Federico Pozzi

Relationship between Physical Impairments and Movement Patterns During Gait in Patients With End-stage Hip Osteoarthritis

Patients with hip osteoarthritis demonstrate limited range of motion, muscle weakness, and altered biomechanics; however, few studies have evaluated the relationships between physical impairments and movement asymmetries. The purpose of this study was to identify the physical impairments related to movement abnormalities in patients awaiting total hip arthroplasty. We hypothesized that muscle weakness and pain would be related to greater movement asymmetries. Fifty‐six subjects who were awaiting total hip arthroplasty were enrolled. Pain was assessed using a 0–10 scale, range of motion was assessed with the Harris Hip Score and isometric hip abductor strength was tested using a hand‐held dynamometer. Trunk, pelvis and hip angles and moments in the frontal and sagittal planes were measured during walking using three dimensional motion analysis. During gait, subjects had 3.49 degrees less peak hip flexion and 8.82 degrees less extension angles (p < 0.001) and had 0.03 Nm/k*m less hip adduction moment on the affected side (p = 0.043). Weaker hip muscles were related to greater pelvis (r = −0.291) and trunk (r = −0.332) rotations in the frontal plane. These findings suggest that hip weakness drives abnormal movement patterns at the pelvis and trunk in patients with hip osteoarthritis to a greater degree than hip pain.

Biofeedback to Promote Movement Symmetry After Total Knee Arthroplasty: A Feasibility Study

STUDY DESIGN Prospective analysis of a longitudinal cohort with an embedded comparison group at a single time point. OBJECTIVES To determine the feasibility and effectiveness of an outpatient rehabilitation protocol that includes movement symmetry biofeedback on functional and biomechanical outcomes after total knee arthroplasty (TKA). BACKGROUND TKA reduces pain and improves functional ability, but many patients experience strength deficits and movement abnormalities in the operated limb, despite outpatient rehabilitation. These asymmetries increase load on the nonoperated limb, and greater asymmetry is related to worse functional outcomes. METHODS Biomechanical and functional metrics were assessed 2 to 3 weeks prior to TKA, at discharge from outpatient physical therapy, and 6 months after TKA in 11 patients (9 men, 2 women; mean ± SD age, 61.4 ± 5.8 years; body mass index, 33.1 ± 5.4 kg/m2) who received 6 to 8 weeks of outpatient physical therapy that included specialized symmetry training. Six-month outcomes were compared to a control group, matched by age, body mass index, and sex (9 men, 2 women; mean ± SD age, 61.8 ± 5 years; body mass index, 34.3 ± 5.1 kg/m2), that did not receive specialized symmetry retraining. RESULTS Of the 11 patients who received added symmetry training, 9 demonstrated clinically meaningful improvements that exceeded the minimal detectable change for all performance-based functional tests at 6 months post-TKA compared to pre-TKA. Six months after TKA, when walking, patients who underwent symmetry retraining had greater knee extension during midstance and had mean sagittal knee moments that were more symmetrical, biphasic, and more representative of normal knee kinetics compared to patients who did not undergo symmetry training. No patients experienced adverse events as the result of the protocol. CONCLUSION Adding symmetry retraining to postoperative protocols is clinically viable, safe, and may have additional benefits compared to rehabilitation protocols that focus on range of motion, strength, and return to independence. LEVEL OF EVIDENCE Therapy, level 4.

Relationship between biomechanical asymmetries during a step up and over task and stair climbing after total knee arthroplasty

BACKGROUND Patients six months after total knee arthroplasty (TKA) demonstrate movement asymmetries and functional deficits, which may be related to poor functional performance. The aims of this study were to 1) compare biomechanical variables between subjects 6 months after TKA and an age-matched healthy control group during a step up and over task and 2) determine the relationship between quadriceps strength, movement patterns and stair climbing performance. METHODS Twenty patients 6 months following unilateral TKA and twenty healthy controls were enrolled. Participants completed questionnaires, isometric quadriceps strength testing and performance based tests to quantify functional performance. Motion analysis was performed during a step up and over task. Functional and biomechanical variables were analyzed using a 2 × 2 ANOVA. The symmetry ratios (operated/non-operated limb*100) for biomechanical variables were analyzed using independent t-tests. Pearson correlations were performed to determine the relationships between biomechanical variables, strength and stair climbing performance. FINDINGS In the TKA group, subjects had lower peak moments, power and sagittal plane excursion in the operated knee compared to the contralateral knee (P<0.05), while the hip on the operated side had greater power generation (P = 0.014). Compared to the control group, all symmetry ratios were significantly lower in the surgical group (P < 0.05). Stair climbing time was correlated with quadriceps strength of the operated limb (R = -0.762, P < 0.001). INTERPRETATION Individuals 6 months after TKA had worse performance with respect to biomechanics, quadriceps strength, and performance-based tests. Biomechanical asymmetries after TKA reduce the demand on the operated knee and increase reliance on the contralateral limb and ipsilateral hip.

Sit-To-Stand Biomechanics Before and After Total Hip Arthroplasty.

The purpose of this study was to evaluate changes in movement patterns during a sit-to-stand (STS) task before and after total hip arthroplasty (THA), and to compare biomechanical outcomes after THA to a control group. Forty-five subjects who underwent THA and twenty-three healthy control subjects participated in three-dimensional motion analysis. Pre-operatively, subjects exhibited inter-limb movement asymmetries with lower vertical ground reaction force (VGRF) and smaller moments on the operated limb. Although there were significant improvements in movement symmetry 3 months after THA, patients continued to demonstrate lower VGRF and smaller moments on the operated limb compared to non-operated and to control limbs. Future studies should identify the contributions of physical impairments and the influence of surgical approach on STS biomechanics.

Relationship Between Strength, Pain, and Different Measures of Functional Ability in Patients With End‐Stage Hip Osteoarthritis

Performance tests and self‐reported questionnaires capture different domains of function in patients with lower extremity osteoarthritis, but the impairments related to each of these domains have not been elucidated. The purpose of this study was to determine how strength and joint pain influence performance‐based tests and self‐reported questionnaires of functional ability of individuals with end‐stage hip osteoarthritis.

Validity and Reliability of a Commercial Fitness Watch for Measuring Running Dynamics

Study Design Validity and reliability study. Background Providing feedback on running mechanics is a common intervention to decrease the risk of injury or to restore running after an injury. Commercially available devices are able to measure running dynamics, such as cadence, ground contact time (GCT), and vertical oscillation (VO), but there is limited evidence on the validity and reliability of these measures. Objective To determine the validity and reliability of measures of cadence, GCT, and VO with a fitness watch compared to a motion-analysis system. Methods Twenty runners ran in 3 conditions: (1) baseline (self-selected speed and cadence), (2) higher cadence, and (3) decreased vertical motion (minimal oscillation). Ten runners also performed an additional baseline running session to measure intrasession reliability. For each condition, the average cadence, GCT, and VO were collected from a watch and from a motion-capture system. Intraclass correlation coefficients (ICCs) were used to assess validity between devices. An analysis of variance with 2 repeated measures was used to determine the ability of the watch and motion analysis to detect change in running dynamics. Results The ICCs between the 2 measuring systems were 0.931, 0.963, and 0.749 for cadence, VO, and GCT, respectively (P<.01). The minimal detectable changes at the 95% confidence interval for cadence, VO, and GCT were 2.53 steps per minute, 0.45 cm, and 0.01 seconds, respectively, for the watch. There were no interaction effects, but there was a main effect for condition; both devices detected changes in running dynamics. Conclusion The watch is a valid and reliable tool for detecting changes in cadence, VO, and GCT. J Orthop Sports Phys Ther 2016;46(6):471-476. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6391.

Neuromuscular control during stepping down in continuous gait in individuals with and without ankle instability

Abstract Ankle sprains are a common injury and those affected are at a risk of developing chronic ankle instability (CAI). Complications of an acute sprain include increased risk of re-injury and persistent disability; however, the exact link between ankle sprains and chronic instability has yet to be elucidated. The purpose of this study was to investigate neuromuscular control (including kinematics, kinetics and EMG) during stepping down from a curb, a common yet challenging daily activity, in persons with ankle instability (n = 11), those with a history of ankle sprain without persistent instability, called ankle sprain “copers” (CPRs) (n = 9) and uninjured controls (CTLs) (n = 13). A significant group difference was noted as the CPR group demonstrated increased tibialis anterior activity in both the preparatory (pre-touchdown) and reactive (post-touchdown) phases when compared to healthy and unstable groups (P < 0.05). It follows that the CPR group also demonstrated a significantly less plantar-flexed position at touchdown than the other two groups (P < 0.05). This is a more stable position to load the ankle and this strategy differed from that used by participants with CAI and uninjured CTLs. These findings provide insight into the neuromuscular control strategies of CPRs, which may allow them to more appropriately control ankle stability following sprains.

Strength and pain are related to different measures of functionalability in patients with end-stage hip osteoarthritis

Performance tests and self‐reported questionnaires capture different domains of function in patients with lower extremity osteoarthritis, but the impairments related to each of these domains have not been elucidated. The purpose of this study was to determine how strength and joint pain influence performance‐based tests and self‐reported questionnaires of functional ability of individuals with end‐stage hip osteoarthritis.

Relationship Between Strength, Pain, and Different Measures of Functional Ability in Patients With End-Stage Hip Osteoarthritis: Pain, Weakness, and Functional Deficits in Hip OA

Performance tests and self‐reported questionnaires capture different domains of function in patients with lower extremity osteoarthritis, but the impairments related to each of these domains have not been elucidated. The purpose of this study was to determine how strength and joint pain influence performance‐based tests and self‐reported questionnaires of functional ability of individuals with end‐stage hip osteoarthritis.