points per day (95% confidence interval [CI], -.10 to.06; P=.62). At discharge, the rate of change in the 2MWT was -.01 m in the experimental group and.15m in the control group; the between-group difference was -.16 m (95% CI, -.37 to.05; P=.14). CONCLUSIONS: Progressive resistance strengthening exercises as applied in our study were not effective when compared with the same exercises given without resistance.     

注射用头孢唑肟钠治疗细菌性感染的多中心随机对照临床研究

目的评价国产注射用头孢唑肟钠治疗呼吸系统及泌尿系统细菌性感染的l临床疗效和安全性。方法采用多中心、随机、盲法、平行对照试验设计，选择呼吸系统和泌尿系统细菌性感染患者，试验组（A组）应用国产注射用头孢唑肟钠，对照组（B组）应用进口注射用头孢唑肟钠（商品名益保世灵），用法均为2．0g，静脉滴注，每12小时1次；下呼吸道感染疗程为7～14d，泌尿系统感染为5～14d。结果本研究共入选病例144例，其中下呼吸道感染和泌尿系统感染各72例。A、B两组基本临床特征差异无统计学意义，资料具有可比性。疗效分析显示．A组与B组的痊愈率分别为81．9％和63．9％，总有效率分别为98．6％和98．6％，两组差异无统计学意义（P〉0．05）。A、B两组细菌清除率分别为100％和98．4％（P〉0．05）。本研究两组不良反应发生率均较低（2．8％与2．8％，P〉0．05），未见严重不良反应。结论国产注射用头孢唑肟钠对临床常见致病菌引起的下呼吸道、泌尿系统感染，临床疗效较好而不良反应发生率低，有较高的临床应用价值。     

等速离心肌力训练治疗膝关节骨关节炎的研究

运动Ｃｙｂｅｘ－６０００型等还肌力测试和训练系统对２０例膝关节骨关节炎患者进行 量等速离心肌力训练，观察训练对患膝肌力、疼痛及下肢功能的影响。结果表明：经过４周的训练，患膝 伸肌群各项测试指标均有不同程度提高，疼痛明显缓解，下肢功能显著改善。说明亚极量等速离心训练对膝关节骨关节炎２的近期疗效是明显的。     

Effects of a community-based progressive resistance training program on muscle performance and physical function in adults with Down syndrome: a randomized controlled trial

Shields N, Taylor NF, Dodd KY. Effects of a community-based progressive resistance training program on muscle performance and physical function in adults with Down syndrome: a randomized controlled trial.

Objective

To determine whether progressive resistance training improves muscle strength, muscle endurance, and physical function in adults with Down syndrome.

Design

Single-blind randomized controlled trial.

Setting

General community.

Participants

Adults (N=20) with Down syndrome (13 men, 7 women; mean age, 26.8±7.8y) were randomly assigned through a concealed allocation block randomized method to either an intervention group (n=9) or a control group (n=11).

Intervention

The intervention was a supervised, group progressive resistance training program, consisting of 6 exercises using weight machines performed twice a week for 10 weeks. Participants completed 2 to 3 sets of between 10 to 12 repetitions of each exercise until they reached fatigue. The control group continued with their usual activities.

Main Outcome Measures

The outcomes measured by blinded assessors were muscle strength (1-repetition maximum [1-RM]), muscle endurance (number of repetitions at 50% of 1-RM) for chest press and leg press, timed stairs test, and the grocery shelving task.

Results

The intervention group showed significant improvement in upper-limb muscle endurance compared with the control group (mean difference in the number of repetitions of the chest press at 50% of 1-RM was 16.7, 95% confidence interval, [CI] 7.1-26.2); and a trend toward an improvement in upper-limb muscle strength (mean difference in chest press 1-RM, 8.6kg; 95% CI, −1.3 to 18.5kg) and in upper-limb function (mean difference in grocery shelving task, −20.3s; 95% CI, −45.7 to 5.2s). There were no significant differences between the groups for lower-limb muscle performance or physical function measures. No major adverse events for the intervention were noted.

Conclusions

Progressive resistance training is a safe and feasible fitness option that can improve upper-limb muscle endurance in adults with Down syndrome (ACTR identifier ACTRN 012606000515594.)     

A double-blind trial of clinical effects of therapeutic ultrasound in knee osteoarthritis

A randomized double blind clinical trial was conducted to determine the effectiveness of ultrasound (US) therapy in knee osteoarthritis (OA). Sixty-seven patients (mean age 54.8 +/-7) were randomized to receive either 1 MHz frequency or 1 watt/cm(2) power continuous ultrasound for 5 min (n = 34) or sham US (n = 33) as a placebo. Ten sessions of treatment were applied to the target knee of the patient. A blinded evaluation at baseline and after treatment was made. Primary outcome was pain on movement assessed by visual analog scale (VAS). Secondary outcomes consisted of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and 50 meters walking time. Both groups showed significant improvements in knee pain on movement. In the treatment group, the improvement in VAS score was statistically and significantly higher (p < 0.001) and more pronounced than in the placebo group. Pain reduction averaged 47.76% in the treatment group (p = 0.013). Secondary outcomes improved in both groups but reached statistical significance only in the treatment group: p = 0.006 for the mean change in total WOMAC scores and p = 0.041 for 50 meters walking time. Results suggest that therapeutic US is safe and effective treatment modality in pain relief and improvement of functions in patients with knee OA.