Jan Cabri

Cross-cultural adaptation and validation of the Portuguese version of the Knee injury and Osteoarthritis Outcome Score (KOOS).

OBJECTIVE The objective of this study was to translate and culturally adapt the Knee injury and Osteoarthritis Outcome Score (KOOS) to the Portuguese language and to test its reliability, validity, floor/ceiling effects and responsiveness. METHODS This new version was obtained with forward/backward translations, consensus panels and a pre-test. The Portuguese KOOS and Medical Outcomes Study - 36 item Short Form (SF-36) questionnaires, visual analogue scales (VAS) of pain, disability and discomfort, and a form for the characteristics of the patients were applied to 223 subjects with knee osteoarthritis (OA). RESULTS Reliability was acceptable with Cronbachs alpha coefficients between 0.77 and 0.95, and intraclass correlation coefficients (ICC) ranging from 0.82 to 0.94 for the KOOS subscales. Construct validity was supported by the confirmation of six of the seven predefined hypotheses involving expected correlations between KOOS subscales, SF-36 subscales and VAS. An additional predefined hypothesis was also confirmed with the subjects that need walking aids obtaining lower scores in all five KOOS subscales (P< or =0.001). Floor/ceiling effects were considered to be not present, except for the subscale function in sport and recreation (33.6% of the subjects reported worst possible score). Responsiveness to 4 weeks of physical therapy was demonstrated with standardized effect size between 0.78 and 1.08, and standardized response mean ranging from 0.83 to 1.37 for the KOOS subscales. CONCLUSION The Portuguese KOOS evidenced acceptable psychometric characteristics.

Does the brake response time of the right leg change after left total knee arthroplasty? A prospective study

Patients undergoing total knee arthroplasty often ask when they can safely resume car driving. There is little evidence available on which physicians can rely when advising patients on this issue. In a prospective study we assessed the brake response time of 24 patients admitted to the clinic for left total knee arthroplasty preoperatively and then 10 days after surgery. On each measurement day the patients performed two tasks, a simple and a complex brake response time task in a car simulator. Ten days after left TKA the brake response time for the simple task had decreased by 3.6% (p=0.24), the reaction time by 3.1% (p=0.34) and the movement time by 6.6% (p=0.07). However, the performance improvement was not statistically significant. Task complexity increased brake response time at both time points. A 5.8% increase was significant (p=0.01) at 10 days after surgery. Based on our results, we suggest that patients who have undergone left total knee arthroplasty may resume car driving 10 days after surgery as long as they drive a car with automatic transmission.

Golf-related injuries: A systematic review

Abstract A review was undertaken to assess the prevalence of musculoskeletal injuries in golf and to stimulate the discussion on possible injury mechanisms. The main conclusion of most published studies is that although professional and amateur golfers show a similar anatomical distribution of injuries by body segment, differences tend to be seen in the ranking of injury occurrence by anatomical site. This could be due to many things, including the players handicap, age, golf swing biomechanics, and training or playing habits. The impact of golf injuries deserves special attention due to the interaction of the nature of the injury, practice routines, amount of practice, handicap, and frequency of activity. Individual differences and clinical and coaching procedures deserve investigation. Other epidemiological information should be regarded as insufficient with respect to a full understanding of injury mechanisms, which can give us a better insight into the evolutionary nature of the injury. Also, a better understanding of golf swing mechanisms and individual neuromuscular aspects can help explain why some individuals are more injury-prone than others.

The Effects of Task Complexity on Brake Response Time Before and After Primary Right Total Knee Arthroplasty

OBJECTIVE To study the effects of an increase in task complexity on brake response time (BRT) in patients undergoing total knee arthroplasty (TKA). DESIGN A prospective repeated-measures design was used. The measurements took place 1 day before and 10 and 30 days after surgery. SETTING Clinic. PARTICIPANTS The data of patients (N=21) who were admitted for primary total arthroplasty of the right knee were pooled for analysis. INTERVENTIONS On each measurement day patients performed 5 practice and 10 test trials for 2 tasks (1 simple, 1 complex) in a car simulator. Task complexity was increased by adding a second movement to the first task performed. MAIN OUTCOME MEASURES BRT, reaction time (RT), and movement time were assessed. RESULTS An increase in task complexity increased BRT, RT, and movement time at all measurement times. Right TKA increased BRT by increasing movement time. Thirty days after surgery BRT was no longer increased compared with preoperative values in both tasks. CONCLUSIONS Task complexity consistently increased BRT and its components. The effects of task complexity remained constant throughout the 3 measurements. After right TKA, we suggest patients should be advised to wait 30 days after surgery before resuming driving.

Electromyography variables during the golf swing: A literature review

The aim of the study was to review systematically the literature available on electromyographic (EMG) variables of the golf swing. From the 19 studies found, a high variety of EMG methodologies were reported. With respect to EMG intensity, the right erector spinae seems to be highly activated, especially during the acceleration phase, whereas the oblique abdominal muscles showed moderate to low levels of activation. The pectoralis major, subscapularis and latissimus dorsi muscles of both sides showed their peak activity during the acceleration phase. High muscle activity was found in the forearm muscles, especially in the wrist flexor muscles demonstrating activity levels above the maximal voluntary contraction. In the lower limb higher muscle activity of the trail side was found. There is no consensus on the influence of the golf club used on the neuromuscular patterns described. Furthermore, there is a lack of studies on average golf players, since most studies were executed on professional or low handicap golfers. Further EMG studies are needed, especially on lower limb muscles, to describe golf swing muscle activation patterns and to evaluate timing parameters to characterize neuromuscular patterns responsible for an efficient movement with lowest risk for injury.

Reliability, validity and responsiveness of the Portuguese version of the Knee injury and Osteoarthritis Outcome Score – Physical Function Short-form (KOOS-PS)

OBJECTIVE To test the reliability, validity and responsiveness of the Portuguese version of the Knee injury and Osteoarthritis Outcome Score--Physical Function Short-form (KOOS-PS). METHODS The Portuguese full KOOS and Medical Outcomes Study e 36 item Short-Form (SF-36) questionnaires, and a form of individual characteristics of the patients were applied to 85 subjects with knee osteoarthritis (OA). RESULTS Cronbachs alpha coefficient was 0.89 and intraclass correlation coefficient (ICC) was 0.85, certifying that KOOS-PS reliability was acceptable. Construct validity was supported by the confirmation of the five predefined hypotheses involving expected correlations between KOOS-PS scale, KOOS subscales and SF-36 subscales. An additional predefined hypothesis was also confirmed with the subjects that need walking aids obtaining higher KOOS-PS scale scores (P = 0.011). Responsiveness to 4 weeks of conventional physical therapy treatments and to a 6-week health education and exercise program was demonstrated with a standardized effect size of 0.88 and 0.50, and a standardized response mean of 1.21 and 0.73, respectively. CONCLUSION The Portuguese KOOS-PS evidenced acceptable psychometric characteristics.

Knee Proprioception after Exercise-Induced Muscle Damage

The purpose of the present study was to investigate whether exercise-induced quadriceps muscle damage affects knee proprioception such as joint position sense (JPS), force sense and the threshold to detect passive movement (TTDPM). Fourteen young men performed sets of eccentric quadriceps contractions at a target of 60% of the maximal concentric peak torque until exhaustion; the exercise was interrupted whenever the subject could not complete two sets. Muscle soreness, JPS, the TTDPM and force sense were examined before the exercise as well as one, 24, 48, 72 and 96 h after exercise. The results were compared using one-way repeated-measure ANOVA. Plasma CK activity, collected at the same times, was analyzed by the Friedmans test to discriminate differences between baseline values and each of the other assessment moments (p<0.05). Relative to the proprioception assessment, JPS at 30 and 70 degrees of knee flexion and force sense were significantly decreased up to 48 h, whereas TTDPM decreased significantly at only one hour and 24 h after exercise, at 30 and 70 degrees of the knee flexion, respectively. The results allow the conclusion that eccentric exercise leading to muscle damage alters joint proprioception, suggesting that there might be impairment in the intrafusal fibres of spindle muscles and in the tendon organs.

Gender differences in the kinematics and ball velocity of overarm throwing in elite team handball players

Abstract The aim of this study was to investigate the throwing velocity and kinematics of overarm throwing in team handball of elite female and male handball players. Kinematics and ball velocity of a 7 metre-throw in eleven elite male (age 23.6 ± 5.2 yr, body mass 87.0 ± 6.8 kg, height 1.85 ± 0.05 m) and eleven elite female (age 20.3 ± 1.8 yr, body mass 69.9 ± 5.5 kg, height 1.75 ± 0.05 m) team handball players were recorded. The analysis consisted of maximal joint angles, angles at ball release, maximal angular velocities of the joint movements, and maximal linear velocities of the distal endpoints of segments and their timing during the throw. The ball release velocity of the male handball players was significantly higher than the females (21.1 vs. 19.2 m · s−1; p < 0.05). No major differences in kinematics were found, except for the maximal endpoint velocities of the hand and wrist segment, indicating that male and female handball players throw with the same technique. It was concluded that differences in throwing velocity in elite male and female handball players are generally not the result of changes in kinematics in the joint movements.

Cross-cultural adaptation and validation of the Portuguese version of the Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS)

The objective of this study was to cross-culturally adapt and validate the Portuguese version of the Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS). This version was obtained with forward/backward translations, consensus panels and pre-testing. The Portuguese KOS-ADLS and Medical Outcomes Study, 36-item Short Form (SF-36) questionnaires, visual analogue scales (VAS) of pain, disability and discomfort, and a form for patient’s characteristics were administered to 168 subjects with knee osteoarthritis (OA). Reliability was acceptable (Cronbach’s alpha = 0.91; ICC = 0.97). There were significant correlations with SF-36 physical component subscales, all VAS, and duration of knee OA. The subjects with bilateral knee OA and that need walking aids obtained lower scores (p < 0.001). No floor/ceiling effects were detected. Responsiveness to physical therapy was showed (standardized effect size = 0.62; standardized response mean = 1.02). The Portuguese KOS-ADLS evidenced acceptable reliability, validity, floor/ceiling effects, and responsiveness.

An Acute Bout of Quadriceps Muscle Stretching has no Influence on Knee Joint Proprioception

Abstract The main objective of this study was to determine if an acute bout of static stretching of the quadriceps muscle affects the sense of joint position, the threshold to detect passive movement, and the sense of force. Thirty young, healthy men (age : 22.1 ± 2.7 years) were randomly divided into two groups. The Stretching Group (n=15) underwent stretching of the dominant quadriceps muscle, which comprised ten passive stretches lasting 30 seconds each, while the Control Group (n=15) remained seated for the same length of time. A repeated-measures analysis of variance was used to establish intragroup differences over time, and an independent sample t-test was used to compare the dependent variables between groups at each moment. None of the measurements revealed any significant change between both groups in each assessment moment or between moments within groups (p>0.05). This study demonstrated that static quadriceps muscle stretching has no effect on the sense of knee joint position, threshold to detect passive movement, and force sense, suggesting that stretching does not have appreciable effect on the spindle firing characteristics and tendon organs activation.