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

Introduction: The 2-Minute Walk Test (2MWT) is a simple, practical, and less time consuming test. Patients do not get fatigued while performing this test as a part of routine physical examination. 2MWT shows an excellent correlation with other walk tests and can be used as an alternative test in patients with multiple co- morbidities. The reliability of a test is a must for its recommendation to be used in clinics as well as research. Measurement properties have been reported in different populations for 2MWT. However, no data exist for 2MWT in patients with Knee Osteoarthritis (KOA). Aim: To establish the test-retest reliability and Minimal Detectable Change (MDC) scores for the 2MWT in patients with bilateral KOA. Materials and Methods: A prospective test-retest research study designed to assess the reliability of 2MWT. Eighty-two patients with KOA (27 males and 55 females) were included in the study. Health status was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The Numeric Pain Rating Scale (NPRS) and WOMAC were assessed on two consecutive days. Participants performed 2MWT on two different occasions with 48 hours difference in between. Both sessions were conducted for 45 minutes each on a 30 meter walking pathway. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 20.0 for Windows (SPSS Inc., Chicago, IL, USA). Results: 2MWT showed an excellent test-retest reliability. Intraclass Correlation Coefficient (ICC) for 2MWT were 0.98. Test-retest reliability assessed by two trials of 2MWT showed 1st trial mean±SD of 154.33±19.59 m and 2nd trial mean±SD of 156.69±19.68 m. Mean difference±SD between both trials was 2.36±2.74, which was statistically significant (p<0.001). The Standard Error of Measurement (SEM) and Minimal Detectable Change at 95% confidence level (MDC95) for 2MWT were 2.76 and 5.52 meters, respectively. Conclusion: The study recommends that 2MWT can be used as a test for assessing walking capacity among patients with KOA. A change of more than 5.52 meters can be considered as change-free of error. It can be used as an alternative to 6MWT in patients with KOA who cannot tolerate a higher duration/intensity walk test.

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Optimal parameters of blood flow restriction and resistance training on quadriceps strength and cross-sectional area and pain in knee osteoarthritis

Isokinetics and Exercise Science ◽

10.3233/ies-200235 ◽

2021 ◽

pp. 1-10

Author(s):

Waleed S. Mahmoud ◽

Ahmed Osailan ◽

Ahmed S. Ahmed ◽

Ragab K. Elnaggar ◽

Nadia L. Radwan

Keyword(s):

Blood Flow ◽

Resistance Training ◽

Knee Osteoarthritis ◽

Quadriceps Strength ◽

Sectional Area ◽

Occlusion Pressure ◽

Total Occlusion ◽

Cross Sectional ◽

Flow Restriction ◽

Low Intensity

BACKGROUND: Knee osteoarthritis (KOA) is one of the most common chronic diseases impacting millions of elderly people. OBJECTIVES: The study compared the effects of two intensities of partial blood flow restriction (BFR) with low-intensity resistance training on quadriceps strength and cross-sectional area (CSA), and pain in people with knee osteoarthritis (PwKOA). METHODS: Thirty-five PwKOA, aged 50–65, participated. Quadriceps CSA was measured by ultrasonography, quadriceps strength – by isokinetic dynamometry and pain by VAS. These outcome variables were obtained at the beginning of the study and re-evaluated eight weeks after the intervention. RESULTS: An interaction effect was present for quadriceps CSA (P= 0.042) and quadriceps strength (P= 0.006), showing that using 70% of total occlusion pressure with 30% 1RM had a more significant effect. Knee pain improved significantly through the main effect of BFR (P< 0.001), and low-intensity resistance training (P= 0.011). Pain improved more at 70% of total occlusion pressure, with 30% of 1RM (2.5 ± 1.06) than 50% total occlusion pressure with 10% of 1RM (5.77 ± 1.46). CONCLUSION: A combination of 70% of total occlusion pressure with 30% 1RM could be beneficial in PwKOA in improving pain, and increasing the quadriceps strength. The changes in the quadriceps strength could be a predictor for knee pain.

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A prospective study to establish the minimal clinically important difference of the Mini-BESTest in individuals with stroke

Clinical Rehabilitation ◽

10.1177/02692155211025131 ◽

2021 ◽

pp. 026921552110251

Author(s):

Marla K Beauchamp ◽

Rudy Niebuhr ◽

Patricia Roche ◽

Renata Kirkwood ◽

Kathryn M Sibley

Keyword(s):

Stroke Rehabilitation ◽

Minimal Clinically Important Difference ◽

Clinical Importance ◽

Minimal Detectable Change ◽

Global Rating ◽

Detectable Change ◽

Clinically Important Difference ◽

Before And After ◽

Small Change ◽

A Prospective Study

Objective: To determine the minimal clinically important difference of the Mini-BESTest in individuals’ post-stroke. Design: Prospective cohort study. Setting: Outpatient stroke rehabilitation. Subjects: Fifty outpatients with stroke with a mean (SD) age of 60.8 (9.4). Intervention: Outpatients with stroke were assessed with the Mini-BESTest before and after a course of conventional rehabilitation. Rehabilitation sessions occurred one to two times/week for one hour and treatment duration was 1.3–42 weeks (mean (SD) = 17.4(10.6)). Main measures: We used a combination of anchor- and distribution-based approaches including a global rating of change in balance scale completed by physiotherapists and patients, the minimal detectable change with 95% confidence, and the optimal cut-point from receiver operating characteristic curves. Results: The average (SD) Mini-BESTest score at admission was 18.2 (6.5) and 22.4 (5.2) at discharge (effect size: 0.7) ( P = 0.001). Mean change scores on the Mini-BESTest for patient and physiotherapist ratings of small change were 4.2 and 4.3 points, and 4.7 and 5.3 points for substantial change, respectively. The minimal detectable change with 95% confidence for the Mini-BESTest was 3.2 points. The minimally clinical importance difference was determined to be 4 points for detecting small changes and 5 points for detecting substantial changes. Conclusions: A change of 4–5 points on the Mini-BEST is required to be perceptible to clinicians and patients, and beyond measurement error. These values can be used to interpret changes in balance in stroke rehabilitation research and practice.

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Comparison of whole-body vibration training and quadriceps strength training on physical function and neuromuscular function of individuals with knee osteoarthritis: A randomised clinical trial

Journal of Exercise Science & Fitness ◽

10.1016/j.jesf.2021.01.003 ◽

2021 ◽

Vol 19 (3) ◽

pp. 150-157

Author(s):

Zhangqi Lai ◽

Seullee Lee ◽

Yiyang Chen ◽

Lin Wang

Keyword(s):

Clinical Trial ◽

Knee Osteoarthritis ◽

Strength Training ◽

Whole Body Vibration ◽

Randomised Clinical Trial ◽

Neuromuscular Function ◽

Quadriceps Strength ◽

Whole Body ◽

Vibration Training ◽

Whole Body Vibration Training

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Inter-laboratory comparison of knee biomechanics and muscle activation patterns during gait in patients with knee osteoarthritis

The Knee ◽

10.1016/j.knee.2021.03.001 ◽

2021 ◽

Vol 29 ◽

pp. 500-509

Author(s):

J.C. Schrijvers ◽

D. Rutherford ◽

R. Richards ◽

J.C. van den Noort ◽

M. van der Esch ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Muscle Activation ◽

Knee Biomechanics ◽

Activation Patterns ◽

Muscle Activation Patterns

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Strain Elastography and Tendon Response to an Exercise Program in Patients With Supraspinatus Tendinopathy: An Exploratory Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120965185 ◽

2020 ◽

Vol 8 (12) ◽

pp. 232596712096518

Author(s):

Karen Brage ◽

Birgit Juul-Kristensen ◽

John Hjarbaek ◽

Eleanor Boyle ◽

Per Kjaer ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Structural Changes ◽

Supraspinatus Tendon ◽

Patient Reported Outcome ◽

Minimal Detectable Change ◽

Detectable Change ◽

Tendon Stiffness ◽

Patient Reported ◽

Tendon Thickness

Background: Shoulder pain is common, with a lifetime prevalence of up to 67%. Evidence is conflicting in relation to imaging findings and pain in the shoulder. Sonoelastography can be used to estimate tissue stiffness and may be a clinically relevant technique for diagnosing and monitoring tendon healing. Purpose: To evaluate changes in supraspinatus tendon stiffness using strain elastography (SEL) and associations with changes in patient-reported outcomes, supraspinatus tendon thickness, and grade of tendinopathy after 12 weeks of unilateral shoulder exercises in patients with supraspinatus tendinopathy. Study Design: Controlled laboratory study. Methods: A total of 23 patients with unilateral clinical supraspinatus tendinopathy performed 12 weeks of “standard care” exercises. At baseline and follow-up, supraspinatus tendon stiffness was measured bilaterally using SEL and compared with tendinopathy grading on magnetic resonance imaging scans and tendon thickness measured using conventional ultrasound. Patient-reported outcome measures included physical function and symptoms from the Disabilities of the Arm, Shoulder and Hand questionnaire and pain rating (visual analog scale). Results: No significant changes in SEL within or between groups (asymptomatic vs symptomatic tendon) were seen. All patient-reported outcomes showed significant improvement from baseline to follow-up, but with no change in tendinopathy grading and tendon thickness. No significant differences in the proportion of patients changing above the minimal detectable change in SEL and PROM were seen, except for discomfort while sleeping. Conclusion: Despite no significant within-group or between-group changes in SEL, significant improvements were found in patient-reported outcomes. An acceptable agreement between patients changing above the minimal detectable change in SEL and patient-reported outcome measure was seen. Further studies should explore the use of SEL to detect changes after tendon repair and long-term training potentially in subgroups of different tendinopathy phases. Clinical Relevance: In the short term, structural changes in supraspinatus tendons could not be visualized using SEL, indicating that a longer time span should be expected in order to observe structural changes, which should be considered before return to sports. Subgrouping based on stage of tendinopathy may also be important in order to evaluate changes over time with SEL among patients with supraspinatus tendinopathy. Registration: NCT03425357 ( ClinicalTrials.gov identifier).

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