Squat test performance and execution in children with and without cerebral palsy

BackgroundKnowledge on lower extremity strength is imperative to informed decision making for children with cerebral palsy (CP) with mobility problems. However, a functional and clinically feasible test is not available. We aimed to determine whether the squat test is suitable for this purpose by investigating test performance and execution in children with cerebral palsy and typically developing (TD) peers.MethodsSquat test performance, defined by the number of two-legged squats until fatigue (max 20), was assessed in twenty children with bilateral CP (6–19 years; gross motor function classification system I–III) and sixteen TD children (7–16 years). Muscle fatigue was assessed from changes in electromyography (EMG). Joint range-of-motion and net torque were calculated for each single squat, to investigate differences between groups and between the 2nd and last squat.FindingsFifteen children with CP performed < 20 squats (median = 13, IQR = 7–19), while all TD children performed the maximum of 20 squats. Median EMG frequency decreased and amplitude increased in mm. quadriceps of both groups. Ankle and knee range-of-motion were reduced in children with CP during a single squat by 10 to 15°. No differences between 2nd and last squat were observed, except for knee range-of-motion which increased in TD children and decreased in children with CP.InterpretationSquat test performance was reduced in children with CP, especially in those with more severe CP. Muscle fatigue was present in both children with CP and TD peers, confirming that endurance of the lower extremity was tested. Minor execution differences between groups suggest that standardized execution is important to avoid compensation strategies. It is concluded that the squat test is feasible to test lower extremity strength in children with CP in a clinically meaningful way. Further clinimetric evaluation is needed before clinical implementation.     

Relationship between obesity and metabolic syndrome among Argentinean elementary school children

BackgroundArgentina has experienced marked increases in the prevalence of childhood overweight (OW)/obesity over the last few decades.ObjectivesWe examined (1) the distribution of the mean values of lipids, glucose, and HOMA-IR according to the presence of OW/obesity, age, and sex and (2) the association between metabolic syndrome and OW/obesity, Tanner stage, gender, and HOMA-IR.MethodsData were collected from 1009 children (508 males) in 10 elementary schools between April and September 2007. BMI, waist circumference, blood pressure, Tanner, lipids, insulin, and glucose were determined. Criteria analogous to ATPIII were used for metabolic syndrome in children.ResultsOver 1009 children (508 males) aged 9.4 ± 2.0 years were evaluated. One hundred and sixty-five (16.4%) were obese (> 95th percentile), and 166 (16.5%) were OW (85-95th). Twenty-five (2.5%) were severely obese (BMI > 99th). Most of the children (62%; 613/979) were at Tanner 1. Triglycerides, insulin, and HOMA-IR were higher (p < 0.001) and HDL-C lower (p < 0.001) in OW/obesity in both age groups and genders. The prevalence of metabolic syndrome was 5.8% overall, 32% in severely obese, 16.4% in OW/obese and 0.4% in normal weight children. Multiple logistic regression showed that BMI (OR 24.48; 95% CI 9.14–65.57), and HOMA-IR (OR 2.09; 95% CI 1.04–4.18) were associated with metabolic syndrome adjusted by gender and Tanner stage. Multiple linear regression also showed that BMI and HOMA-IR were independently associated with the number of metabolic syndrome components (R² = 0.46).ConclusionsA substantial number of OW/obese children have the metabolic syndrome. HOMA-IR and BMI were strong predictors of metabolic syndrome in children suggesting that OW/obese school children are at a higher risk for future cardiovascular disease.     

Hip muscle weakness and reduced joint range of motion in patients with femoroacetabular impingement syndrome: a case-control study

BackgroundFemoroacetabular impingement (FAI) syndrome is a hip joint motion-related clinical disorder characterized by abnormal contact between the hip joint structures. Abnormal hip morphology and joint pain may impair the hip joint range of motion (ROM) and muscle function. However, FAI effects on hip joint ROM and muscle strength remain controversial.ObjectivesThe purpose of this study was to compare hip joint ROM and muscle strength between FAI syndrome patients and healthy controls.MethodsTwenty FAI syndrome male patients and 20 healthy male controls (CG) matched for age (FAI = 28 ± 6 years; CG = 27 ± 5 years), body mass (FAI = 81 ± 12 kg; CG = 80 ± 13 kg) and height (FAI = 177 ± 6 cm; CG = 178 ± 6 cm), participated in the study. Hip joint ROM for flexion, internal rotation and external rotation were assessed through goniometry. Maximal isometric strength for hip flexion, extension, abduction and adduction were evaluated through hand-held dynamometry.ResultsHip joint ROM was significantly lower in FAI syndrome patients compared with CG for passive flexion (−4%; effect size – ES = 0.65), active internal rotation (−42%; ES = 1.60), active external rotation (−28%; ES = 1.46) and passive external rotation (−23%; ES = 1.63). FAI patients’ hip extensors (−34%; ES = 1.46), hip adductors (−33%; ES = 1.32), and hip flexors (−25%; ES = 1.17) were weaker compared to the CG subjects.ConclusionsFAI syndrome patients presented both hip muscle weakness and reduced joint ROM compared to match CG.     

Postoperative paediatric pain prevalence: A retrospective analysis in a university teaching hospital

BackgroundOverall pain prevalence in paediatric patients is well documented, but relatively little attention has been paid to pain prevalence and intensity on specific postoperative days within the first week following an operation.ObjectivesTo evaluate reported pain prevalence on the day of surgery and each day during the following week and to analyse pain trajectories.DesignRetrospective study.SettingSingle centre university hospital.Participants815 postoperative children and adolescents (age ≤ 18 years) were included (female: 36%, age 9.8 ± 5.8). Children with ear, nose, throat (e.g. tonsillectomy), eye (e.g. strabismus repair) or dental surgery (e.g. dental extraction) were treated at other departments and therefore were not included in this study.MethodsRetrospective analysis of the overall and clinically relevant (pain score ≥4/10) postoperative pain prevalence in children and adolescents during the first week after surgery. Possible influencing factors (age, sex, body mass index, type of anaesthesia, type of surgery and duration of surgery) on pain trajectories are analysed using mixed model techniques.ResultsOverall, 36% of 815 analysed children and adolescents suffered from pain ≥4 during their entire hospital stay. Compared to the day of surgery, the number of patients with pain ≥4 was slightly higher on day 1 after surgery (21% vs. 25%, respectively). In self-reported pain intensity rating (done for patients age ≥ 4 years) the type of surgery (p < .001) was the only significant variable influencing pain intensity. In observational pain assessment (age < 4 years) pain scores increased with patient's age (p = .004). In this patient group, pain intensity ratings did not differ between types of surgery (p = .278).ConclusionType of surgery is an important predictor for self-reported pain intensity ratings in children but not for observational pain assessment in younger children. In younger children observational pain assessment ratings increase with age.     

Lower limb kinematics and hip extensors strengths are associated with performance of runners at high risk of injury during the modified Star Excursion Balance Test

BackgroundReduced trunk and lower limb movement and hip and trunk muscles weakness may compromise the athletes’ performance on the modified Star Excursion Balance Test (mSEBT).ObjectiveTo investigate the relationship of trunk and lower limb kinematics and strength with the performance on the mSEBT of runners at high risk of injury.MethodsThirty-nine runners performed the mSEBT with the dominant limb as the support limb. An Inertial System was used to capture the trunk, hip, knee and ankle movement during the mSEBT. A handheld dynamometer was used to measure the strength of trunk extensors and lateral flexors muscles, and hip extensors, lateral rotators and abductors of the support limb. Multiple regressions were used to investigate if trunk and lower limbs kinematics and trunk and hip muscles strength are associated with performance during the mSEBT.ResultsReduced hip flexion and greater knee flexion range of motion (ROM) were associated with anterior reach in the mSEBT (r² = 0.45; p < .001), greater hip flexion ROM was associated with posteromedial reach (r² = 0.15; p = .012) and greater knee flexion ROM was associated with posterolateral reach (r² = 0.23; p < .001). Hip extensor strength was associated with posteromedial (r² = 0.14; p = .017), posterolateral (r² = 0.10; p = .038) and composite reaches (r² = 0.16; p = .009).ConclusionHip and knee kinematics in the sagittal plane explained 15–45% of the runners’ performance on the mSEBT and hip extensor strength explained 10–16% of the mSEBT performance. These findings provide useful information on the contribution of joints kinematics and strength when evaluating dynamic postural control in runners at high risk of injury.     

Sex-specific hip osteoarthritis-associated gait abnormalities: Alterations in dynamic hip abductor function differ in men and women

BackgroundHip osteoarthritis results in abnormal gait mechanics, but it is not known whether abnormalities are the same in men and women. The hypothesis tested was that gait abnormalities are different in men and women with hip osteoarthritis vs. sex-specific asymptomatic groups.Methods150 subjects with mild through severe radiographic hip osteoarthritis and 159 asymptomatic subjects were identified from an Institutional Review Board-approved motion analysis data repository. Sagittal plane hip range of motion and peak external moments about the hip, in all three planes, averaged from normal speed walking trials, were compared for men and women, with and without hip osteoarthritis using analysis of variance.FindingsThere were significant sex by group interactions for the external peak hip adduction and external rotation moments (P = 0.009–0.045). Although asymptomatic women had peak adduction and external rotation moments that were respectively 12% higher and 23% lower than asymptomatic men (P = 0.026–0.037), these variables did not differ between men and women with hip osteoarthritis (P ≥ 0.684). The osteoarthritis vs. asymptomatic group difference in the peak hip adduction moment was 45% larger in women than in men. The osteoarthritis vs. asymptomatic group difference in the peak hip external rotation moment was 55% larger for men than for women (P < 0.001). Sex did not influence the association between radiographic severity and gait variables.InterpretationNormal sex differences in gait were not seen in hip osteoarthritis. Sex-specific adaptations may reflect different aspects of hip abductor function. Men and women with hip osteoarthritis may require different interventions to improve function.     

The effect of total hip and hip resurfacing arthroplasty on vertical ground reaction force and impulse symmetry during a sit-to-stand task

BackgroundThe aim of this study was to determine the influence of total hip arthroplasty and hip resurfacing arthroplasty on limb loading symmetry before, and after, hip reconstruction surgery during a sit-to-stand task.MethodsFourteen patients were recruited that were about to receive either a total hip prosthesis (n = 7) or a hip resurfacing prosthesis (n = 7), as well as matched controls. Patients performed a sit-to-stand movement before, 3 months after, and 12 months after surgery. Peak vertical ground reaction force and impulse were measured for each leg, from which ground reaction force and impulse symmetry ratios were calculated.FindingsBefore surgery, hip resurfacing patients showed a small asymmetry which was not different to normal for ground reaction force (0.88(0.28) vs. 1.00(0.11); p = 0.311) or impulse (0.87(0.29) vs. 0.99(0.09); p = 0.324) symmetry ratios. Total hip patients offloaded their affected hip by 30% in terms of impulse symmetry ratio (0.71(0.36) vs. 0.99(0.23); p = 0.018). At 3 months following surgery asymmetries were seen that were different to normal in both hip resurfacing patients for ground reaction force (0.77(0.16); p = 0.007), and total hip patients for ground reaction force (0.70(0.15); p = 0.018) and impulse (0.72(0.16); p = 0.011) symmetry ratios. By 12 months after surgery total hip patients regained a symmetrical loading pattern for both ground reaction force (0.95(0.06); p = 0.676) and impulse (1.00(0.06); p = 0.702) symmetry ratios. Hip resurfacing patients, however, performed the task by overloading their operated hip, with impulse symmetry ratio being larger than normal (1.16(0.16); p = 0.035).InterpretationPhysiotherapists should appreciate the need for early recovery of limb loading symmetry as well as subsequent differences in the responses observed with different prostheses.     

Effects of hip and trunk muscle strengthening on hip function and lower limb kinematics during step-down task

BackgroundStrengthening of the hip and trunk muscles has the potential to change lower limb kinematic patterns, such as excessive hip medial rotation and adduction during weight-bearing tasks. This study aimed to investigate the effect of hip and trunk muscles strengthening on hip muscle performance, hip passive properties, and lower limb kinematics during step-down task in women.MethodsThirty-four young women who demonstrated dynamic knee valgus during step-down were divided into two groups. The experimental group underwent three weekly sessions of strengthening exercises for eight weeks, and the control group continued their usual activities. The following evaluations were carried out: (a) isokinetic maximum concentric and eccentric work of hip lateral rotators, (b) isokinetic hip passive torque of lateral rotation and resting transverse plane position, and (c) three-dimensional kinematics of the lower limb during step-down.FindingsThe strengthening program increased concentric (P < 0.001) and eccentric (P < 0.001) work of hip lateral rotators, and changed hip resting position toward lateral rotation (P < 0.001). The intervention did not significantly change hip passive torque (P = 0.089, main effect). The program reduced hip (P = 0.002), thigh (P = 0.024) and shank (P = 0.005) adduction during step-down task. Hip, thigh and knee kinematics in transverse plane and foot kinematics in frontal plane did not significantly modify after intervention (P ≥ 0.069, main effect).InterpretationHip and trunk strengthening reduced lower limb adduction during step-down. The changes in hip maximum work and resting position may have contributed to the observed kinematic effects.     

Does trunk and hip muscles strength predict performance during a core stability test?

BackgroundA better understanding about the relationship between trunk and hip muscles strength and core stability may improve evaluation and interventions proposed to improve core stability.ObjectivesTo investigate if trunk and hip muscles strength predict pelvic posterior rotation during the bridge test with unilateral knee extension.MethodsThis is a cross-sectional study. Sixty-one healthy individuals of both sexes (age, 28 ± 6.4 years, weight, 66.5 ± 10.9 kg, height, 167 ± 9.5 cm) performed the bridge test with unilateral knee extension. The pelvic posterior rotation during the bridge test was obtained with two-dimensional video analysis. Isometric strength of the trunk extensors and rotators, and hip abductors, external and internal rotators and extensors were measured with a hand-held dynamometer. Multiple linear regression analysis was performed to identify if the strength variables could explain the pelvic posterior rotation during the test.ResultsMuscle strength predicted pelvic posterior rotation during the bridge test (r = 0.54; p = 0.003). Strength of the trunk rotators (p = 0.045) and hip internal rotators (p = 0.015) predicted reduced magnitude of pelvic posterior rotation during the bridge test, and strength of the hip extensors (p = 0.003) predicted increased magnitude of pelvic posterior rotation.ConclusionsTrunk rotators and hip internal rotators and extensors strength predict 29% of the performance during the bridge test with unilateral knee extension. The strength of these muscles should be evaluated in individuals with increased pelvic posterior rotation during the bridge test with unilateral knee extension.     

Decrease in post-stroke spasticity and shoulder pain prevalence over the last 15 years

ObjectivesThe usual complications after recent stroke such as disabling spasticity and shoulder pain seemed less frequent in recent years. This study examined the frequency of spasticity and shoulder pain in recent post-stroke patients over time in our physical and rehabilitation medicine department.MethodsThis was a retrospective study of post-stroke inpatients over the last 15 years. Spasticity and shoulder pain prevalence were analyzed, as were demographic, clinical and stroke characteristics.ResultsWe reviewed medical records for 786 patients (506 men); mean age 58.1 years (SD 13.2); 530 (68%) with ischemic stroke and 256 (32.36%) hemorrhagic stroke. After a first increase from 2000 to 2006, the prevalence of disabling spasticity decreased from 2006 to 2015 (31%–10%; P < 0.001). Shoulder pain at admission and during hospitalization also decreased (13% of patients in 2000 to 8% in 2015, P < 0.001). Disabling spasticity was associated with shoulder pain (26% of patients with disabling spasticity presented shoulder pain at admission vs 7% with hyperreflexia of the deep tendon reflexes, P < 0.05). Characteristics of stroke, time of admission after stroke and length of stay did not change over the years. We observed an increase in number of walking patients at admission and number with a functional paretic arm at admission and discharge (P < 0.05), which may explain the increase in functional independence measure scores at admission and discharge (both P < 0.05). Prevalence of cognitive disorders increased over the same period (24% in 2000 vs 63% in 2015, P < 0.05).ConclusionsDisabling spasticity and shoulder pain frequency in recent post-stroke patients decreased over the last 15 years, and functional abilities both at admission and discharge improved. Confirmation of these results in a multicentric study may be important evidence of an improvement in stroke healthcare both in stroke and physical and rehabilitation medicine units in the last 10 years in France and could affect future estimations of the need for rehabilitation care after stroke.     

Prevalencia de las úlceras de pierna en la provincia de Cuenca: un estudio en Atención Primaria

ObjectiveTo determine the prevalence of leg ulcers, and to describe the affected patients, wounds, and treatment.MethodObservational, cross-sectional prevalence study. An ad hoc online questionnaire was sent to all nurses attending Primary Care centres of the “Gerencia de Atención Integrada de Cuenca” (Integrated Care Management of Cuenca, Spain). Data regarding patient sociodemographic and clinical variables, lesion characteristics and the type of intervention (concerning prevention and treatment) were collected.ResultsIn total, 152 professionals (response rate = 98.1%) completed the questionnaire, collecting data from 131,190 inhabitants. A total of 63 patients (75.5 ± 12.6 years old) with 75 ulcers were identified, finding an overall prevalence of 0.480‰ (CI 95%: 0.375-0.614), distributed as: venous ulcer 0.274‰ (n = 36), diabetic foot 0.145‰ (n = 19), and arterial ulcer 0.061‰ (n = 8).The prevalence was similar regarding gender (0.535‰ vs. 0.426‰, respectively, p = .365), but men exhibited more diabetic foot (0.214‰ vs. 0.076‰, p = .037).In all three types of lesions prevalence increased with age, reaching 1.743‰ in 64 + age group.The median of the leg ulcer duration and corrected area were 190.0 ± 340.0 days and 5.0 ± 13.7 cm², respectively, with a recurrence rate of 74.7%.ConclusionsThe prevalence of chronic leg ulcers was lower than that reported in other studies, although with high recurrence rates. Overall estimators from previous studies may have overestimated the prevalence, especially in regions with a high rural component.     

Age explains limited hip extension recovery at one year from total hip arthroplasty

BackgroundTo investigate the dependency of the one-year recovery in gait after total hip arthroplasty on age and preoperative conditions.MethodsLongitudinal retrospective study on 20 elderly patients with unilateral total hip arthroplasty consequent to hip osteoarthritis, assessed by gait analysis before surgery (T0), 2 weeks (T1), 6 (T2) and 12 months (T3) post-surgery. A set of variables assessing primary gait deviations and compensatory mechanisms were extracted from gait analysis data. Their variations throughout the one-year period were analyzed through a repeated measures ANOVA. Their dependency on preoperative conditions (age, hip passive limitations and Thomas Test) at one year after surgery were assessed through a correlation analysis and an ANCOVA.FindingsHip sagittal range significantly increased (P < 0.05) after each measurement session from mean 21 (SD 10) degrees at T0, to 31 (6) at T1, to 34 (6) at T2 until 36 (4) degrees at T3. The peak of hip and ankle power generation significantly increased from T0 to T3, with a progressive reduction of compensatory mechanisms towards normal values.At T3, preoperative hip passive extension and Thomas Test score did not affect hip sagittal range during gait, while age did (P < 0.05, R² = 0.36). Ankle and hip peak powers were also correlated with age (P = 0.033 and P = 0.008, respectively). In our sample, age was the main cause of hip sagittal joint range limitation.InterpretationAt one year from total hip arthroplasty, age affects hip joint limitations and gait recovery more than preoperative passive restrictions due to muscle shortening.     

Matrix metalloproteinase-1 promoter genotypes and haplotypes are associated with carotid plaque presence

ObjectivesMatrix metalloproteinase (MMP)-1 degrades fibrillar collagens suggesting important role in vascular remodeling. Data about MMP-1 promoter polymorphisms and carotid atherosclerosis (CA) are scarce. The aim of this study was to evaluate association of MMP-1 genotypes/haplotypes with carotid plaque (CP) presence in Serbian population.Design and methodsStudy enrolled a total of 702 participants: 274 controls and 428 consecutive patients with CA who underwent carotid endarterectomy. MMP-1 polymorphisms ? 1607 1G/2G, ? 519 A/G and ? 340 T/C were genotyped by PCR and RFLP methods.ResultsIndividuals carrying MMP-1 ? 1607 2G allele had significantly increased allele dose-dependent risk for CP presence (1G1G vs. 1G2G vs. 2G2G; OR = 1; OR = 1.87 95% CI 1.29–2.07; OR = 3.49 95% CI 1.67–7.30, p = 0.0009, respectively). Compared to the referent haplotype 2G_? 1607-T_? 340-A_? 519, the haplotypes 1G_? 1607-T_? 340-A_? 519, 1G_? 1607-T_? 340-G_? 519 and 2G_? 1607-C_? 340-A_? 519 had statistically significant protective effect on CP presence (OR = 0.41, 95% CI 0.29–0.81, p = 0.01; OR = 0.56, 95% CI 0.44–0.89, p = 0.01; OR = 0.43, 95% CI 0.27–0.86, p = 0.02, respectively).ConclusionsMMP-1 ? 1607 G/2G polymorphism solely and specific haplotypes of three analyzed promoter polymorphisms are significantly and independently associated with occurrence of CP. Replication studies in other populations are needed.     

Prevalence and Attitude towards Smoking in First,Third and Fifth-year Pharmacy Students in Spain: PRECOTABAC Study

Aim of this studyThe aim of this study is to calculate smoking prevalence among first, third and fifth-year pharmacy students in Spain, and to describe their attitude towards giving up smoking.MethodsCross-sectional multi-center study using an ad hoc self-administered questionnaire in first, third and fifth-year pharmacy students at seven Spanish universities. Bivariate analysis with chi-square and Student’s t-test, statistical significance p < 0.05.ResultsSmoking prevalence: 34.92%. The smokers smoke 31.04 (SD = 43.182) cigarettes/week on average. Pharmacy students have a positive attitude towards giving up smoking, with differences between year groups (p = 0.036).ConclusionsFour in ten pharmacy students in Spain smoke every day by the time they finish their degree. Smoking prevalence is lower in the first few years of the degree and increases over time. Students also have a positive attitude towards giving up smoking, and are in favor of measures that can be taken to try to stop people smoking.     

Factors associated with complementary medicine use in pediatric musculoskeletal conditions: Results from a national survey

ObjectivesComplementary and alternative medicine (CAM) use is common in children, but its use has only been investigated in children with musculoskeletal conditions (MSK) to a limited extent. We aimed to characterize factors associated with CAM use in children with MSK conditions.MethodsWithin the 2012 National Health Interview Survey dataset (including its child CAM supplement), we examined factors associated with CAM use in children with MSK conditions and performed an analysis examining the perceived usefulness of CAM therapies for MSK conditions.ResultsOverall, there were 10,218 children in the dataset. 28.0% of children with MSK conditions used CAM, compared to 8.8% of children without MSK conditions. Gender (p = 0.003), region (p = 0.001), race (p = 0.001), parental CAM use (p < 0.001), education (<0.001), and having anxiety, stress or depression (p = 0.030) were correlated with CAM use. Among 90 children who reported on CAM use, 89.7% said that CAM helped some or a great deal for their MSK condition.ConclusionsSeveral factors, particularly parental education and parental CAM use, were associated with CAM use, and self-reported improvement rates were high. Interventional trials are needed to determine the efficacy of specific CAM therapies for treating different MSK conditions in children.     

Epidemiology of elevated blood pressure in the ED

ObjectivesTo determine the prevalence and demographics of elevated blood pressure (BP) in emergency department (ED) patients.MethodsRetrospective study at an academic ED. ED patients with any systolic blood pressure (SBP) ≥ 140 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg over a 1-year period were included. Data pertaining to frequency of elevated BP across different ethnic categories, age groups, days of the week, shifts, and gender were collected.ResultsA total of 44 435 patient records were accessed. Overall 47.6% (95% CI, 47.2%-48.1%) of patients had elevated BP (SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg). Fifty three percent (95% CI, 52%-54%) were women. Among patients with elevated BP, 18% (95% CI, 17.8%-18.9%) had severe BP elevation (SBP ≥ 180 or DBP ≥ 110). Overall, patients > 45 years old were more likely to have elevated BP in ED. Across all ethnic groups, BP increased with age. Significant differences were noted in the prevalence of elevated BP between whites (52%), and other ethnic groups (African Americans [45%] and Hispanics [31%]) (P < .01). Overall, 64% (95% CI, 63.3%-64.6%) of patients with elevated BP were discharged from the ED. Forty four percent (95% CI, 42.4%-45.5%) of patients with severe BP elevation were also discharged from the ED.ConclusionsThis study provides knowledge of distribution of elevated BP among different age, gender and ethnic groups in the ED which can be used to develop specific interventions to improve recognition, prevention, detection, and treatment of hypertension.