Amanda Seay

Rapid changes in gait, musculoskeletal pain, and quality of life after bariatric surgery

BACKGROUND Joint pain is a common musculoskeletal complaint of morbidly obese patients that can result in gait abnormalities, perceived mobility limitations, and declining quality of life (QOL). It is not yet known whether weight loss 3 months after bariatric surgery can induce favorable changes in joint pain, gait, perceived mobility, and QOL. Our objectives were to examine whether participants who had undergone bariatric surgery (n = 25; laparoscopic Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding) demonstrate improvements in joint pain, gait (speed, stride/step length, width of base of support, toe angles, single/double support, swing and stance time, functional ambulatory profile), mobility, and QOL by 3 months compared with nonsurgical controls (n = 20). The setting was an orthopedics laboratory at a university hospital in the United States. METHODS The present study was a prospective, comparative study. Numeric pain scales (indicating the presence and severity of pain), mobility-related surveys, and the Medical Outcomes Study short-form 36-item questionnaire (SF-36) were completed, and gait and walking speed were assessed at baseline and at month 3. RESULTS The bariatric group lost an average of 21.6 ± 7.7 kg. Significant differences existed between the 2 groups at month 3 in step length, heel to heel base of support, and the percentage of time spent in single and double support during the gait cycle (all P <.05). The severity of low back pain and knee pain decreased by 54% and 34%, respectively, with no changes in the control group (P = .05). The walking speed increased by 15% in the bariatric group (108-123 cm/s; P <.05) but not in the control group. Compared with the control group, fewer bariatric patients perceived limitations with walking and stair climbing by month 3. The bariatric group had a 4.8-cm increase in step length, 2.6% increase in single support time during the gait cycle, and 2.5-cm reduction in the base of support (all P <.05). The SF-36 physical component scores increased 11.8 points in the bariatric group compared with the control group, which showed no improvement by month 3 (P <.0001). CONCLUSIONS Improvements in some, but not all, gait parameters, walking speed, and QOL and of perceived functional limitations occur by 3 months after a bariatric procedure.

Obesity and long term functional outcomes following elective total hip replacement.

IntroductionObesity rates continue to rise and more total hip arthroplasty procedures are being performed in progressively younger, obese patients. Hence, maintenance of long term physical function will become very important for quality of life, functional independence and hip prosthesis survival. Presently, there are no reviews of the long term efficacy of total hip arthroplasty on physical function. This review: 1) synopsized available data regarding obesity effects on long term functional outcomes after total hip arthroplasty, and 2) suggested future directions for research.MethodsA literature search was conducted from 1965 to January of 2011 for studies that evaluated long term functional outcomes at one year or longer after THA in obese (body mass index values ≥30 kg/m2) and non-obese patients (body mass index <30 kg/m2).ResultsFive retrospective studies and 18 prospective studies were identified as those that assessed physical function before surgery out to ≥ one year after total hip arthroplasty. Study sample sizes ranged from 108–18,968 and followed patients from one to twenty years. Total hip arthroplasty confers significant pain reduction and improvement in quality of life irrespective of body mass index. Functional improvement occurred after total hip arthroplasty among all studies, but obese patients generally did not attain the same level of physical function by the follow-up time point.DiscussionUncontrolled obesity after total hip arthroplasty is related to worsening of comorbidities and excessive health care costs over the long term. Aggressive and sustainable rehabilitation strategies that include physical exercise, psychosocial components and behavior modification may be highly useful in maximizing and maintaining weight loss after total hip arthroplasty.

Hyaluronic Acid (HA) Viscosupplementation on Synovial Fluid Inflammation in Knee Osteoarthritis: A Pilot Study

Objective: This study examined the changes in synovial fluid levels of cytokines, oxidative stress and viscosity six months after intraarticular hyaluronic acid (HA) treatment in adults and elderly adults with knee osteoarthritis (OA). Design: This was a prospective, repeated-measures study design in which patients with knee OA were administered 1% sodium hyaluronate. Patients (N=28) were stratified by age (adults, 50-64 years and elderly adults, ≥65 years). Ambulatory knee pain values and self-reported physical activity were collected at baseline and month six. Materials and Methods: Knee synovial fluid aspirates were collected at baseline and at six months. Fluid samples were analyzed for pro-inflammatory cytokines (interleukins 1β, 6,8,12, tumor necrosis factor-α, monocyte chemotactic protein), anti-inflammatory cytokines (interleukins 4, 10 13), oxidative stress (4-hydroxynonenal) and viscosity at two different physiological shear speeds 2.5Hz and 5Hz. Results: HA improved ambulatory knee pain in adults and elderly groups by month six, but adults reported less knee pain-related interference with participation in exercise than elderly adults. A greater reduction in TNF-α occurred in adults compared to elderly adults (-95.8% ± 7.1% vs 19.2% ± 83.8%, respectively; p=.044). Fluid tended to improve at both shear speeds in adults compared to the elderly adults. The reduction in pain severity correlated with the change in IL-1β levels by month six (r= -.566; p=.044). Conclusion: Reduction of knee pain might be due to improvements in synovial fluid viscosity and inflammation. Cartilage preservation may be dependent on how cytokine, oxidative stress profiles and viscosity change over time.

Functional Pain Severity and Mobility in Overweight Older Men and Women with Chronic Low Back Pain: Part I

ObjectiveThis study determined whether mobility and functional pain were different among older men and women with chronic low-back pain and varying body mass index levels. DesignThis was a comparative, descriptive study of older adults with obesity with low-back pain (N = 55; 60–85 yrs). The participants were stratified on the basis of body mass index: overweight (25–29.9 kg/m2), obese (30–34.9 kg/m2), and severely obese (35 kg/m2). The participants completed a functional test battery (walking endurance, chair rise, stair climb, 7-day activity monitoring, and gait parameters) and pain ratings with activity (“functional pain”). ResultsThe functional pain scores during walking and stair climb were highest in the severely obese group compared with the overweight group (P < 0.05), but the functional test scores were not found to be significantly different by body mass index. Gait base of support was 36% greater and single/double support times were 3.1%–6.1% greater in the severely obese group compared with the overweight group (P < 0.05). The women had slower chair rise and stair climb times and had slower walking velocity than did the men. Daily step numbers were lowest in the severely obese group compared with the obese and overweight groups (2971 vs. 3511 and 4421 steps per day; P < 0.05) but were not different by sex. Normalized lumbar extensor, abdominal curl, and leg press strength values were lowest in the severely obese group, and the women had 18%–34% lower strength values than did the men for all three exercises (P < 0.05). Lumbar strength was associated with stair climb, chair rise, and walking endurance times. Body mass index was an independent predictor of walking endurance time but not of steps taken per day. ConclusionsIn this study, the persons with obesity reported higher functional pain values during walking and stair climb and had lower lumbar strength compared with the overweight participants. Rehabilitation strategies that include lumbar extensor strengthening may help improve functional mobility and walking duration, both of which can help with weight management in older adults with obesity with chronic low-back pain.

Resistance Exercise, Disability, and Pain Catastrophizing in Obese Adults with Back Pain

PURPOSE The purpose of this study was to compare the effects of two different resistance exercise protocols on self-reported disability, fear avoidance beliefs, pain catastrophizing, and back pain symptoms in obese, older adults with low back pain (LBP). METHODS Obese adults (n = 49, 60-85 yr) with chronic LBP were randomized into a total body resistance exercise intervention (TOTRX), lumbar extensor exercise intervention (LEXT), or a control group (CON). Main outcomes included perceived disability (Oswestry Disability Index, Roland Morris Disability Questionnaire). Psychosocial measures included the Fear Avoidance Beliefs survey, Tampa Scale of Kinesiophobia, and Pain Catastrophizing Scale. LBP severity was measured during three functional tasks: walking, stair climbing, and chair rise using an 11-point numerical pain rating scale. RESULTS The TOTRX group had greater reductions in self-reported disability scores due to back pain (Oswestry Disability Index, Roland Morris Disability Questionnaire) compared with those in the LEXT (P < 0.05). The Pain Catastrophizing Scale scores decreased in the TOTRX group compared with that in the CON group by month 4 (64.3% vs 4.8%, P < 0.05). Pain severity during chair rise activity and walking was decreased in both the LEXT and TOTRX groups relative to the CON group. CONCLUSIONS Greater reductions in perceived disability due to LBP can be achieved with TOTRX compared with those achieved with LEXT. Pain catastrophizing and pain severity decreased most with TOTRX. The positive change in psychological outlook may assist obese, older adults with chronic back pain in reconsidering the harmfulness of the pain and facilitate regular participation in other exercise programs.

Back Strength Predicts Walking Improvement in Obese, Older Adults With Chronic Low Back Pain

To compare the effects of 4 months of isolated lumbar resistance exercise and total body resistance exercise on walking performance in obese, older adults with chronic low back pain. A secondary analysis examined whether responsiveness to training modulated walking improvement.

Effects of obesity on rehabilitation outcomes after orthopedic trauma.

Objective This study examined whether differences existed in inpatient rehabilitation outcomes and therapy participation in nonobese and obese patients with orthopedic trauma. Design This was a retrospective study of 294 consecutive patients admitted to an inpatient rehabilitation hospital. Main outcomes included participation in therapy sessions, Functional Independence Measure (FIM) ratings, walking distance and stair climb, length of stay, FIM efficiency (FIM score gain/length of stay), and discharge to home. Data were stratified by patient body mass index values (nonobese, <30 kg/m2; or obese, ≥30 kg/m2). Results There were no differences in therapy participation or length of stay between groups. Both total and motor FIM ratings at discharge were lower in obese patients compared with nonobese patients (P < 0.05). FIM efficiency was significantly lower in the obese than in the nonobese group (2.6 ± 1.5 vs. 3.1 ± 1.5 points gained per day; P = 0.05). Walking distance and stair climb ability were similar between groups by discharge. Even morbidly obese patients attained some improvement with independence in walking. Conclusions Obese patients make significant functional improvement during rehabilitation, but at a lesser magnitude and rate as their nonobese counterparts. Even with morbid obesity, small but important functional gains can occur during rehabilitation for orthopedic trauma.

Kinesiophobia and Fear Avoidance Beliefs in Overweight Older Adults with Chronic Low Back Pain, Relationship to Walking Endurance: Part II

ObjectiveThis study determined whether kinesiophobia levels were different among older adults with chronic low back pain (LBP) and varying body mass index and whether kinesiophobia predicted perceived disability or walking endurance. DesignThis study was a secondary analysis from a larger interventional study. Older adults with obesity with LBP (N = 55; 60–85 yrs) were participants in this study. Data were stratified on the basis of body mass index: overweight (25–29.9 kg/m2), obese (30–34.9 kg/m2), and severely obese (35 kg/m2). The participants completed a battery of surveys (the modified Tampa Scale of Kinesiophobia [TSK-11], the Fear-Avoidance Beliefs Questionnaire, the Pain Catastrophizing Scale, and the perceived disability measures of the Oswestry Disability Index and the Roland Morris Disability Questionnaire). Walking endurance time was captured using a symptom-limited graded walking treadmill test. The peak LBP ratings were captured during the walk test. ResultsWalking endurance times did not differ by body mass index group, but the peak LBP ratings were higher in the moderately and severely obese groups compared with the overweight group (3.0 and 3.1 vs. 2.1 points; P < 0.05). There was no difference in the kinesiophobia scores (the TSK-11, the Pain Catastrophizing Scale, and the Fear-Avoidance Beliefs Questionnaire work and activity subscores) or the perceived disability scores (the Oswestry Disability Index and the Roland Morris Disability Questionnaire). However, adjusted regression analyses revealed that the TSK-11 scores contributed 10%–21% of the variance of the models pain with walking and perceived disability caused by back pain. Kinesiophobia was not a significant contributor to the variance of the regression model for walking endurance. ConclusionsIn the older population with obesity with LBP, the TSK-11 might be a quick and simple measure to identify patients at risk for poor self-perception of functional ability. The TSK and the Oswestry Disability Index may be quick useful measures to assess initial perceptions before rehabilitation. Kinesiophobia may be a good therapeutic target to address to help affected older adults with obesity fully engage in therapies for LBP.

Associations of self-report measures with gait, range of motion and proprioception in patients with lumbar spinal stenosis

INTRODUCTION Spinal stenosis is defined as neurogenic claudication due to narrowing of the spinal canal lumen diameter. As the disease progresses, ambulation and gait may be impaired. Self-report measures are routinely used in the clinical setting to capture data related to lumbar pain symptoms, function and perceived disability. The associations between self-report measures and objective measures of physical function in patients with lumbar spinal stenosis are not well characterized. The purpose of this study was to determine the correlation between self-reported assessments of function with objective biomechanical measures of function. METHODS 25 subjects were enrolled in this study. Subjects completed self-report questionnaires and biomechanical assessments of gait analysis, lumbar 3D ROM and lumbar proprioception. Correlations were determined between self-report measures and biomechanical data. RESULTS The Oswestry Disability Index (ODI) was strongly correlated with stride length and gait velocity and weakly correlated with base of support. ODI was also weakly correlated with left lateral bending proprioception but not right lateral bending. The SF12 was not significantly correlated with any of the biomechanical measurements. Pain scores were weakly correlated with velocity, and base of support, and had no correlation any of the other biomechanical measures. DISCUSSION There is a strong correlation between gait parameters and functional disability as measured with the ODI. Quantified gait analysis can be a useful tool to evaluate patients with lumbar spinal stenosis and to assess the outcomes of treatments on this group of patients.

“Functional Pain,” Functional Outcomes, and Quality of Life After Hyaluronic Acid Intra-articular Injection for Knee Osteoarthritis

To compare the effect of hyaluronic acid (HA) intra‐articular knee injections on pain and functional outcomes in persons with knee osteoarthritis (OA) over 6 months, and to determine whether or not changes in functional pain are related to improvements in quality of life.