Physiotherapy - Research Publications
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ItemNo Preview AvailableEffect of functional weightbearing versus non-weightbearing quadriceps strengthening exercise on contact force in varus-malaligned medial knee osteoarthritis: A secondary analysis of a randomized controlled trial(ELSEVIER, 2022-12)BACKGROUND: Knee osteoarthritis progression may be related to altered knee loads, particularly in those with varus malalignment. Using randomized controlled trial data, this secondary analysis of complete datasets (n = 67) compared the effects of a functional weightbearing (WB) and non-weightbearing quadriceps strengthening exercise (NWB) program on measures of medial tibiofemoral joint contact force (MTCF) during walking. METHODS: Participants aged ≥50 years and with medial knee osteoarthritis and varus malalignment were randomly allocated to a 12-week, home-based, physiotherapist-prescribed exercise program comprised of WB exercises (n = 31), or NWB exercise (n = 36). Three-dimensional lower-body motion, ground reaction forces, and surface electromyograms from six lower-limb muscles were acquired during walking at baseline and at 12-weeks follow-up. An electromyogram-informed neuromusculoskeletal model estimated bodyweight (BW) normalized MTCF (peak and impulse), including external and muscular contributions to MTCF. RESULTS: There was no between-group difference in the change in peak MTCF (-0.02 [-0.12, 0.09] BW) or MTCF impulse (-0.01 [-0.06, 0.03] BW·s). There was a between-group difference in the muscle contribution to peak MTCF (-0.08 [-0.15, -0.00] BW) and MTCF impulse (-0.04 [-0.08, -0.00] BW·s), whereby the muscle contribution reduced more in the NWB group over time compared to the WB group. There was also a between group-difference in the external contribution to peak MTCF (0.09 [0.01, 0.18] BW), but this reduced more in the WB group than in the NWB group. CONCLUSIONS: Our findings suggest no difference in MTCF between the two exercise programs, but differences in the contribution to MTCF between the two exercise programs were observed in those with medial knee osteoarthritis and varus malalignment.
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ItemNo Preview AvailableWalking-related knee contact forces and associations with knee pain across people with mild, moderate and severe radiographic knee osteoarthritis: a cross-sectional study(ELSEVIER SCI LTD, 2022-06)OBJECTIVE: To investigate knee contact forces (KCFs), and their relationships with knee pain, across grades of radiographic knee osteoarthritis (OA) severity. DESIGN: Cross-sectional exploratory analysis of 164 participants with medial knee OA. Radiographic severity was classified as mild (grade 2), moderate (grade 3) or severe (grade 4) using the Kellgren & Lawrence (KL) scale. Walking knee pain was assessed using an 11-point numerical rating scale. External knee adduction moment (external KAM) and internal muscle forces were used to calculate medial, lateral and total KCFs using a musculoskeletal computational model. Force-time series across stance phase of gait were compared across KL grades using Statistical Parametric Mapping. Associations between KCFs and pain across KL grades were assessed using linear models. RESULTS: Medial KCFs during early and middle stance were higher in participants with KL3 and KL4 compared to those with KL2. In contrast, lateral KCFs were higher in those with KL2 compared to KL3 and KL4 in middle to late stance. The external loading component (i.e., KAM) of the medial KCF during middle to late stance was also greater in participants with KL3 and KL4 compared to those with KL2, whereas the internal (i.e., muscle) component was greater in those with KL3 and KL4 compared to KL3 during early stance. There were no associations between medial KCF and knee pain in any KL grade. CONCLUSIONS: Medial and lateral KCFs differ between mild, moderate and severe radiographic knee OA but are not associated with knee pain severity for any radiographic OA grade.
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ItemHip joint kinematics and segment coordination variability according to pain and structural disease severity in hip osteoarthritis(WILEY, 2020-08)This study aimed to evaluate hip joint kinematic variability and segment coordination variability during walking according to pain and radiographic disease severity in people with hip osteoarthritis. Fifty-five participants with hip osteoarthritis had pain severity assessed during walking using an item on the Western Ontario and McMasters Universities Osteoarthritis Index (no pain = 10; mild pain = 28; moderate pain = 17). Radiographic disease severity was graded by Kellgren and Lawrence scale (KL2 = 29; KL3 = 21; KL4 = 5). Hip kinematics variability was estimated as the curve coefficient of variation. Vector coding was used to calculate coordination variability for select joint couplings. One-way analysis of variances with planned adjusted post hoc comparisons were used to compare hip kinematics variability and coordination variability of select segment couplings (pelvis sagittal vs thigh sagittal; pelvis frontal vs thigh frontal; pelvis transverse vs thigh transverse; thigh sagittal vs shank sagittal; thigh frontal vs shank sagittal; thigh transverse vs shank sagittal) according to pain and radiographic disease severity. No main effect of pain severity was observed for sagittal or transverse plane hip kinematic variability (P ≥ .266), and although there was a main effect for frontal plane hip kinematic variability (P = .035), there were no significant differences when comparing between levels of pain severity (P > .006). There was no main effect of radiographic disease severity on hip kinematic variability in the sagittal (P = .539) or frontal (P = .307) plane. No significant differences in coordination of variability of segment couplings were observed (all P ≥ .229). Movement variability as assessed in this study did not differ according to pain severity during walking or radiographic disease severity.
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ItemNo Preview AvailableHip biomechanics during stair ascent and descent in people with and without hip osteoarthritis(WILEY, 2017-07)Hip osteoarthritis (OA) is often associated with pain and impaired function. Understanding biomechanical alterations in patients with hip OA during challenging activities such as stair use is important to inform treatments. The aim of this study was to determine whether kinematics and kinetics during stair ambulation differed between people with hip OA and healthy controls. Fifteen participants with symptomatic and radiographic hip OA and 15 asymptomatic healthy controls underwent 3-D motion analysis during stair ascent and descent. Trunk, pelvis, and hip kinematics as well as hip kinetics were evaluated. Analyses were performed unadjusted and adjusted for speed and leg length. In both the unadjusted and adjusted analyses, participants with hip OA ascended stairs with less hip range of motion in all three planes and a lower peak external rotation moment compared to controls. In the unadjusted analysis, hip OA participants descended stairs with greater ipsilateral trunk lean, less sagittal plane range of motion, lower peak extension moment, lower peak external rotation moment, and greater hip adduction moment impulse compared to controls. In the adjusted results, peak internal rotation moment and hip adduction moment impulse were greater in hip OA participants compared to controls. Findings show that individuals with hip OA display limited range of hip joint movement, particularly during stair ascent, and overall indicate the use of strategies (e.g., trunk lean; lower peak external rotation moment; higher adduction moment impulse) that implicate altered hip abductor function. Future research is required to further understand the implications of these findings on hip OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1505-1514, 2017.
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ItemIs the relationship between increased knee muscle strength and improved physical function following exercise dependent on baseline physical function status?(BIOMED CENTRAL LTD, 2017-12-08)BACKGROUND: Clinical guidelines recommend knee muscle strengthening exercises to improve physical function. However, the amount of knee muscle strength increase needed for clinically relevant improvements in physical function is unclear. Understanding how much increase in knee muscle strength is associated with improved physical function could assist clinicians in providing appropriate strength gain targets for their patients in order to optimise outcomes from exercise. The aim of this study was to investigate whether an increase in knee muscle strength is associated with improved self-reported physical function following exercise; and whether the relationship differs according to physical function status at baseline. METHODS: Data from 100 participants with medial knee osteoarthritis enrolled in a 12-week randomised controlled trial comparing neuromuscular exercise to quadriceps strengthening exercise were pooled. Participants were categorised as having mild, moderate or severe physical dysfunction at baseline using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Associations between 12-week changes in physical function (dependent variable) and peak isometric knee extensor and flexor strength (independent variables) were evaluated with and without accounting for baseline physical function status and covariates using linear regression models. RESULTS: In covariate-adjusted models without accounting for baseline physical function, every 1-unit (Nm/kg) increase in knee extensor strength was associated with physical function improvement of 17 WOMAC units (95% confidence interval (CI) -29 to -5). When accounting for baseline severity of physical function, every 1-unit increase in knee extensor strength was associated with physical function improvement of 24 WOMAC units (95% CI -42 to -7) in participants with severe physical dysfunction. There were no associations between change in strength and change in physical function in participants with mild or moderate physical dysfunction at baseline. The association between change in knee flexor strength and change in physical function was not significant, irrespective of baseline function status. CONCLUSIONS: In patients with severe physical dysfunction, an increase in knee extensor strength and improved physical function were associated. TRIAL REGISTRATION: ANZCTR 12610000660088 . Registered 12 August 2010.
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ItemA longitudinal study of impact and early stance loads during gait following arthroscopic partial meniscectomy(ELSEVIER SCI LTD, 2014-09-22)People following arthroscopic partial medial meniscectomy (APM) are at increased risk of developing knee osteoarthritis. High impact loading and peak loading early in the stance phase of gait may play a role in the pathogenesis of knee osteoarthritis. This was a secondary analysis of longitudinal data to investigate loading-related indices at baseline in an APM group (3 months post-surgery) and a healthy control group, and again 2 years later (follow-up). At baseline, 82 participants with medial APM and 38 healthy controls were assessed, with 66 and 23 re-assessed at follow-up, respectively. Outcome measures included: (i) heel strike transient (HST) presence and magnitude, (ii) maximum loading rate, (iii) peak vertical force (Fz) during early stance. At baseline, maximum loading rate was lower in the operated leg (APM) and non-operated leg (non-APM leg) compared to controls (p ≤ 0.03) and peak Fz was lower in the APM leg compared to non-APM leg (p ≤ 0.01). Over 2 years, peak Fz increased in the APM leg compared to the non-APM leg and controls (p ≤ 0.01). Following recent APM, people may adapt their gait to protect the operated knee from excessive loads, as evidenced by a lower maximum loading rate in the APM leg compared to controls, and a reduced peak Fz in the APM leg compared to the non-APM leg. No differences at follow-up may suggest an eventual return to more typical gait. However, the increase in peak Fz in the APM leg may be of concern for long-term joint health given the compromised function of the meniscus.