心理治疗在人工全膝关节置换术后的临床应用

目的：探讨心理治疗在人工全膝关节置换术（TKR）后康复中的临床价值。方法：48例TKR患者分为心理组28例和对照组20例，均采用术前康复指导，术后康复功能训练，心理组同时给予心理治疗。结果：治疗2、6周和3个月时2组患者膝关节功能评分都较治疗前增加（P〈0．001），心理组评分高于对照组（P〈0．001）。于术后开始锻炼1及2周后，心理组视觉模拟评分（VAS）明显低于对照组。结论：心理治疗在TKR的康复治疗中具有非常重要的作用。     

Weight-Bearing Asymmetry in Relation to Measures of Impairment and Functional Mobility for People With Knee Osteoarthritis

Christiansen CL, Stevens-Lapsley JE. Weight-bearing asymmetry in relation to measures of impairment and functional mobility for people with knee osteoarthritis.

Objectives

To compare weight-bearing asymmetry (WBA) for people with unilateral knee osteoarthritis (OA) with that for healthy adults of similar age. In addition, associations between WBA and clinical measures of knee impairment and functional mobility were evaluated.

Design

Cross-sectional design with age-matched control (CTL) group.

Setting

Clinical research laboratory.

Participants

People with end-stage unilateral knee OA (n=50) (OA group) and healthy people (n=17) (CTL group) were enrolled in the study (N=67).

Interventions

Not applicable.

Main Outcome Measures

WBA during a Five Times Sit-to-Stand Test (FTSST) based on average vertical ground reaction force under each foot, self-reported knee pain assessed using a Numerical Pain Rating Scale, knee extensor strength asymmetry based on peak isometric knee extension torque, knee motion asymmetry based on maximum passive knee extension and flexion angles, FTSST time, six-minute walk test distance, and Stair Climbing Test time.

Results

The OA group demonstrated greater WBA than the CTL group during transitions between sitting and standing as measured by an absolute symmetry index (P=.015). No correlation was found between WBA and knee motion asymmetry, but comparisons of WBA with all the other outcome variables indicated fair relationships (range, r=.29-.44).

Conclusions

Weight-bearing asymmetry during transitions between sitting and standing can serve as a clinically relevant measure related to both knee impairment and functional mobility for people with unilateral knee OA.     

A Specific Inpatient Aquatic Physiotherapy Program Improves Strength After Total Hip or Knee Replacement Surgery: A Randomized Controlled Trial

Rahmann AE, Brauer SG, Nitz JC. A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial.

Objective

To evaluate the effect of inpatient aquatic physiotherapy in addition to usual ward physiotherapy on the recovery of strength, function, and gait speed after total hip or knee replacement surgery.

Design

Pragmatic randomized controlled trial with blinded 6-month follow-up.

Setting

Acute-care private hospital.

Participants

People (n=65) undergoing primary hip or knee arthroplasty (average age, 69.6±8.2y; 30 men).

Interventions

Participants were randomly assigned to receive supplementary inpatient physiotherapy, beginning on day 4: aquatic physiotherapy, nonspecific water exercise, or additional ward physiotherapy.

Main Outcome Measures

Strength, gait speed, and functional ability at day 14.

Results

At day 14, hip abductor strength was significantly greater after aquatic physiotherapy intervention than additional ward treatment (P=.001) or water exercise (P=.011). No other outcome measures were significantly different at any time point in the trial, but relative differences favored the aquatic physiotherapy intervention at day 14. No adverse events occurred with early aquatic intervention.

Conclusions

A specific inpatient aquatic physiotherapy program has a positive effect on early recovery of hip strength after joint replacement surgery. Further studies are required to confirm these findings. Our research indicates that aquatic physiotherapy can be safely considered in this early postoperative phase.     

Randomized Controlled Trial of the Effectiveness of Continuous Passive Motion After Total Knee Replacement

Objective

To determine the effects of using a continuous passive motion (CPM) device for individuals with poor range of motion (ROM) after a total knee replacement (TKR) admitted for postacute rehabilitation.

Design

Randomized controlled trial.

Setting

Inpatient rehabilitation facility (IRF).

Participants

Adults (N=141) after TKR with initial active knee flexion <75° on admission to the IRF.

Intervention

Two randomized groups: group 1 (n=71) received the conventional 3 hours of therapy per day, and group 2 (n=70) received the addition of daily CPM use for 2 hours throughout their length of stay.

Main Outcome Measures

The primary outcome measure was active knee flexion ROM. Secondary outcome measures included active knee extension ROM length of stay, estimate of function using the FIM and Timed Up and Go test, girth measurement, and self-reported Western Ontario and McMaster Universities Osteoarthritis Index scores.

Results

All subjects significantly improved from admission to discharge in all outcome measures. However, there were no statistically significant differences in any of the discharge outcome measures of the CPM group compared with the non-CPM group.

Conclusions

CPM does not provide an additional benefit over the conventional interventions used in an IRF for patient after TKR, specifically in patients with poor initial knee flexion ROM after surgery.     

人工膝关节置换术后康复指导

目的提高人工膝关节置换术后康复效果.方法针对不同问题,因人而异,分期指导,亲自示范,协助鼓励病人功能锻炼. 结果出院时及3个月后复查优良率达92.3%.结论全面、及时、有效的康复指导是提高手术效果的保证.     

Assistive Walking Devices in Nonambulant Patients Undergoing Rehabilitation After Stroke: The Effects on Functional Mobility, Walking Impairments, and Patients' Opinion

Tyson SF, Rogerson L. Assistive walking devices in nonambulant patients undergoing rehabilitation after stroke: the effects on functional mobility, walking impairments, and patients' opinion.

Objective

To assess the immediate effects of assistive walking devices on functional mobility, walking impairments, and patients' opinions in nonambulant patients after stroke.

Design

Randomized crossover trial.

Setting

Inpatient rehabilitation units of 3 United Kingdom hospitals.

Participants

Twenty nonambulant patients with stroke undergoing rehabilitation to restore walking.

Interventions

Five walking conditions: (1) Walking with no device (the control condition), (2) walking with a walking cane, (3) ankle foot orthosis, (4) slider shoe, and (5) a combination of all 3 devices.

Main Outcome Measures

Functional mobility (functional ambulation categories), walking impairments (speed, step length of the weak leg), and patients' opinions.

Results

Functional mobility improved with all assistive devices (P<.0001-.005; effect sizes 1.68-0.52; number needed to treat=2-5). Walking impairments were unchanged (P<.800-.988). Participants were generally positive about the devices. They felt their walking, confidence, and safety improved and found the appearance and comfort of the devices acceptable. They would rather walk with the devices than delay walking until a normative gait pattern was achieved without them.

Conclusions

Assistive walking devices improved functional mobility in nonambulant rehabilitation patients with stroke. No changes in walking impairments were found. Participants were generally positive about using the devices. The results support the use of assistive walking devices to enable early mobilization after stroke; 2 patients would need to be treated with a cane or combined devices for 1 to improve functional mobility.     

Effects of Inpatient Rehabilitation in Hip and Knee Osteoarthritis: A Naturalistic Prospective Cohort Study With Intraindividual Control of Effects

Objectives

To quantify pain, function, and health-related quality of life in comparison with normative data, and to quantify intervention effects.

Design

Naturalistic cohort study without a control group. Correction of the effects observed during the intervention by those observed during waiting time prior to the intervention.

Setting

Inpatient rehabilitation clinic.

Participants

Patients with hip (n=88) and knee (n=164) osteoarthritis.

Intervention

Comprehensive, multidisciplinary inpatient rehabilitation lasting 3 weeks.

Main Outcome Measures

Medical Outcomes Study 36-Item Short-Form Health Survey and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Results

Four or more comorbid conditions had 45.3% of the hip and 51.8% of the knee patients on entry to and discharge from the clinic. On entry, physical health and some dimensions of psychosocial health were significantly diminished compared with population norms. At discharge, hip osteoarthritis had improved by a corrected effect size of .20 to .47 in pain, .04 to .39 in function, and −.04 to .32 in psychosocial health. Knee osteoarthritis showed a corrected effect size of .43 to .62 in pain, .19 to .51 in function, and .19 to .30 in psychosocial health. All but 1 effect in WOMAC pain and WOMAC function were higher than the minimal clinically important differences.

Conclusions

Hip and knee osteoarthritis patients admitted to the inpatient intervention were affected by a substantial burden of disease and comorbidities. Inpatient rehabilitation resulted in small to moderate, statistically significant, and clinically important improvements in pain, function, and psychosocial health.     

不同时期分阶段膝关节康复训练对全膝关节置换术患者的影响

目的：探讨不同时期分阶段膝关节康复训练对全膝关节置换术患者的影响。方法：选取2018年1月1日～2020年12月31日行全膝关节置换术患者80例为研究对象,根据手术先后顺序分为对照组和观察组各40例;对照组采用常规康复训练,观察组采用不同时期分阶段康复训练。比较两组护理后自护能力[采用自我护理能力量表(ESCA)],护理前后膝关节功能评分[采用特种外科医院膝关节量表(HSS)]和疼痛评分[采用视觉模拟评分法(VAS)],护理后康复依从性。结果：护理后,观察组ESCA评分高于对照组(P<0.01,P<0.05),HSS评分高于对照组(P<0.05),VAS评分低于对照组(P<0.01),康复依从率高于对照组(P<0.05)。结论：不同时期分阶段膝关节康复训练主要是通过对患者进行评估,根据恢复时间对患者采取不同康复锻炼方法,有助于促进患者关节功能恢复,减轻疼痛,提高康复依从性和自护能力。     

The Effects of 12 Weeks of Resistance Exercise Training on Disease Severity and Autonomic Modulation at Rest and After Acute Leg Resistance Exercise in Women with Fibromyalgia

Kingsley JD, McMillan V, Figueroa A. The effects of 12 weeks of resistance exercise training on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia.

Objective

To determine the effects of 12 weeks of resistance exercise training (RET) on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia (FM) and healthy controls (HCs).

Design

Before-after trial.

Setting

Testing and training occurred in a university setting.

Participants

Women with FM (n=9; mean age ± SD, 42±5y) and HCs (n=15; mean age, 45±5y).

Intervention

Both groups underwent testing before and after 12 weeks of whole-body RET consisting of 3 sets of 8 to 12 repetitions on 5 different exercises.

Main Outcome Measures

Disease severity was assessed using the number of active tender points, myalgic score, and the Fibromyalgia Impact Questionnaire (FIQ). Heart rate and autonomic modulation using power spectral analysis of heart rate variability (HRV) were measured at rest and 20 minutes after 5 sets of leg-press exercise.

Results

There was no group-by-time interaction for any variable. Women with FM and HCs had similar increases in maximal strength (P<.05) after RET. Number of active tender points, myalgic score, and FIQ score were decreased (P<.05) after RET in women with FM. Heart rate and natural log (Ln) high frequency (LnHF) were recovered, whereas Ln low frequency (LnLF) and LnLF/LnHF ratio were increased (P<.05) 20 minutes after acute leg resistance exercise. There were no significant effects of RET on HRV at rest or postexercise.

Conclusions

These findings indicate that cardiovagal modulation of heart rate recovers early after leg resistance exercise in women with FM and HCs. It is concluded that RET reduces the severity of FM, but it has no impact on autonomic modulation of heart rate.     

Prevalence and Predictors of Symptom Resolution and Functional Restoration in the Index Knee After Knee Arthroplasty: A Longitudinal Study

Objectives

To determine the prevalence of a 1- to 2-year postsurgical pain-free state and pain plus symptom-free state as well as functional restoration after knee arthroplasty (KA) and to identify predictors of these outcomes.

Effects of Aquatic Backward Locomotion Exercise and Progressive Resistance Exercise on Lumbar Extension Strength in Patients Who Have Undergone Lumbar Diskectomy

Kim Y-S, Park J, Shim JK. Effects of aquatic backward locomotion exercise and progressive resistance exercise on lumbar extension strength in patients who have undergone lumbar diskectomy.

Objective

To compare the effects of aquatic backward locomotion exercise and progressive resistance exercise with a machine on lumbar extension strength in patients who have undergone diskectomy for a lumbar disk herniation.

Design

Prospective comparative study.

Setting

Department of Kinesiology at a state university.

Participants

Male patients (N=30) with disk herniation at spinal levels L3 to S1 completed this study as subjects.

Intervention

After the diskectomy for a lumbar disk herniation, all patients had 6 weeks of rest time. At the end of the rest period, the aquatic backward locomotion exercise and progressive resistance exercise groups, respectively, started first 6 weeks of underwater training and lumbar extension training twice per week. After completion of the first 6-week training, subjects participated in a second 6-week training. After the whole 12-week training, subjects had no training for 6 weeks (detraining) and a follow-up 6-week training (retraining). The control (CON) group did not undergo any training.

Main Outcome Measures

For each test, maximum voluntary isometric lumbar extension strength was measured in 7 trunk positions (72°, 60°, 48°, 36°, 24°, 12°, and 0° of the trunk angle).

Results

The progressive resistance exercise and aquatic backward locomotion exercise groups showed increases in lumbar extension strength after the first 6-week training, although they were not statistically different from the CON group. After a second 6-week training, the progressive resistance exercise and aquatic backward locomotion exercise groups showed statistically significant increases in their strength levels as compared with the CON group. After the detraining period, the strength levels of the progressive resistance exercise and aquatic backward locomotion exercise groups did not statistically differ from the CON group. After the retraining period, the progressive resistance exercise and aquatic backward locomotion exercise groups showed increases in their strength levels, which were different from that of the CON group.

Conclusions

The results obtained suggested that the aquatic backward locomotion exercise is as beneficial as progressive resistance exercise for improving lumbar extension strength in patients after lumbar diskectomy surgery.     

Effects of Weight-Bearing Versus Nonweight-Bearing Exercise on Function, Walking Speed, and Position Sense in Participants With Knee Osteoarthritis: A Randomized Controlled Trial

Jan M-H, Lin C-H, Lin Y-F, Lin J-J, Lin D-H. Effects of weight-bearing versus nonweight-bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: a randomized controlled trial.

Objective

To investigate whether weight-bearing (WB) exercise enhances functional capacity to a greater extent than nonweight-bearing (NWB) exercise in participants with knee osteoarthritis.

Design

Randomized controlled trial.

Setting

Kinesiology laboratory.

Participants

Participants (N=106) were randomly assigned to WB exercise, NWB exercise, or a control group (no exercise).

Intervention

WB exercise and NWB exercise groups underwent an 8-week knee extension-flexion exercise program.

Main Outcome Measures

Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function scale, walking speed, muscle torque, and knee reposition error were assessed before and after intervention.

Results

Equally significant improvements were apparent for all outcomes after WB exercise and NWB exercise, except for reposition error, for which improvement was greater in the WB exercise group. In contrast, there were no improvements in the control group.

Conclusions

Simple knee flexion and extension exercises (WB and NWB) performed over 8 weeks resulted in significant improvement in the WOMAC function scale and knee strength compared with the control group. NWB exercise alone may be sufficient enough to improve function and muscle strength. The additional benefit of WB exercise was improved position sense, which may enhance complex walking tasks (walking on figure of 8 route and spongy surface).     

The Prevalence of Osteoarthritis of the Intact Hip and Knee Among Traumatic Leg Amputees

Struyf PA, van Heugten CM, Hitters MW, Smeets RJ. The prevalence of osteoarthritis of the intact hip and knee among traumatic leg amputees.

Objective

To determine the prevalence of osteoarthritis (OA) in the knee and/or hip of the intact leg among traumatic leg amputees compared with the general population and its relationship with amputation level, time since amputation, age, and mobility.

Design

Cross-sectional observational study.

Setting

Outpatient population of 2 Dutch rehabilitation centers.

Participants

Patients (N=78) with a unilateral traumatic transtibial amputation, knee disarticulation, or transfemoral amputation of at least 5 years ago; ability to walk with a prosthesis; older than 18 years of age; and able to understand Dutch. Patients were excluded if they had bilateral amputations, other pathologies of the knee or hip, or central neurologic pathologies.

Interventions

Not applicable.

Main Outcome Measure

The prevalence of OA.

Results

The prevalence of knee OA was 27% (men 28.3%, women 22.2%) and hip OA was 14% (men 15.3%, women 11.1%). This was higher compared with the general population (knee OA men 1.58%, women 1.33%, hip OA men 1.13%, women 0.98%, age adjusted). No significant relationships between the prevalence of OA and level of amputation, time since amputation, mobility, and age were found.

Conclusions

The prevalence of OA is significantly greater for both the knee and hip in the traumatic leg amputee population. No specific risk factors were identified. Although no specific risk factors in this specific population could be identified, it might be relevant to apply commonly known strategies to prevent OA as soon as possible after the amputation.     

Differential Effects of Cardiovascular and Resistance Exercise on Functional Mobility in Individuals With Advanced Cancer: A Randomized Trial

Objective

To compare the effects of resistance and cardiovascular exercise on functional mobility in individuals with advanced cancer.

Design

Prospective, 2-group pretest-posttest pilot study with randomization to either resistance or cardiovascular exercise mode.

Setting

Comprehensive community cancer center and a hospital-based fitness facility.

Participants

Volunteer sample of individuals (N=66; 30 men; 36 women; mean age, 62y) with advanced cancer recruited through the cancer center, palliative care service, rehabilitation department, and a local hospice.

Interventions

Ten weeks of individualized resistance or cardiovascular exercise, prescribed and monitored by oncology-trained exercise personnel.

Main Outcome Measures

Functional mobility was assessed using the Short Physical Performance Battery (SPPB); self-reported pain and fatigue were assessed secondarily using visual analog scales. Data were analyzed using a split plot 2×2 analysis of variance (α=.05).

Results

Fifty-two patients (78.8%) completed the study: 23 (67.7%) of 34 patients in the resistance arm and 29 (90.6%) of 32 patients in the cardiovascular arm. No participant withdrew because of study adverse events. Ten-week outcomes (n=52) included a significant increase in SPPB total score (P<.001), increase in gait speed (P=.001), and reduction in fatigue (P=.05). Although cardiovascular exercise participants had a modestly greater improvement in SPPB total score than resistance training participants (F_1,49=4.21, P=.045), the difference was not confirmed in a subsequent intention-to-treat analysis (N=66).

Conclusions

Individuals with advanced cancer appear to benefit from exercise for improving functional mobility. Neither resistance nor cardiovascular exercise appeared to have a strong differential effect on outcome.     

Association of Dynamic Joint Power With Functional Limitations in Older Adults With Symptomatic Knee Osteoarthritis

Segal NA, Yack HJ, Brubaker M, Torner JC, Wallace R. Association of dynamic joint power with functional limitations in older adults with symptomatic knee osteoarthritis.

Objectives

To determine which lower-limb joint moments and powers characterize the level of gait performance of older adults with symptomatic knee osteoarthritis (OA).

Design

Cross-sectional observational study.

Setting

University motion analysis laboratory.

Participants

Community-dwelling adults (N=60; 27 men, 33 women; age 50-79y) with symptomatic knee OA.

Interventions

Not applicable.

Main Outcome Measures

Physical function was measured using the long-distance corridor walk, the Short Physical Performance Battery, and the Late Life Function and Disability Instrument (LLFDI Function). Joint moments and power were estimated using an inverse dynamics solution after 3-dimensional computerized motion analysis.

Results

Subjects aged 64.2±7.4 years were recruited. Ranges (mean ± SD) for the 400-m walk time and the LLFDI Advanced Lower-Limb Function score were 215.3 to 536.8 (304.1±62.3) seconds and 31.5 to 100 (57.0±14.9) points, respectively. In women, hip abductor moment (loading response), hip abductor power (midstance), eccentric hamstring moment (terminal stance), and power (terminal swing) accounted for 41%, 31%, 14%, and 48% of the variance in the 400-m walk time, respectively (model R²=.61, P<.003). In men, plantar flexor and hip flexor power (preswing) accounted for 19% and 24% of the variance in the 400-m walk time, respectively (model R²=.32, P=.025).

Conclusions

There is evidence that men and women with higher mobility function tend to rely more on an ankle strategy rather than a hip strategy for gait. In higher functioning men, higher knee extensor and flexor strength may contribute to an ankle strategy, whereas hip abductor weakness may bias women with lower mobility function to minimize loading across the knee via use of a hip strategy. These parameters may serve as foci for rehabilitation interventions aimed at reducing mobility limitations.     

Validity of the Community Balance and Mobility Scale in Community-Dwelling Persons After Stroke

Knorr S, Brouwer B, Garland SJ. Validity of the Community Balance and Mobility Scale in community-dwelling persons after stroke.

Objectives

To examine the convergent validity, sensitivity to change, floor and ceiling effects of the Community Balance and Mobility Scale (CB&M) in community-dwelling stroke survivors. The secondary objective was to determine the correlations between the CB&M and lower-limb motor recovery and strength.

Design

Validity study.

Setting

Two university-based research centers.

Participants

Community-dwelling persons after stroke (N=44; 24 men, 20 women; mean age, 62.6±12.6y). Baseline measures were taken 3 months after the onset of stroke (98.6±52.6d); participants were reassessed 8 months poststroke (246.8±57.2d).

Interventions

Not applicable.

Main Outcome Measures

CB&M, Berg Balance Scale (BBS), Timed Up & Go (TUG), Chedoke McMaster Stroke Assessment (CMSA) Impairment Inventory for leg and foot, concentric bilateral isokinetic strength of the lower-limb flexor and extensor muscle groups using a dynamometer. The magnitude of the associations and the standardized response means (SRMs) among the CB&M, BBS, and TUG were used to examine the convergent validity and sensitivity to change, respectively.

Results

Moderate to high convergent validities (ρ=.70 to .83, P<.001) were observed among the CB&M, BBS, and TUG. The CB&M was moderately correlated with the CMSA leg and foot scores (ρ=.61 and .63, respectively, P<.001) and the paretic limb strength (ρ=.67, P<.001). The CB&M demonstrated the greatest ability to detect change between the baseline and follow-up assessments (SRM=.83).

Conclusions

The CB&M is valid and sensitive to change in assessing functional balance and mobility in ambulatory stroke survivors with moderate to mild neurologic impairments.     

Individuals With Chronic Traumatic Brain Injury Improve Walking Speed and Mobility With Intensive Mobility Training

Objective

To determine the feasibility and impact of different dosages of Intensive Mobility Training (IMT) on mobility, balance, and gait speed in individuals with chronic traumatic brain injury (TBI).

Design

Prospective, single group design with 3-month follow-up.

Setting

University research laboratory.

Participants

Volunteer sample of participants with chronic TBI (N=10; ≥3mo post-TBI; able to ambulate 3.05m with or without assistance; median age, 35.4y; interquartile range, 23.5–46y; median time post-TBI, 9.91y; interquartile range, 6.3–14.2y). Follow-up data were collected for all participants.

Interventions

Twenty days (5d/wk for 4wk), with 150min/d of repetitive, task-specific training equally divided among balance; gait training; and strength, coordination, and range.

Main Outcome Measures

Pain and fatigue were recorded before and after each session to assess feasibility. Treatment outcomes were assessed before training (pre), after 10 sessions (interim), after 20 sessions (post), and at 3-months follow-up and included the Berg Balance Scale and gait speed.

Results

Participants averaged 150.1±2.7 minutes per session. Median presession and postsession pain scores were 0 (out of 10) for 20 sessions; median presession fatigue scores ranged from 0 to 2.5 (out of 10); and postsession scores ranged from 3 to 5.5 (out of 10). Four outcome measures demonstrated significant improvement from the pretest to interim, with 7 out of 10 participants exceeding the minimal detectable change (MDC) for fast walking speed. At the posttest, 2 additional measures were significant, with more participants exceeding the MDCs. Changes in fast walking speed and Timed Up and Go test were significant at follow-up.

Conclusions

Limited fluctuations in pain and fatigue scores indicate feasibility of IMT in this population. Participants demonstrated improvements in walking speed, mobility, and balance postintervention and maintained gains in fast walking speed and mobility at 3 months.     

Minimal Detectable Change in Quadriceps Strength and Voluntary Muscle Activation in Patients With Knee Osteoarthritis

Kean CO, Birmingham TB, Garland SJ, Bryant DM, Giffin JR. Minimal detectable change in quadriceps strength and voluntary muscle activation in patients with knee osteoarthritis.

Objective

To examine the test-retest reliability and quantify the minimal detectable change (MDC) in quadriceps strength and voluntary activation in patients with knee osteoarthritis (OA).

Design

Repeated measures over a 1-week interval.

Setting

Tertiary care center.

Participants

A convenience sample of patients (N=20) diagnosed with knee OA.

Intervention

Isokinetic and isometric quadriceps strength testing and voluntary quadriceps activation testing using interpolated twitch technique.

Main Outcome Measures

Peak isokinetic and isometric knee extension torque (Nm) and percentage of voluntary quadriceps activation (%).

Results

The mean differences with 95% confidence intervals between the 2 test sessions for quadriceps isokinetic strength, isometric strength, and percent of voluntary activation were −4.34Nm (−14.01 to 5.34Nm), 1.56Nm (−5.56 to 8.68Nm), and 1.34% (−.53 to 3.22%), respectively. The intraclass correlation coefficients for all measures ranged from .93 to .98. The standard errors of measurement (SEMs) for quadriceps isokinetic and isometric strength were 14.57Nm and 10.76Nm, respectively. The SEM for percentage of voluntary activation was 2.84%. Based on these values, the MDCs were 33.90Nm, 25.02Nm, and 6.60% for quadriceps isokinetic strength, isometric strength, and percentage of voluntary activation, respectively.

Conclusions

Maximal quadriceps isokinetic strength, isometric strength, and percentage of voluntary activation measures demonstrate excellent test-retest reliability in patients with knee OA. In addition to research applications, the present findings suggest these measures are appropriate for use when evaluating change in neuromuscular function of the quadriceps in individual patients.