Anna L. Hatton

The effect of textured surfaces on postural stability and lower limb muscle activity.

Textured insoles may enhance sensory input on the plantar surfaces of the feet, thereby influencing neuromuscular function. The aim of this study was to investigate whether textured surfaces alter postural stability and lower limb muscle activity during quiet bipedal standing balance with eyes open. Anterior-posterior (AP) and mediolateral (ML) sway variables and the intensity of electromyographic (EMG) activity in eight dominant lower limb muscles were collected synchronously over 30s in 24 young adults under three randomised conditions: control surface (C), texture 1 (T1) and texture 2 (T2). Repeated measures ANOVA showed that the textured surfaces did not significantly affect AP or ML postural sway in comparison to the control condition (p>0.05). Neither did the textured surfaces significantly alter EMG activity in the lower limbs (p>0.05). Under the specific conditions of this study, texture did not affect either postural sway or lower limb muscle activity in static bipedal standing. The results of this study point to three areas of further work including the effect of textured surfaces on postural stability and lower limb muscle activity: (i) in young healthy adults under more vigorous dynamic balance tests, (ii) post-fatigue, and (iii) in older adults presenting age-related deterioration.

Standing on textured surfaces: effects on standing balance in healthy older adults

BACKGROUND standing on textured surfaces or wearing textured shoe insoles can alter balance performance. This evidence, although inconclusive, offers a potential intervention for improving balance in older adults. This study explored the effect of standing on textured surfaces on double-limb balance in older adults and changes in muscle activity as a possible mechanism of effect. METHODS 50 healthy older adults (29 female, age mean [1SD] 75.1 [5.0]) stood quietly in six conditions-eyes open and closed on two different textured surfaces and a smooth surface control. Mediolateral sway, anterior-posterior sway and centre of pressure velocity were extracted from a force platform and lower limb muscle activity collected using surface electromyography (EMG) over 30 s. RESULTS for mediolateral range with eyes closed, there was a statistically significant effect of texture (F [2, 47] = 3.840, P = 0.033). This was attributed to a 9.2% decrease with Texture 1 compared with Control. No such effects were seen in any other balance variable or lower limb EMG activity for either visual condition. CONCLUSION the results suggest an effect of standing on textured surfaces on mediolateral sway in older adults, supporting further work to develop the therapeutic benefits of textured surfaces as an intervention to improve balance.

Hip Arthroscopy in the Setting of Hip Osteoarthritis: Systematic Review of Outcomes and Progression to Hip Arthroplasty

BackgroundHip arthroscopy is now commonly used to treat hip pain and pathology, including osteoarthritis (OA). Despite this, little is known about the effect of hip arthroscopy on outcomes of pain and function and progression to total hip arthroplasty (THA) in hip OA.Questions/purposesThis systematic review aimed to (1) determine pain and function outcomes after hip arthroscopy in people with hip OA; (2) compare the outcome after hip arthroscopy between people with and without hip OA; and (3) report the likelihood of progression to THA in patients with hip OA after hip arthroscopy.MethodsThis review was conducted in accordance with the PRISMA statement. The Downs and Black checklist was used for quality appraisal. Studies scoring positively on at least 50% of items were included in final analyses. Standardized mean differences (SMDs) were calculated where possible or study conclusions are presented.ResultsTwenty-two studies were included in the final analyses. Methodological quality and followup time varied widely. Moderate to large SMDs were reported for people with and without hip OA; however, the positive effects of the intervention were smaller for people with hip OA. Greater severity of hip OA and older age each predicted more rapid progression to THA.ConclusionsPatients with hip OA report positive outcomes from hip arthroscopy, although observed positive effects may be inflated as a result of methodological limitations of the included studies. Patients with hip OA had inferior results compared with those who did not. Chondropathy severity and patient age were associated with a higher risk and more rapid progression to THA. High-quality comparative studies are required to confirm the effects of hip arthroscopy on symptoms and structural change in people with hip OA.

Altering gait by way of stimulation of the plantar surface of the foot: the immediate effect of wearing textured insoles in older fallers

BackgroundEvidence suggests that textured insoles can alter gait and standing balance by way of enhanced plantar tactile stimulation. However, to date, this has not been explored in older people at risk of falling. This study investigated the immediate effect of wearing textured insoles on gait and double-limb standing balance in older fallers.MethodsThirty older adults >65 years (21 women, mean [SD] age 79.0 [7.1]), with self-reported history of ≥2 falls in the previous year, conducted tests of level-ground walking over 10 m (GAITRite system), and double-limb standing with eyes open and eyes closed over 30 seconds (Kistler force platform) under two conditions: wearing textured insoles (intervention) and smooth (control) insoles in their usual footwear.ResultsWearing textured insoles caused significantly lower gait velocity (P = 0.02), step length (P = 0.04) and stride length (P = 0.03) compared with wearing smooth insoles. No significant differences were found in any of the balance parameters (P > 0.05).ConclusionsA textured insole worn by older adults with a history of falls significantly lowers gait velocity, step length and stride length, suggesting that this population may not have an immediate benefit from this type of intervention. The effects of prolonged wear remain to be investigated.

Footwear interventions: a review of their sensorimotor and mechanical effects on balance performance and gait in older adults.

Footwear interventions, including shoe insoles and foot orthoses, have the capacity to enhance balance control and gait in older people. This review assessed the evidence for the effect of footwear interventions on static and dynamic balance performance and gait in older populations and explored proposed theories for underlying sensorimotor and mechanical mechanisms. We searched the Medline, EMBASE, CINAHL (the Cumulative Index to Nursing and Allied Health Literature), and AMED databases and conducted hand searches. Of 115 relevant articles screened, 14 met the predefined inclusion criteria. Articles were grouped into one of three categories based on balance task (static balance performance during quiet standing, dynamic balance performance during walking, and dynamic balance performance during perturbed standing or functional tasks) and were scored for methodological quality using the Downs and Black Quality Index tool. Footwear interventions seem to alter underlying strategies controlling static and dynamic movement patterns through a combination of sensorimotor and mechanical mechanisms in older people, including those with chronic sensory and musculoskeletal conditions. Evidence shows a consistent trend toward footwear interventions markedly improving lateral stability measures, which are predictors of falls in the elderly. In-depth investigation of neurophysiologic responses to footwear interventions is necessary to help confirm any sensorimotor adaptations. The long-term effects of footwear interventions on balance, gait, and the prevention of falls in older people require further investigation.

Impairment of Dynamic Single-Leg Balance Performance in Individuals With Hip Chondropathy

Impaired balance control has been reported in the elderly with hip osteoarthritis, yet this relationship has not been explored in young adults with hip chondropathy. This study aimed to determine whether people with hip chondropathy demonstrated impaired balance ability during a dynamic single‐leg squat with eyes open (SquatEO) and a single‐leg standing task with eyes closed (StandEC) and whether hip range of motion (ROM) and hip muscle strength were correlated with balance measures in adults with hip chondropathy.

Effect of textured insoles on balance and gait in people with multiple sclerosis: an exploratory trial.

OBJECTIVES To investigate the immediate effects of textured insoles on balance and gait in people with multiple sclerosis (MS), and to explore any effects after 2 weeks of wear. STUDY DESIGN Within-session repeated-measures design with an exploratory follow-up period. SETTING Hospital gait laboratory. PARTICIPANTS Forty-six individuals with MS (34 females, 12 males), with a mean (SD) age of 49 (7) years, who could walk 100m unassisted or using one stick/crutch. INTERVENTION Participants were tested wearing three types of insoles in a random order: control (smooth), Texture 1 (Algeos) or Texture 2 (Crocs™). Participants were allocated at random to wear one type of textured insoles for 2 weeks, after which they were retested. MAIN OUTCOME MEASURES Standing balance (centre of pressure excursions and velocity) was measured with eyes open and eyes closed on a Kistler force platform. Spatio-temporal parameters of gait were measured using a GAITRite system. RESULTS The textured insoles had no significant immediate effects on balance or gait, apart from an increase in anteroposterior sway range with eyes open for Texture 2 insoles [mean difference 4.5 (95% confidence interval 0.6 to 8.4)mm]. After 2 weeks, balance was not significantly different, but both types of textured insoles showed significant effects on spatio-temporal parameters of gait, with mean stride length increases of 3.5cm (Texture 1) and 5.3cm (Texture 2) when wearing the insoles. CONCLUSIONS After 2 weeks of wear, there were improvements in spatio-temporal parameters of gait. However, it is unclear whether this was a placebo effect or a learning effect.

Rollover footwear affects lower limb biomechanics during walking

AIM To investigate the effect of rollover footwear on walking speed, metabolic cost of gait, lower limb kinematics, kinetics, EMG muscle activity and plantar pressure. METHODS Twenty subjects (mean age-33.1 years, height-1.71 m, body mass-68.9 kg, BMI 23.6, 12 male) walked in: a flat control footwear; a flat control footwear weighted to match the mass of a rollover shoe; a rollover shoe; MBT footwear. Data relating to metabolic energy and temporal aspects of gait were collected during 6 min of continuous walking, all other data in a gait laboratory. RESULTS The rollover footwear moved the contact point under the shoe anteriorly during early stance, increasing midfoot pressures. This changed internal ankle dorsiflexion moments to plantarflexion moments earlier, reducing ankle plantarflexion and tibialis anterior activity after initial contact, and increasing calf EMG activity. In mid stance the rollover footwear resulted in a more dorsiflexed ankle position but less ankle movement. During propulsion, the rollover footwear reduced peak ankle dorsiflexion, peak internal plantarflexor ankle moments and the range of ankle plantarflexion. Vertical ground reaction loading rates were increased by the rollover footwear. There were no effects on temporal or energy cost of gait and no effect of elevated shoe weight. CONCLUSION Investigating all proposed effects of this footwear concurrently has enabled a more valid investigation of how the footwear effects are interrelated. There were concurrent changes in several aspects of lower limb function, with greatest effects at the foot and ankle, but no change in the metabolic cost of walking.

Use of Condition-Specific Patient-Reported Outcome Measures in Clinical Trials among Patients with Wrist Osteoarthritis: A Systematic Review

Background. This paper aimed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer-reviewed evidence supporting their reliability, validity, and responsiveness to change. Methods. A systematic review of randomised controlled trials among people with wrist osteoarthritis was undertaken. Studies reporting reliability, validity, or responsiveness were identified using a systematic reverse citation trail audit procedure. Psychometric properties of the instruments were examined against predefined criteria and summarised. Results. Thirteen clinical trials met inclusion criteria. The most common patient-reported outcome was the disabilities of the arm, shoulder, and hand questionnaire (DASH). The DASH, the Michigan Hand Outcomes Questionnaire (MHQ), the Patient Evaluation Measure (PEM), and the Patient-Reported Wrist Evaluation (PRWE) had evidence supporting their reliability, validity, and responsiveness. A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis Hand Index as another suitable instrument that had favourable reliability, validity, and responsiveness. Conclusions. The DASH, MHQ, and AUSCAN Osteoarthritis Hand Index instruments were supported by the most favourable empirical evidence for validity, reliability, and responsiveness. The PEM and PRWE also had favourable empirical evidence reported for these elements. Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted.

The formation of friction blisters on the foot: the development of a laboratory-based blister creation model

Friction blisters on the foot are a debilitating pathology that have an impact on activities of daily living and can severely impair function. The purpose of this study was to test the hypotheses that digital infrared thermographic imaging will reveal: 1) a correlation between load application to the skin and the creation of blisters, and 2) a correlation between thermographic readings and contact thermometric temperatures.