Exploratory Analysis Using Machine Learning of Predictive Factors for Falls in Persons with Type 2 Diabetes: A Longitudinal Study

We aimed to investigate the status of falls and to identify important risk factors for falls in persons with type 2 diabetes (T2D) including the non-elderly. Participants were 316 persons with T2D. They were assessed for medical history, laboratory data and physical capabilities during the hospitalization and given a questionnaire on falls one year after discharge. Two different statistical models, logistic regression and random forest classifier were used to investigate important predictors of falls. The response rate to the survey was 72%; of the 226 respondents, there were 129 males and 97 females (median age 62 years). The fall rate during the first year after discharge was 19%. Logistic regression revealed that knee extension strength (β= -0.698, P = 0.002), fasting C-peptide (F-CPR) level (β= 0.492, P = 0.009) and dorsiflexion strength (β= -0.432, P = 0.047) were independent predictors of falls. The random forest classifier placed knee extension strength, grip strength (0.234), F-CPR level and dorsiflexion strength in the top 4 important variables for falls. Lower extremity muscle weakness as well as elevated F-CPR levels and reduced grip strength was shown to be important risk factors for falls in T2D.

Relationships between Cognitive Function and Odor Identification, Balance Capability, and Muscle Strength in Middle-Aged Persons with and without Type 2 Diabetes

Aim. We investigated the relationship between cognitive function and olfactory and physical functions in middle-aged persons with and without type 2 diabetes (T2D) to examine the potential of olfactory and physical functions as biomarkers for early cognitive impairment. Methods. Enrolled were 70 T2D patients (age 40 to <65 y) and 81 age-matched control participants without diabetes. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCA), Trail Making Test parts A and B (TMT-A/-B), Wisconsin Card Sorting Test (WCST), Quick Inventory of Depressive Symptomatology Self-Report (QIDS), and Starkstein Apathy Scale (SAS). Multiple linear regression analyses were performed. Results. Odor identification was an independent determinant shown in the results of the TMT-A in the entire participant group and was independently associated with the MoCA and TMT-B in the T2D group. Balance capability assessed with a stabilometer was independently associated with all cognitive function tests except for QISD and SAS in the entire participant group and the T2D group and was independently associated with TMT-A in the control group. Knee extension strength was independently associated with the SAS in the entire participant group and the T2D group. Conclusions. Odor identification, balance capability, and knee extension strength were potential markers for cognitive decline in middle-aged persons with T2D.

Functional Recovery after Revision Anterior Cruciate Ligament Reconstruction with a Second Autograft: A Matched Cohort Analysis in Adolescent Patients (197)

Objectives: Young patients are the highest risk demographic for ACL graft failure and revision surgery. Previous studies have shown higher rates of graft failure with the use of allograft tissue for ACL reconstruction (ACLR) in both primary and revision surgeries. However, questions remain regarding the functional consequence of harvesting a second autograft from the ipsilateral knee for revision ACLR. The purpose of this study was to evaluate 6-month functional testing in patients who underwent revision ACLR with use of a second autograft from the ispilateral knee, when compared to matched cohorts of primary ACLR patients. Methods: A retrospective review of prospectively collected data from patients aged 19 or younger who underwent revision ACLR with a second autograft of an opposite muscle group (either revision patellar tendon (BTB) following primary hamstring (HS) or revision HS following primary BTB) at the study institution was performed. Exclusion criteria were patients who underwent iliotibial band autograft ACLR, those with two autografts from synergistic muscle groups, grafts from the contralateral knee, debilitating injury or surgery to the contralateral lower extremity, and multi-ligamentous knee injury. All subjects underwent functional return to sports (RTS) testing 5-8 months after revision surgery, which included anthropometric measures, isometric strength, Y-Balance, and functional hop testing. Side-to-side deficits were then compared using standard limb symmetry index (LSI) metrics, after matching a cohort of primary ACLR patients based on age, sex, and body mass index (BMI). Multivariate analysis of variance (MANOVA) was used to compare RTS metrics, and if significance was detected, pairwise comparison was performed by Bonferroni post-hoc correction. Statistical significance of p<0.05 was applied. Results: The cohort of 37 revision ACLR patients were compared to cohorts of 62 primary HS and 47 BTB ACLR patients, respectively (Table 1). The revision cohort showed comparable knee extension strength deficits to the BTB cohort (-9.45±12.09% vs -8.81±13.83%, p=0.999), which were significantly greater than that of the HS cohort (-9.45±12.09% vs -0.99±12.00%, p<0.05). Greater knee flexion strength deficits were seen in the HS cohort than the revision cohort (-38.90±16.21% vs -28.13±23.22%, p=0.009), whose deficits were, in kind, significantly greater than that of the BTB cohort (-28.13±23.22% vs -1.17±12.41%, p=0.001). The HS cohort also showed greater triple hop deficit (-21.08±25.99%) than the other two cohorts (-21.08±25.99% vs -10.75±12.85 vs -6.84±23.81, p=0.024), which were not significantly different from each other. Conclusions: After revision ACLR with a second autograft from the opposing muscle group of the ipsilateral knee, adolescents show similar knee extension strength deficits compared to primary ACLR patients with BTB grafts, but improved knee flexion strength deficits compared to primary ACLR patients with HS grafts.

EARLY STRENGTH TESTING AFTER ACL RECONSTRUCTION IMPACTS ISOKINETIC STRENGTH PERFORMANCE AT TIME OF RETURN TO SPORT

Background: The standard of care in ACL reconstruction (ACLR) typically involves standardized strength testing at 6 months or later to assess a patient’s readiness to return to play (RTP) using isokinetic and isometric testing, and functional strength testing. Recent literature suggests that isokinetic knee extension strength should demonstrate 89% limb symmetry index (LSI) or greater prior to returning to sport. However, there is little known on the effects of strength testing early in the rehabilitation process and the relationship to strength test performance at time of RTP. Purpose: The purpose of this study was to examine how early post-operative strength test performance impacts isokinetic strength outcomes at RTP testing in adolescents. Methods: The retrospective cohort study included patients undergoing primary ACLR between 12 and 18 years of age, early post-operative strength measures, and isokinetic dynamometer strength at RTP from July 2017 and April 2019. Data was dichotomized into desired outcomes at 3 months: >70% isometric knee extension LSI, > 20 repetitions on anterior stepdown test (AST), > 90% LSI Y Balance. At RTP testing, isokinetic knee extension strength data was categorized into >89% LSI at 3 speeds (300, 180, 60°/sec). Chi square testing and odds ratio statistics were used to examine association and its magnitude. Results: 63 patients met inclusion criteria (38 females; 15.37±1.66 years old). >70% LSI isometric knee extension strength at 3 months showed a significant association (Table 2) and demonstrated the strongest odds of having >89% LSI on isokinetic strength tests at all 3 speeds at RTP with 180°/sec being the highest (OR=14.5; 95% CI=4.25,49.43; p= <0.001). Performance on AST showed a significant association (χ2 (1, n=63) = 17.00, p <0.001), and highest odds at 180°/sec (OR=4.61; 95% CI = 1.59, 13.39, p=<0.001) and 60°/sec (OR= 3.07; 95% CI = 1.10, 8.63, p= 0.04). Combination of performance on isometric strength tests and AST showed a significant association to isokinetic strength at all three speeds, but less predictive then isometrics in isolation. (Table 2). There was no significant relationship between YBR LSI at 3 months and isokinetic strength at 6 months. Conclusion: Standardized strength testing early in rehabilitation can help identify patients that will successfully complete RTP testing. Our results suggest that isometric knee extension strength and timed anterior stepdown test provide meaningful clinical information early in the rehabilitation process. This data also suggests that the use of YBAL for predicting isokinetic strength performance is limited. [Table: see text][Table: see text]

LOWER QUARTER Y-BALANCE TEST SCORES ARE ASSOCIATED WITH ISOKINETIC KNEE STRENGTH

Background: Lower extremity asymmetry has been shown to be associated with increased risk of anterior cruciate ligament injury. Return-to-sport screens commonly involve assessing the restoration of symmetrical strength and balance. Therefore, it is important to understand how these measures are related. Hypothesis/Purpose: To determine if relationships exist between the Lower Quarter Y-Balance Test (LQ-YBT) component scores, composite scores, and isokinetic knee strength in healthy, female athletes. Methods: Female adolescent athletes completed the LQ-YBT and isokinetic knee strength as a part of a comprehensive evaluation in competitive level athletes (Tegner activity scale≥7). LQ-YBT anterior, posteromedial, and posterolateral component scores for the each leg were normalized to leg length, and composite scores for each leg were calculated for each participant. Knee flexion/extension strength was collected at 120°/second using a Biodex System 4. Peak torque was normalized by body weight, and paired t-tests were used to compare legs ( α<0.05). Spearman correlation coefficients were calculated to test whether any LQ-YBT measures were associated to knee strength. Results: A total of 106 participants (age 13.8±2.4 years; BMI 20.2±3.0) were tested, and all were right leg dominant. No differences were found between LQ-YBT right and left component (Table 1), or composite scores (right 97.9 vs left 98.2, p=0.29). Flexion and extension strength were significantly increased on the right side ( p=0.02, <0.01 respectively). There were significant, weak to moderate correlations between all LQ-YBT scores (components and composite) versus knee flexion strength (r=0.26 to 0.40) (Table 2). Left knee extension strength was weakly correlated to left anterior and posteromedial component scores (r=0.24, 0.34 respectively), as well as the left composite score (r=0.29). Right knee extension strength was only correlated to the right posteromedial component score (r=0.21) and the right composite score (r=0.22). Conclusion: Weak to moderate relationships exist between both component and composite LQ-YBT scores and knee strength. The strongest correlations were found between the LQ-YBT composite scores and knee flexion strength. LQ-YBT composite scores were relatively high, indicating a low chance of injury while differences were seen in knee strength between legs. Future injury prevention programs would benefit from utilizing both tools as the Y-Balance test evaluates motor control and isokinetic strength identifies muscular imbalance, both of which are important in reducing future injury risk. Tables/Figures: [Table: see text][Table: see text]

FUNCTIONAL RECOVERY AFTER REVISION ACL RECONSTRUCTION WITH A SECOND AUTOGRAFT: A MATCHED COHORT ANALYSIS IN ADOLESCENT PATIENTS

Background: Young patients are the highest risk demographic for ACL graft failure and revision surgery. Previous studies have shown higher rates of graft failure with the use of allograft tissue for ACL reconstruction (ACLR) in both primary and revision surgeries. However, questions remain regarding the functional consequence of taking a second autograft from the same knee for revision ACLR. Purpose: The purpose of this study was to evaluate 6-month functional testing in patients who underwent revision ACLR with a second autograft from the same knee compared to matched cohorts of primary ACL patients. Methods: We retrospectively reviewed prospectively collected data from patients aged 19 or younger who had revision ACLR with a second autograft at our institution. We excluded patients with iliotibial band autografts, two autografts from a synergistic muscle groups, or grafts from the contralateral knee. Patients with previous significant injury or surgery to the contralateral leg, and those with multiligamentous knee injuries were excluded. Patients underwent functional testing 5-8 months after revision surgery including anthropometric measures, isometric strength, Y-Balance, and hop testing. Side-to-side deficits were then compared to age, sex, and BMI matched cohorts of primary ACLR patients, with hamstring or patellar tendon autografts. Multivariate analysis of variance (MANOVA) was used, and if significance was detected, pairwise comparison was performed by Bonferroni post-hoc correction. Statistical significance of p<0.05 was applied. Results: Thirty-seven adolescents underwent functional testing at 6.25±0.56 months after revision ACLR with a second autograft. These patients were matched to 62 patients who underwent primary ACLR with hamstring autograft, and 47 who underwent ACLR with patellar tendon autograft (Table 1). Revision ACLR patients showed comparable knee extension strength deficits to the patellar tendon group (-9.45±12.09% vs -8.81±13.83%, p=0.999) which were significantly greater than hamstring group (-9.45±12.09% vs -0.99±12.00%, p<0.05). Greater strength deficits were seen in knee flexion strength in the hamstring group than the revision group (-38.90±16.21% vs -28.13±23.22%, p=0.009) which had significantly greater knee flexion strength deficits than the patellar tendon group (-28.13±23.22% vs -1.17±12.41%, p=0.001). The hamstring primary group also showed greater triple hop deficit (-21.08±25.99%) than the other two groups (-21.08±25.99% vs -10.75±12.85 vs -6.84±23.81, p=0.024), which were similar. Conclusions: After revision ACLR with a second autograft from the same knee, adolescents show similar knee extension strength deficits compared to primary ACL patients with patellar tendon grafts, but improved knee flexion strength deficits compared to primary ACL patients with hamstring grafts. Tables/Figures: [Table: see text]

Correlation of grip and knee extension strength in mature adults

BACKROUND AND OBJECTIVE: Grip and knee strength are commonly measured but controversy exists as to whether either is a proxy for the other. The purpose of this meta-analysis was to summarize the correlation between the 2 variables. METHODS: Relevant literature was sought using PubMed, Google, and a hand search. Information on populations, measurements, and correlations were extracted. Correlational data were subjected to meta-analysis. RESULTS: Results from 17 studies were consolidated. The summary correlation between grip and knee extension strength was 0.64 with 95% CI of 0.57 to 0.71. Data were highly heterogeneous but did not show publication bias. CONCLUSION: The correlation between the grip and knee extension strength is good. However, it is not good enough to justify using either as a proxy for the other.

Feasibility and preliminary effect of anabolic steroids in addition to strength training and nutritional supplement in rehabilitation of patients with hip fracture: a randomized controlled pilot trial (HIP-SAP1 trial)

Background Anabolic steroid has been suggested as a supplement during hip fracture rehabilitation and a Cochrane Review recommended further trials. The aim was to determine feasibility and preliminary effect of a 12-week intervention consisting of anabolic steroid in addition to physiotherapy and nutritional supplement on knee-extension strength and function after hip fracture surgery. Methods Patients were randomized (1:1) during acute care to: 1. Anabolic steroid (Nandrolone Decanoate) or 2. Placebo (Saline). Both groups received identical physiotherapy (with strength training) and a nutritional supplement. Primary outcome was change in maximal isometric knee-extension strength from the week after surgery to 14 weeks. Secondary outcomes were physical performance, patient reported outcomes and body composition. Results Seven hundred seventeen patients were screened, and 23 randomised (mean age 73.4 years, 78% women). Target sample size was 48. Main limitations for inclusion were “not home-dwelling” (18%) and “cognitive dysfunction” (16%). Among eligible patients, the main reason for declining participation was “Overwhelmed and stressed by situation” (37%). Adherence to interventions was: Anabolic steroid 87%, exercise 91% and nutrition 61%. Addition of anabolic steroid showed a non-significant between-group difference in knee-extension strength in the fractured leg of 0.11 (95%CI -0.25;0.48) Nm/kg in favor of the anabolic group. Correspondingly, a non-significant between-group difference of 0.16 (95%CI -0.05;0.36) Nm/Kg was seen for the non-fractured leg. No significant between-group differences were identified for the secondary outcomes. Eighteen adverse reactions were identified (anabolic = 10, control = 8). Conclusions Early inclusion after hip fracture surgery to this trial seemed non-feasible, primarily due to slow recruitment. Although inconclusive, positive tendencies were seen for the addition of anabolic steroid. Trial registration Clinicaltrials.gov NCT03545347.