James Selfe

IMPAIRMENTS, ACTIVITY LIMITATIONS AND PARTICIPATION RESTRICTIONS 6 AND 12 MONTHS AFTER BREAST CANCER OPERATION

OBJECTIVE To describe the impairments of upper body and limbs, activity limitations and participation restrictions 6 and 12 months after operation for breast cancer and to examine the impact of impairments on activity limitations. DESIGN A prospective survey 6 and 12 months after operation. PATIENTS Ninety-six breast cancer patients. METHODS A questionnaire for assessing the impairments, activity limitations and participation restrictions was developed. RESULTS The most common impairments 6 months after operation were breast and axilla scar tightness, axilla oedema and neck-shoulder pain. At 12-month follow-up the breast scar tightness (p=0.008) and axilla oedema (p=0.023) decreased, and limb ache (p=0.005) increased significantly. The most limiting impairments were axilla oedema and limb numbness 6 months after operation, and at 12-month follow-up axilla oedema. Lifting, carrying and reaching out caused worsening of impairments to more than half of the respondents at 6-month follow-up. Regression analysis showed that many impairments together were determinants of activity limitations and sleep impairment. Participation restrictions were constant. Respondents had not given up participation in activities in the home, but some had abandoned leisure activities and felt that their work ability had decreased. CONCLUSION Impairments and their impact on activities were frequent and constant. There is an urgent need for developing rehabilitation protocols for breast cancer patients.

Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review

BackgroundPatellofemoral osteoarthritis (PFOA) is a common form of knee OA in middle and older age, but its relation to PF disorders and symptoms earlier in life is unclear. Our aim was to conduct a systematic review to investigate the strength of evidence for an association between anterior knee pain (AKP) in younger adults and subsequent PFOA.MethodsThe search strategy included electronic databases (Pubmed, EMBASE, AMED, CINAHL, Cochrane, PEDro, SportDiscus: inception to December 2009), reference lists of potentially eligible studies and selected reviews. Full text articles in any language, - identified via English titles and abstracts, were included if they were retrospective or prospective in design and contained quantitative data regarding structural changes indicative of PFOA, incident to original idiopathic AKP. Eligibility criteria were applied to titles, abstracts and full-texts by two independent reviewers. Data extraction included study location, design, date, sampling procedure, sample characteristics, AKP/PFOA definitions, follow-up duration and rate, and main findings. Foreign language articles were translated into English prior to examination.ResultsSeven articles satisfied eligibility (5 English, 2 German). Only one case-control study directly investigated a link between PFOA and prior AKP, providing level 3b evidence in favour of an association (OR 4.4; 95%CI 1.8, 10.6). Rough estimates of the annual risk of PFOA from the remaining six small, uncontrolled, observational studies (mean follow-up range: 5.7 to 23 years) ranged from 0% to 3.4%. This was not the primary aim of these studies, and limitations in design and methodology mean this data should be interpreted with caution.ConclusionsThere is a paucity of high-quality evidence reporting a link between AKP and PFOA. Further, well-designed cohort studies may be able to fill this evidence gap.

2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures

Patellofemoral pain (PFP) typically presents as diffuse anterior knee pain, usually with activities such as squatting, running, stair ascent and descent. It is common in active individuals across the lifespan,1–4 and is a frequent cause for presentation at physiotherapy, general practice, orthopaedic and sports medicine clinics in particular.5 ,6 Its impact is profound, often reducing the ability of those with PFP to perform sporting, physical activity and work-related activities pain-free. Increasing evidence suggests that it is a recalcitrant condition, persisting for many years.7–9 In an attempt to share recent innovations, build on the first three successful biennial retreats and define the ‘state of the art’ for this common, impactful condition; the 4th International Patellofemoral Pain Research Retreat was convened. The 4th International Patellofemoral Research Retreat was held in Manchester, UK, over 3 days (September 2–4th, 2015). After undergoing peer-review for scientific merit and relevance to the retreat, 67 abstracts were accepted for the retreat (50 podium presentations, and 17 short presentations). The podium and short presentations were grouped into five categories; (1) PFP, (2) factors that influence PFP (3) the trunk and lower extremity (4) interventions and (5) systematic analyses. Three keynote speakers were chosen for their scientific contribution in the area of PFP. Professor Andrew Amis spoke on the biomechanics of the patellofemoral joint. Professor David Felson spoke on patellofemoral arthritis,10 and Dr Michael Ratleffs keynote theme was PFP in the adolescent patient.11 As part of the retreat, we held structured, whole-group discussions in order to develop consensus relating to the work presented at the meeting as well as evidence gathered from the literature. ### Consensus development process In our past three International Patellofemoral Research Retreats, we developed a consensus statement addressing different presentation categories.12–14 In Manchester in 2015, we revised the format. For the exercise and …

Muscle, Skin and Core Temperature after −110°C Cold Air and 8°C Water Treatment

The aim of this investigation was to elucidate the reductions in muscle, skin and core temperature following exposure to −110°C whole body cryotherapy (WBC), and compare these to 8°C cold water immersion (CWI). Twenty active male subjects were randomly assigned to a 4-min exposure of WBC or CWI. A minimum of 7 days later subjects were exposed to the other treatment. Muscle temperature in the right vastus lateralis (n = 10); thigh skin (average, maximum and minimum) and rectal temperature (n = 10) were recorded before and 60 min after treatment. The greatest reduction (P<0.05) in muscle (mean ± SD; 1 cm: WBC, 1.6±1.2°C; CWI, 2.0±1.0°C; 2 cm: WBC, 1.2±0.7°C; CWI, 1.7±0.9°C; 3 cm: WBC, 1.6±0.6°C; CWI, 1.7±0.5°C) and rectal temperature (WBC, 0.3±0.2°C; CWI, 0.4±0.2°C) were observed 60 min after treatment. The largest reductions in average (WBC, 12.1±1.0°C; CWI, 8.4±0.7°C), minimum (WBC, 13.2±1.4°C; CWI, 8.7±0.7°C) and maximum (WBC, 8.8±2.0°C; CWI, 7.2±1.9°C) skin temperature occurred immediately after both CWI and WBC (P<0.05). Skin temperature was significantly lower (P<0.05) immediately after WBC compared to CWI. The present study demonstrates that a single WBC exposure decreases muscle and core temperature to a similar level of those experienced after CWI. Although both treatments significantly reduced skin temperature, WBC elicited a greater decrease compared to CWI. These data may provide information to clinicians and researchers attempting to optimise WBC and CWI protocols in a clinical or sporting setting.

A blinded, randomized, controlled trial assessing conservative management strategies for frozen shoulder

BACKGROUND There is little evidence for the optimal form of nonoperative treatment in the management of frozen shoulder. This study assesses the efficacy of current physiotherapy strategies. METHODS All primary care referrals of frozen shoulder to our physiotherapy department were included during a 12-month period. Of these referrals, 17% met the inclusion criteria for primary idiopathic frozen shoulder. The 75 patients were randomly assigned to 1 of 3 groups: group exercise class, individual physiotherapy, and home exercises alone. A single independent physiotherapist, who was blinded to the treatment groups, made all assessments. Range of motion, Constant score, Oxford Shoulder Score, Short Form 36, and Hospital Anxiety and Disability Scale (HADS) outcome measures were performed at baseline, 6 weeks, 6 months, and 1 year. RESULTS The exercise class group improved from a mean Constant score of 39.8 at baseline to 71.4 at 6 weeks and 88.1 at 1 year. There was a significant improvement in shoulder symptoms on Oxford and Constant scores (P < .001). This improvement was greater than with individual physiotherapy or home exercises alone (P < .001). The improvement in range of motion was significantly greater in both physiotherapy groups over home exercises (P < .001). HADS scores significantly improved during the course of treatment (P < .001). The improvement in HADS anxiety score was significantly greater in both physiotherapy intervention groups than in home exercises alone. CONCLUSIONS A hospital-based exercise class can produce a rapid recovery from a frozen shoulder with a minimum number of visits to the hospital and is more effective than individual physiotherapy or a home exercise program.

The effect of three different (-135°C) whole body cryotherapy exposure durations on elite rugby league players.

Background Whole body cryotherapy (WBC) is the therapeutic application of extreme cold air for a short duration. Minimal evidence is available for determining optimal exposure time. Purpose To explore whether the length of WBC exposure induces differential changes in inflammatory markers, tissue oxygenation, skin and core temperature, thermal sensation and comfort. Method This study was a randomised cross over design with participants acting as their own control. Fourteen male professional first team super league rugby players were exposed to 1, 2, and 3 minutes of WBC at −135°C. Testing took place the day after a competitive league fixture, each exposure separated by seven days. Results No significant changes were found in the inflammatory cytokine interleukin six. Significant reductions (p<0.05) in deoxyhaemoglobin for gastrocnemius and vastus lateralis were found. In vastus lateralis significant reductions (p<0.05) in oxyhaemoglobin and tissue oxygenation index (p<0.05) were demonstrated. Significant reductions (p<0.05) in skin temperature were recorded. No significant changes were recorded in core temperature. Significant reductions (p<0.05) in thermal sensation and comfort were recorded. Conclusion Three brief exposures to WBC separated by 1 week are not sufficient to induce physiological changes in IL-6 or core temperature. There are however significant changes in tissue oxyhaemoglobin, deoxyhaemoglobin, tissue oxygenation index, skin temperature and thermal sensation. We conclude that a 2 minute WBC exposure was the optimum exposure length at temperatures of −135°C and could be applied as the basis for future studies.

Four Outcome Measures for Patellofemoral Joint Problems

Summary Background and Purpose This work represents part of a PhD project investigating outcome measures for patellofemoral joint problems – critical angle and angular velocity as measured by video analysis of an eccentric step test, a treadmill test and a Modified Functional Index Questionnaire (MFIQ). This paper presents the results of a clinical trial that investigated the issues of reliability, clinical sensitivity and agreement between the outcome measures. Methods A controlled repeated measures study was carried out in the physiotherapy department at Burnley General Hospital, where 88 patients were considered for inclusion. The patients were assessed using the four outcome measures at four separate visits. The first two assessments took place before treatment began (control period). Assessment 3 was on the day of discharge, and assessment 4 took place at three-month follow-up. Results Reliability was assessed during the pre-treatment control period using paired t-tests and no statistically significant changes in mean scores occurred. Clinical sensitivity was assessed by comparing the change in mean scores for each of the outcome measures to the 95% CI obtained during the pre-treatment control period. Only the MFIQ showed a mean change in score (13 points) that was greater than the 95% CI obtained during the control period (11.2 points). The level of agreement was assessed using a linear regression model with MFIQ as the primary response variable. Critical angle was not predictive of MFIQ scores. Angular velocity and the treadmill test together accounted for18% of the predicted change in MFIQ score. Conclusion Critical angle does not appear to be a useful outcome measure. Angular velocity and the treadmill test have potential but require further investigation. The MFIQ is the most useful with a change of 10 points probably being clinically significant. It is recommended that this questionnaire be used routinely by physiotherapists to measure outcome in patellofemoral patients.

AN EXPLORATORY THERMOGRAPHIC INVESTIGATION OF THE EFFECTS OF CONNECTIVE TISSUE MASSAGE ON AUTONOMIC FUNCTION

OBJECTIVE The purpose of this study was to measure effects of connective tissue massage (CTM) on the autonomic nervous system using thermography and physiological measurements. METHODS A repeated-measures design was used. The setting was a university laboratory. Skin temperature at the site of massage, blood pressure, heart rate, and dorsal foot temperature were measured in 8 healthy participants before CTM, immediately after, and at 15-minute intervals for 1 hour. RESULTS The effect of CTM on skin temperature was statistically significant, P = .011. Post hoc pairwise comparisons revealed that the 15-, 30-, 45-, and 60-minute data all differed significantly from the pre-CTM data (all P < .05) and also from the immediately post-CTM data (all P < .05). For diastolic blood pressure, the main analysis of variance showed a statistical significance at P = .062. For other variables, there was no evidence for an effect. CONCLUSIONS Evidence was seen of some effects of CTM on autonomic function. This is information that will increase our knowledge of how CTM affects the autonomic nervous system.

Exploratory study of a non-invasive method based on acoustic emission for assessing the dynamic integrity of knee joints

The paper presents the development of a new measurement system based on acoustic emission (AE) for assessing the dynamic integrity of knee joints, and the evaluation of its efficacy, through an exploratory study using healthy and osteoarthritic knees. For the former, the paper describes the system implemented to acquire joint angle-based AE and the protocol developed to obtain repeatable results. For the latter, the paper reports significant differences between healthy and osteoarthritic knees using statistical analysis of AE occurrence and distribution of AE features in different movement phases. Osteoarthritic knees are found to produce 6-10 times more acoustic emissions than healthy knees, with amplitudes which can be 20 dB higher, and durations which can be 10 times longer. These findings lead to a visual representation method of AE feature profiles based on multidimensional density of AE hits per repeated movement and the use of principal component analysis for objective assessment of the clinical status of knee joints.

A clinical study of the biomechanics of step descent using different treatment modalities for patellofemoral pain

INTRODUCTION In the previous study we have demonstrated that in healthy subjects significant changes in coronal and transverse plane mechanics can be produced by the application of a neutral patella taping technique and a patellar brace. Recently it has also been identified that patients with patellofemoral pain syndrome (PFPS) display alterations in gait in the coronal and transverse planes. OBJECTIVE This study investigated the effect of patellar bracing and taping on the three-dimensional mechanics of the knee of patellofemoral pain patients during a step descent task. METHOD Thirteen patients diagnosed with patellofemoral pain syndrome performed a slow step descent. This was conducted under three randomized conditions: (a) no intervention, (b) neutral patella taping, (c) patellofemoral bracing. A 20cm step was constructed to accommodate an AMTI force platform. Kinematic data were collected using a ten camera infra-red Oqus motion analysis system. Reflective markers were placed on the foot, shank and thigh using the Calibrated Anatomical System Technique (CAST). RESULTS The coronal plane knee range of motion was significantly reduced with taping (P=0.031) and bracing (P=0.005). The transverse plane showed a significant reduction in the knee range of motion with the brace compared to taping (P=0.032) and no treatment (P=0.046). CONCLUSION Patients suffering from patellofemoral pain syndrome demonstrated improved coronal plane and torsional control of the knee during slow step descent following the application of bracing and taping. This study further reinforces the view that coronal and transverse plane mechanics should not be overlooked when studying patellofemoral pain.