scholarly journals Implications of Walking Aid Selection for Nonweightbearing Ambulation on Stance Limb Plantar Force, Walking Speed, Perceived Exertion, and Device Preference in Healthy Adults 50 Years of Age and Older

2021 ◽  
Vol 6 (1) ◽  
pp. 247301142199893
Author(s):  
David C. Kingston ◽  
Sarah Ferwerda ◽  
Curtis Fontaine ◽  
Marhanda Keeping ◽  
Jeffrey Stewart ◽  
...  
Keyword(s):  
Perceived Exertion ◽  
Walking Speed ◽  
Healthy Adults ◽  
Level Of Evidence ◽  
Walking Aids ◽  
Level Ii ◽  
Selection For ◽  
Plantar Force ◽  
Randomized Crossover Study ◽  
Walking Aid

Background: Young adults often tolerate the increased energy expenditure, coordination, and stance limb discomfort associated with walking aids for nonweightbearing ambulation. Adults aged ≥50 years may not have the same tolerance. Therefore, the objective of this study was to determine how walking aid selection affects stance limb plantar force, walking speed, perceived exertion, and device preference in adults aged ≥50 years. Methods: A prospective randomized crossover study was performed using healthy adults, aged ≥50 years, with no use of walking aids within 5 years. Participants walked 200 m in 4 randomized conditions: single nonweightbearing ambulation using crutches, a walker, a wheeled knee walker, and unaided walking. An in-shoe sensor measured stance limb plantar force, a stopwatch timed each walk, perceived exertion was reported using the BORG CR-10 scale, and device preference was identified. Results: Twenty-one participants (7 male; age: 56 ± 5 years; BMI: 26.6 ±1.9) showed stance limb plantar force was lowest when using a wheeled knee walker ( P < .001). Walking speed was similar in unaided and wheeled knee walker conditions (1.41 and 1.31 m/s), but slower with crutches or a walker (42%-68%, P < .001). Perceived exertion was similar in unaided and wheeled knee walker conditions (1.6 and 2.8), but higher with crutches or a walker (5.7 and 6.1, P < .001). Most (20/21) participants preferred the wheeled knee walker. Conclusions: Using a wheeled knee walker for nonweightbearing ambulation reduced stance limb plantar force, maintained unaided walking speed and perceived exertion, and was preferred to crutches or a walker. Level of Evidence: Level II, comparative study.

scholarly journals Intra-operative Laxity Following Total Knee Arthroplasty is Highly Variable and Different Than Osteoarthritic and Normal Knees

2020 ◽  
Author(s):  
Robert A. Siston ◽  
Erin E. Hutter ◽  
Joseph A. Ewing ◽  
Rachel K. Hall ◽  
Jeffrey F. Granger ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Laxity ◽  
Maximum Load ◽  
Similar Data ◽  
Level Of Evidence ◽  
Large Variability ◽  
Level Ii ◽  
Total Knee ◽  
Manual Manipulation

AbstractBackgroundAchieving a stable joint is an important yet challenging part of total knee arthroplasty (TKA). Neither manual manipulation of the knee nor instrumented sensors biomechanically characterize knee laxity or objectively characterize how TKA changes the laxity of an osteoarthritic (OA) knee. Therefore, the purposes of this study were: 1) objectively characterize changes in knee laxity due to TKA, 2) objectively determine whether TKA resulted in equal amounts of varus-valgus motion under a given load (i.e., balance) and 3) determine how TKA knee laxity and balance differ from values seen in non-osteoarthritic knees.MethodsTwo surgeons used a custom navigation system and intra-operative device to record varus-valgus motion under quantified loads in a cohort of 31 patients (34 knees) undergoing primary TKA. Similar data previously were collected from a cohort of 42 native cadaveric knees.ResultsPerforming a TKA resulted in a “looser knee” on average, but great variability existed within and between surgeons. Under the maximum applied moment, 20 knees were “looser” in the varus-valgus direction, while 14 were “tighter”. Surgeon 1 generally “loosened” knees (OA laxity 6.1°±2.3°, TKA laxity 10.1°±3.6°), while Surgeon 2 did not substantially alter knee laxity (OA laxity 8.2°±2.4°, TKA laxity 7.5°±3.3°). TKA resulted in balanced knees, and, while several differences in laxity were observed between OA, TKA, and cadaveric knees, balance was only different under the maximum load between OA and cadaveric knees.ConclusionsLarge variability exists within and between surgeons suggests in what is considered acceptable laxity and balance of the TKA knee when it is assessed by only manual manipulation of the leg. Knees were “balanced” yet displayed different amounts of motion under applied load.Clinical RelevanceOur results suggest that current assessments of knee laxity may leave different patients with biomechanically different knees. Objective intra-operative measurements should inform surgical technique to ensure consistency across different patients.Level of EvidenceLevel II prospective observational study

scholarly journals Conventional versus Smart Wireless Navigation in Total Knee Replacement: Similar Outcomes in a Randomized Prospective Study

Joints ◽  
2018 ◽  
Vol 06 (02) ◽  
pp. 090-094 ◽  
Author(s):  
Matteo Denti ◽  
Francesco Soldati ◽  
Francesca Bartolucci ◽  
Emanuela Morenghi ◽  
Laura De Girolamo ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Tibial Slope ◽  
Computer Assisted ◽  
Level Of Evidence ◽  
Assisted Navigation ◽  
Level Ii ◽  
Before And After ◽  
Total Knee ◽  
Generation Computer ◽  
Navigated Tka

Purpose The development of new computer-assisted navigation technologies in total knee arthroplasty (TKA) has attracted great interest; however, the debate remains open as to the real reliability of these systems. We compared conventional TKA with last generation computer-navigated TKA to find out if navigation can reach better radiographic and clinical outcomes. Methods Twenty patients with tricompartmental knee osteoarthritis were prospectively selected for conventional TKA (n = 10) or last generation computer-navigated TKA (n = 10). Data regarding age, gender, operated side, and previous surgery were collected. All 20 patients received the same cemented posterior-stabilized TKA. The same surgical instrumentation, including alignment and cutting guides, was used for both the techniques. A single radiologist assessed mechanical alignment and tibial slope before and after surgery. A single orthopaedic surgeon performed clinical evaluation at 1 year after the surgery. Wilcoxon's test was used to compare the outcomes of the two groups. Statistical significance was set at p < 0.05. Results No significant differences in mechanical axis or tibial slope was found between the two groups. The clinical outcome was equally good with both techniques. At a mean follow-up of 15.5 months (range, 13–25 months), all patients from both groups were generally satisfied with a full return to daily activities and without a significance difference between them. Conclusion Our data showed that clinical and radiological outcomes of TKA were not improved by the use of computer-assisted instruments, and that the elevated costs of the system are not warranted. Level of Evidence This is a Level II, randomized clinical trial.

scholarly journals Responsiveness of the PROMIS and FAAM Instruments in Foot and Ankle Orthopedic Population

2018 ◽  
Vol 40 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Man Hung ◽  
Judith F. Baumhauer ◽  
Frank W. Licari ◽  
Jerry Bounsanga ◽  
Maren W. Voss ◽  
...  
Keyword(s):  
T Test ◽  
Measurement Information ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Paired Samples ◽  
Level Ii ◽  
Patient Reported ◽  
Prospective Comparative Study ◽  
Ability Measure

Background: Investigating the responsiveness of an instrument is important in order to provide meaningful interpretation of clinical outcomes. This study examined the responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), the PROMIS Pain Interference (PI), and the Foot and Ankle Ability Measure (FAAM) Sports subscale in an orthopedic sample with foot and ankle ailments. Methods: Patients presenting to an orthopedic foot and ankle clinic during the years 2014–2017 responded to the PROMIS and FAAM instruments prior to their clinical appointments. The responsiveness of the PROMIS PF v1.2, PROMIS PI v1.1, and FAAM Sports were assessed using paired samples t test, effect size (ES), and standardized response mean (SRM) at 4 different follow-up points. A total of 785 patients with an average age of 52 years (SD = 17) were included. Results: The PROMIS PF had ESs of 0.95 to 1.22 across the 4 time points (3, >3, 6, and <6 months) and SRMs of 1.04 to 1.43. The PROMIS PI had ESs of 1.04 to 1.63 and SRMs of 1.17 to 1.23. For the FAAM Sports, the ESs were 1.25 to 1.31 and SRMs were 1.07 to 1.20. The ability to detect changes via paired samples t test provided mixed results. But in general, the patients with improvement had statistically significant improved scores, and the worsening patients had statistically significant worse scores. Conclusion: The PROMIS PF, PROMIS PI, and FAAM Sports were sensitive and responsive to changes in patient-reported health. Level of Evidence: Level II, prospective comparative study.

scholarly journals Health Literacy and Recall of Postoperative Instructions in Patients Undergoing the Lapidus Procedure

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142094022
Author(s):  
Jonathan H. Garfinkel ◽  
Amelia Hummel ◽  
Jonathan Day ◽  
Andrew Roney ◽  
Mackenzie Jones ◽  
...  
Keyword(s):  
Health Literacy ◽  
Objective Measure ◽  
Senior Author ◽  
Bachelor's Degree ◽  
Level Of Evidence ◽  
Verbal Instructions ◽  
Level Ii ◽  
Before And After ◽  
History Of ◽  
Poor Health Literacy

Background: Active participation in patients’ own care is essential for success after Lapidus procedure. Poor health literacy, comprehension, and retention of patient instructions may be correlated with patient participation. Currently, there is no objective measure of how well patients internalize and retain instructions before and after a Lapidus procedure. We performed this study to assess how much of the information given to patients preoperatively was able to be recalled at the first postoperative visit. Methods: All patients between ages 18 and 88 years undergoing a Lapidus procedure for hallux valgus by the senior author between June 2016 and July 2018 were considered eligible for inclusion. Patients were excluded if they had a history of previous bunion surgery or if the procedure was part of a flatfoot reconstruction. Patients were given written and verbal instructions at the preoperative visit. Demographic and comprehension surveys were administered at their first visit approximately 2 weeks postoperatively. A total of 50 patients, of which 42 (84%) were female and 43 (86%) had a bachelor’s degree or higher, were enrolled. Results: Mean overall score on the comprehension survey was 6.2/8 (±1.2), mean procedure subscore was 1.8/3 (±0.64), and mean postoperative protocol subscore was 4.4/5 (±0.8). The most frequently missed question asked patients to identify the joint fused in the procedure. Conclusion: Although comprehension and retention of instructions given preoperatively was quite high in our well-educated cohort, our findings highlight the importance of delivering clear instructions preoperatively and reinforcing these instructions often. Level of Evidence: Level II, prospective cohort study.

scholarly journals Strength Decrease, Perceived Physical Exertion and Endurance Time for Backpacking Tasks

2019 ◽  
Vol 16 (7) ◽  
pp. 1296 ◽  
Author(s):  
Kai Way Li ◽  
Jenn Chun Chu ◽  
Ching Chung Chen
Keyword(s):  
Heart Rate ◽  
Material Handling ◽  
Perceived Exertion ◽  
Walking Speed ◽  
Physical Exertion ◽  
Rating Of Perceived Exertion ◽  
Endurance Time ◽  
Manual Material Handling ◽  
Human Participants ◽  
Do So

Manual material handling (MMH) tasks create a burden for workers which could result in musculoskeletal injuries. Assessments of the decrease of muscular strength and the maximum endurance time (MET) for MMH tasks are essential in studying the ergonomic risk of MMH tasks. A backpacking experiment was conducted for measuring the MET for MMH tasks. Human participants carried a load on their back and walked on a treadmill under various load, walking speed, and ramp angle conditions until they coud no longer do so. It was found that the participants were able to walk for approximately 15 min to two hours before they needed to have a pause. Their back and leg strengths declined moderately due to performing the tasks. These tasks resulted in an increase in heart rate and elevated perceived physical exertion. The rating of perceived exertion (RPE)/heart rate ratio in our backpacking tasks was 31% higher than that in the literature, implying the calibration of the RPE may be required for such tasks. A MET model incorporating the fMVC_back, body weight, walking speed, and ramp angle was established. This model may be used to determine the work/rest allowance for backpacking tasks under conditions similar to this study.

scholarly journals Prospective evaluation of parental anxiety related to newborn foot disorder

2019 ◽  
Vol 13 (5) ◽  
pp. 500-507
Author(s):  
S. T. Mahan ◽  
P. E. Miller ◽  
C. J. May ◽  
J. R. Kasser
Keyword(s):  
Orthopaedic Surgeon ◽  
Parental Anxiety ◽  
Level Of Evidence ◽  
Prenatal Counselling ◽  
Level Ii ◽  
Group A ◽  
Anxiety Levels ◽  
Paediatric Orthopaedic ◽  
Group B ◽  
Foot Disorder

Purpose The presence of a clubfoot is often found prenatally and some families seek counselling with a specialist. The purpose of this study was to compare the parental anxiety levels in families that: a) knew prenatally and had prenatal counselling; b) knew prenatally but did not seek prenatal counselling; and c) did not know until after delivery. Methods This prospective cohort study evaluated the anxiety of parents as they presented to the paediatric orthopaedic clinic with their newborn with a foot disorder (prior to the diagnostic confirmation of clubfoot). Each family filled out the ‘Pre-visit orthopaedic surgeon questionnaire’ and then after the initial visit with the orthopaedic surgeon (confirming the clubfoot diagnosis) the family filled out the ‘Immediately post-visit orthopaedic surgeon questionnaire’. Through these questionnaires, anxiety level was assessed prior to meeting postnatally with the paediatric orthopaedic specialist, as well as after the meeting and compared across groups. Results A total of 121 parents completed questionnaires: 71% (86/121) confirmed clubfoot; 69% of families (59/86) received prenatal counselling (Group A); 16% (14/86) knew prenatally but had no counselling (Group B); and 15% (13/86) found out at birth (Group C). There was no difference in anxiety levels across groups before (p = 0.78) or after (p = 0.57) meeting with the paediatric orthopaedic surgeon; however, overall anxiety reduced significantly (p < 0.001). Conclusion We found no difference in the anxiety levels of across the three groups. Prenatal counselling for parents of children with likely clubfoot may not decrease parental anxiety, but nonetheless is very appreciated by the families who receive it. Level of Evidence Prognostic Level II

scholarly journals Midcarpal Structure Effect on Force Distribution through the Radiocarpal Joint

2019 ◽  
Vol 08 (06) ◽  
pp. 477-481
Author(s):  
Ronit Wollstein ◽  
Aviv Kramer ◽  
Scott Friedlander ◽  
Frederick Werner
Keyword(s):  
Compressive Force ◽  
Structural Variations ◽  
Level Of Evidence ◽  
Ulnar Deviation ◽  
Level Ii ◽  
Force Transfer ◽  
Radiocarpal Joint ◽  
Flexion Extension ◽  
Tensile Forces ◽  
Midcarpal Joint

Abstract Background Wrist structure is complicated by distinct anatomical patterns. Previous studies defined radiographic wrist types based on lunate and capitate shape within the midcarpal joint. We hypothesized that these disparate structural patterns will transfer forces differently through the wrist. Objective This study aims to correlate force transferred to the distal radius and ulna with morphological measurements in cadaver arms. Methods Radiographs from 46 wrists, previously tested for force transfer between the radius and ulna, were examined. The percentage of compressive force through the distal ulna was determined by mounting load cells to the radius and ulna, while 22.2 Newton (N) tensile forces were individually applied to multiple tendons. Each wrist was tested in a neutral flexion–extension and radial-ulnar deviation position. Results Wrist type and lunate type were associated with percentage of force transfer through the ulna (p = 0.002, p = 0.0003, respectively). Percentage of force transfer was correlated with capitate circumference (p = 0.02, r = 0.34). Conclusions This study supports distinct force transfer between morphological wrist types. Clinical Relevance Understanding the mechanical significance of different structural variations in the wrist bones will improve our ability to understand wrist function and the distinctive development of wrist pathology. Level of Evidence This is a Level II study.

THE PHYSICAL, SOCIAL & ECONOMIC EXTENT OF MULTIPLE SCLEROSIS IN SUSSEX

2015 ◽  
Vol 86 (11) ◽  
pp. e4.14-e4
Author(s):  
Jacob Howells ◽  
Waqar Rashid
Keyword(s):  
Multiple Sclerosis ◽  
Informal Care ◽  
Social Care ◽  
Full Time ◽  
Walking Aids ◽  
Relapsing Remitting ◽  
The Uk ◽  
Α Level ◽  
The Impact ◽  
Walking Aid

BackgroundMultiple sclerosis (MS) is the most common disabling illness of young adults in the UK causing significant social and economical cost. The aim of this study was to ascertain further detail of the characteristics of the MS population in an area of Sussex representing about 25% of the whole region.MethodsThe following was obtained from community databases: (a) demographics; (b) employment status; (c) DMT use; (d) walking aid use and (e) utilisation of social care.ResultsN=665. The mean (SD) age was 54 (13.2) years; Relapsing-Remitting MS 51%, Secondary Progressive MS 29% and Primary Progressive MS 15%. Of participants <65 years: 56% were unemployed, 44% worked part or full-time; 57.8% of participants required walking aids to mobilise, 23.3% were on a DMT, 35.1% required informal care and 20.2% required external social care. We found associations (at α level=0.05) between unemployment and: SPMS, walking aid use, informal care and external social care.DiscussionThis study highlights the needs of people with MS in Sussex. Of note is the impact on employment and the need for walking aids and additional care associated with MS. This knowledge will allow us to better develop services for people with MS with commissioners.

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