Publications and abstracts

Knee osteoarthritis (KOA) presents heterogeneous phenotypes, motivating a need for clinicians to deliver targeted therapies. There is a plethora of options that can be encompassed in KOA treatment regimes. Clinical decision support (CDS) tools that incorporate individual patient data have the capacity to tailor treatments to meet a patient's individual needs and assist with clinical decision-making. We aim to identify and evaluate CDS tools for individuals with KOA that use individualised prediction models to guide intervention decisions. A scoping review of the literature. A systematic search of six electronic databases, including Ovid Embase, Ovid Medline, Cochrane, CHINAL Ultimate, Scopus and Web of Science, was conducted for articles published between January 1, 2010 and May 17, 2024. Two reviewers independently screened articles and extracted data on study design, tool implementation and underlying prediction models. Eligible studies implemented personalised decision aids, designed to support clinical decisions regarding KOA interventions. The search yielded 5376 publications, of which 2445 were duplicates, leaving 2931 for screening. After title/abstract and full-text reviews, 14 studies were included in the final analysis, with one added through citation searching. Ten distinct decision aids were identified across the included studies. Most studies originated from the United States. Fewer than half of the decision aids included personalised information about non-surgical alternatives. Outcomes such as knee pain and physical function were the most commonly addressed, while psychosocial and financial impacts were rarely reported. Limited details were provided about the development and functionality of the underlying prediction models. Personalised decision aids for KOA show promise in supporting patient-centred decision-making. However, their clinical utility is constrained by limited transparency in model development and implementation. Future studies should emphasise the inclusion of non-surgical treatment options, early-stage KOA patients and personalised outcomes beyond pain and function to enhance their relevance and impact in clinical practice.

BACKGROUND: Physical activity (PA) is a key modifiable behaviour for secondary prevention and recovery after stroke, yet effective and scalable PA interventions remain limited. MOTIVATE (Multi-mOdal Training program to promote physical actIVity After sTrokE) is a theory-informed, co-designed behaviour change intervention to address these gaps.

AIM: To determine whether MOTIVATE increases device-measured moderate-to-vigorous physical activity (MVPA) at 3 and 6 months among community-dwelling stroke survivors, compared with general PA information, and whether it is cost-effective. Implementation outcomes are collected concurrently and reported in a separate process evaluation protocol.

METHODS: MOTIVATE is a hybrid type 1 effectiveness-implementation, phase III randomised controlled trial with concealed allocation, assessor-blinded outcomes and intention-to-treat analysis. Adults aged ≥21 years, ≥6 months post-stroke, living at home, and ambulant (with or without an aid) are eligible and randomised to MOTIVATE or general PA information. Outcomes are assessed at baseline, 3 and 6 months, alongside process and economic evaluations. Recruitment of 120 participants provides 80% power to detect a 10-min/day MVPA difference, allowing for 20% attrition.

STUDY OUTCOMES: The primary outcome is average daily MVPA minutes measured using Fitbit Inspire 3. Secondary outcomes include additional PA measures, physical function, participation, and quality of life, analysed using Bayesian mixed-effects models. Self-efficacy, fatigue, mood, and sleep are collected to explore hypothesised mechanisms via post-trial mediation/moderation analyses, reported separately. Health service utilisation is collected for economic evaluation.

DISCUSSION: MOTIVATE will provide new evidence on the effectiveness and cost-effectiveness of a co-designed, personalised behaviour change intervention to increase PA after stroke.

TRIAL DESIGN: Individually randomised, parallel-group, superiority hybrid type 1 effectiveness-implementation trial (allocation ratio 1:1).

PRIMARY PURPOSE: Secondary prevention/behaviour change.

TARGET SAMPLE SIZE: 120 Participants.

REGISTRATION: www.

CLINICALTRIALS: gov; NCT06409351.

OBJECTIVES: To investigate the effect of preterm birth on physical activity (PA) in 9- to 12-year-old children, and to describe group differences in relationships between PA and lung function, and PA and respiratory morbidity, between children born preterm and term.

STUDY DESIGN: A total of 343 children completed follow-up including children born very preterm (VPT; <30 weeks of gestation, n = 91), moderate-to-late preterm (MLPT; 32-36 weeks of gestation, n = 139), and term (n = 113). PA was measured using 7-day accelerometry and the Physical Activity Questionnaire for Older Children (PAQ-C). Imputation models were used to handle missing data as the total sample recruited at birth included 551 participants.

RESULTS: Children born VPT had more stationary (mean difference (MD): 32 minutes, 95% CI 4, 60; P = .024) and screen time (MD: 25 minutes, 95% CI 0.2, 50; P = .048), and had lower PAQ-C scores (MD: -0.3, 95% CI -0.4, -0.1; P = .001) than term-born children. Children born MLPT completed more screen time (MD: 22 minutes, 95% CI 1, 43; P = .038) than term-born children. All children failed to meet moderate-vigorous PA recommendations (≥60 minutes/day), with 16.6 minutes on average observed across all participants.

CONCLUSIONS: Children born VPT were more sedentary with lower PAQ-C scores, and both preterm groups (VPT and MLPT) had higher screen time than children born at term. No children met moderate-vigorous PA guidelines, indicating early, targeted strategies to curb sedentary behavior and promote activity should be prioritized.

OBJECTIVES: Current guidelines for preclinical mobility limitation (PCML) screening recommend habitual and fast gait speed testing; however, comparative evidence on their discriminative accuracy is limited, and empirical gait speed thresholds for PCML have not been established. We aimed to (i) compare habitual and fast gait speed on their discriminative ability and (ii) derive interpretation thresholds for PCML among community-dwelling middle-aged and older adults.

DESIGN: In this cross-sectional study, 235 participants (mean[SD], 68[7.3]years) completed the 4-metre gait speed assessment. PCML classification was based on questions regarding the use of compensatory stair gait strategy.

RESULTS: In multinomial regression, reduced habitual and fast gait speed were associated with increased odds of "PCML likely" (versus "PCML unlikely"): adjusted interquartile-range odds ratios (95%CI) were 2.6 (1.2-5.7) and 5.8 (1.5-22.5) for habitual and fast gait speed, respectively. Fast gait speed showed greater discriminative ability (pairwise AUC [95%CI], 0.80 [0.68-0.92]) than habitual gait speed (0.74 [0.62-0.87]). The interpretation thresholds (95% CI) for PCML were 1.24 m/s (1.20-1.31m/s) and 1.67m/s (1.61-1.78m/s) for habitual and fast gait speed, respectively.

CONCLUSIONS: Fast gait speed was more adept than habitual gait speed in differentiating between individuals with and without PCML, and empirically-derived thresholds were estimated to complement existing cut-points for PCML.

OBJECTIVES: Despite the widespread usage of the Short Physical Performance Battery (SPPB), psychometric limitations in the SPPB have impeded its use for outcome monitoring and clinical decision making. We propose an alternative assessment and scoring approach for the SPPB, and we compared the modified and the original SPPB on their discriminative and clinical value concerning the risk of prefrailty/frailty, probable sarcopenia, and restricted life-space mobility (RLSM).

DESIGN: Cross-sectional study conducted from June 2018 to August 2023.

SETTING AND PARTICIPANTS: A community-dwelling sample of 2331 participants [mean (SD), 66 (7.5) years; 71% women] completed a survey and fitness assessment.

METHODS: SPPB scores, FRAIL (fatigue, resistance, ambulation, illness, and loss of weight) scores, handgrip strength, and Life-Space Assessment scores were obtained from all participants. SPPB modifications involved (1) increasing the difficulty of the full-tandem balance test and (2) adopting a continuous scoring system. Participants with a FRAIL score ≥1, a weak handgrip strength (<18 kg for women and <28 kg for men), and a Life-Space Assessment <60 points were classified as having prefrailty/frailty, probable sarcopenia, and RLSM, respectively. Discriminative validity was evaluated using multivariable logistic regression and area-under-the-curve (AUC) analyses, whereas clinical utility was assessed using decision curve analysis.

RESULTS: The proposed modifications significantly reduced the ceiling effect of the SPPB (original vs modified SPPB: 70% vs 27%, P < .001) and improved its discriminative validity for prefrailty/frailty, sarcopenia, and RLSM outcomes (AUC increments, 0.03-0.08; P values < .001). In decision curve analyses, these improvements translated to greater net benefit particularly in the 10% to 20% decision risk range.

CONCLUSIONS AND IMPLICATIONS: Although requiring further validation in diverse populations and longitudinal studies, the proposed modifications to the SPPB have the potential to widen its scope of use and facilitate more accurate risk stratification and granular outcome monitoring in community-dwelling adults.

BACKGROUND: Stair climbing tests are pivotal when assessing physical performance in knee osteoarthritis patients, yet the biomechanical strategies that underpin poor stair climbing ability are heterogeneously reported. Single step tasks emulate a step-by-step gait pattern, an approach associated with knee pain when stair climbing. The objective of this study is to analyse the biomechanics and electromyography activity of both the leading and trailing limbs during single Step-up and Down tasks in knee osteoarthritis patients.

METHODS: Three-dimensional motion analysis captured biomechanical data of twenty participants with knee osteoarthritis (n = 20) and twenty four (n = 24) age matched controls completing isolated Step-Up and Step-Down tasks. Data was collected from both the leading and trailing limbs and analysed continuously using One-dimensional Statistical Parametric Mapping (α = 0.05).

FINDINGS: During Step-Up, knee osteoarthritis participants demonstrated kinematic (p < 0.001), kinetic (p = 0.045), and electromyography (p < 0.001) variance compared to control participants, whilst Step-Down induced elevated external knee adduction moments (p = 0.042). Across both tasks, knee osteoarthritis participants stood with increased lower limb flexion in quiet standing and spent a proportionally elevated time in transitional double stance during Step-Up (p = 0.02).

INTERPRETATION: Our study reveals that knee osteoarthritis patients display distinctive biomechanical strategies during single Step-Up and Down tasks, that deviate depending on whether the osteoarthritic knee is leading or trailing. Single-step tasks are a safer and practical alternative to other stair climbing tests. We hope that clinicians can use these findings to guide treatments that promote less effortful step and stair ambulation in knee osteoarthritis patients with advanced disease.

BACKGROUND: Biomechanics of knee osteoarthritis (KOA) patients have been extensively studied using motion capture systems, but less have explored standing knee joint angles with the walking parameters, particularly in Asians. We aim to determine gait biomechanical differences between healthy and KOA participants in an Asian population using One-dimensional Statistical Parametric Mapping (SPM1D) and explore if they are associated with standing joint angles.

METHODS: A total of 20 KOA and 24 healthy stood upright and walked 10 m at self-selected speeds. The standing angles, walking kinematic and kinetic parameters of the ankle, knee, hip and trunk were analysed. Lower limb muscle excitation was measured via electromyography. SPM1D was used to compare the healthy group with the KOA group, and for further subgroup analysis.

RESULTS: The all KOA group had significantly greater standing knee flexion angles (KFA) (p < 0.001), standing ankle dorsiflexion angles (ADA) (p < 0.001), walking KFA during terminal stance (p = 0.001) and terminal swing (p = 0.02) and walking ADA during terminal stance (p = 0.02) and mid-swing to terminal swing (p = 0.001). Knee adduction moment (p = 0.04) and knee flexion moment (p = 0.03) were higher in severe KOA. A positive correlation was found between standing KFA and initial KFA (R 2 = 0.579), and mean walking KFA (R 2 = 0.801) in the KOA group.

CONCLUSION: The increase in standing KFA was associated with an increase in walking KFA in the KOA group. Static joint angles remain as an essential parameter, although further studies need to be carried out to determine if the increase in standing joint angles can be recommended as an adjunctive measure during gait analysis of KOA using motion capture.

AIM: To investigate the effects of community environment on physical activity and quality of life (QoL) and to describe the relationship between community participation with physical activity and QoL, in children born very preterm and at term.

METHOD: Participants in this cross-sectional study were 45 children aged 4 to 5 years old, born before 30 weeks' gestation and 89 term-born children. Measures were community participation (Young Children's Participation and Environment Measure; frequency, involvement, environmental helpfulness, environmental resources), QoL (Pediatric Quality of Life Inventory 4.0; PedsQL), and physical activity (7-day accelerometry). Effects of environmental helpfulness and resources on physical activity and QoL were estimated using g-computation. Relationships between participation frequency and involvement with physical activity and QoL were estimated using linear regression.

RESULTS: Environmental helpfulness increased physical activity (average minute increase per percentage point environmental helpfulness score increase; 3, 95% confidence interval [CI] 0.1-7), reduced stationary time (-2, 95% CI -5 to -0.2) and improved QoL (average PedsQL social functioning score increase; 0.7, 95% CI 0.1-1.2). Greater community involvement was associated with better QoL (average PedsQL total score increase per unit involvement score increase; 5.8, 95% CI 0.7-10.9).

INTERPRETATION: Improving environmental helpfulness may improve physical activity and QoL for 4- to 5-year-old children. Greater community involvement is associated with better QoL.

BACKGROUND: To address the lack of a composite intrinsic capacity (IC) score based on the World Health Organization (WHO) Integrated Care for Older People (ICOPE) Screening tool, we propose a model-based approach to computing the composite score by developing and validating a model that uses the ICOPE screening items to predict the presence of impaired IC in community-dwelling older adults.

METHODS: In this cross-sectional study, a sample of 1235 participants (mean [SD], 68 [7] years) completed a multidomain geriatric and fitness assessment, from which we (1) operationalized the ICOPE Steps 1-2 screening/assessment and (2) derived a 5-point count-based Step 1 composite IC score and an 8-point Step 2 composite IC score. Proportional-odds regression analysis, leveraging on ICOPE screening items, was used to predict, for a given person, the probability that the Step 2 score was ≤6 points (impaired IC) and the corresponding mean score (model-based composite IC score).

RESULTS: The model c-statistic for impaired IC was 0.81 (95%CI, 0.79 to 0.86) and calibration was excellent. The model-based IC scores showed stronger discriminative validity than did the count-based scores for the prefrailty/frailty, sarcopenia, and restricted life-space-mobility outcomes (AUC differences, 0.05-0.12; p-values < .001). At a decision threshold of 20%, the model-based approach yielded greater net benefit (0.016), and it allowed a greater proportion of participants to potentially delay Step 2 assessment (n = 633 vs 317) without compromising positive and negative predictive values.

CONCLUSIONS: If externally validated, composite IC scores derived from the proposed model-based approach have the potential to facilitate more granular risk stratification and IC monitoring.

OBJECTIVES: To promote standardization and feasible measurements of gait speed across the field, we developed a device that used light detection and ranging (LiDAR) technology to measure gait speed from a standing-start testing procedure conducted on a 4-m total walkway. We compared this automated (LiDAR-based) standing-start 4-m gait speed test (AS-4MG) with automated and manual (stopwatch-based) dynamic-start 4-m gait speed tests (AD-4MG and MD-4MG, respectively) on between-method agreement, measurement repeatability, and predictive validity with functional outcomes.

METHODS: A sample of 48 community-dwelling adults (mean [SD], 69 [9] years) participated in this method comparison study. Participants completed a survey and a physical function assessment, from which self-reported stair difficulty, handgrip strength, sit-to-stand performance, and gait speed (AS-, AD-, and MD-4MG) were measured.

RESULTS: Mean AS-4MG, AD-4MG, and MD-4MG were 1.12, 1.13, and 1.14 m/s, respectively, with a strong correlation (r = 0.94) and no systematic bias observed between AS-4MG and the referent AD-4MG. In the analyses of repeated gait measurements, coefficients of repeatability were <0.20 m/s for the automated tests (0.16 and 0.18 m/s for AS-4MG and AD-4MG, respectively) but not for MD-4MG (0.22 m/s). Correlations between gait speed and functional measures ranged between 0.44 and 0.68 (Ps < 0.01). Correlations for the automated tests were comparable, while AS-4MG correlations tended to exceed MD-4MG correlations.

CONCLUSIONS: In community-dwelling adults, the AS-4MG test was unbiased when compared with the AD-4MG, encompassing a 9-m walkway, with both tests showing equivalence of measurement repeatability and predictive validity. The AS-4MG potentially allows gait measurements in confined spaces (e.g., doctor's office) where the gait speed test was previously unfeasible. Geriatr Gerontol Int 2025; 25: 449-453.

OBJECTIVES: To provide an easy-to-use measure, as existing objective assessments for freezing of gait (FOG) severity may be unwieldy for routine clinical practice, this study explored time taken to complete the recently validated FOG severity tool and its components.

DESIGN: A cross-sectional study.

SETTING: Outpatient clinics of a tertiary hospital.

PARTICIPANTS: People with Parkinson disease who could independently ambulate 8-meters, understand instructions, and without co-morbidities affecting gait were consecutively recruited. Thirty-five participants were included (82.9% [n=29] male; median [IQR]: age of 73.0 [11.0] years and disease duration of 4.0 [4.5] years).

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Participants were assessed with the FOG severity tool in a test-retest design, with time taken for each component recorded using a stopwatch during video-analysis. Validity of total FOG severity tool time, time taken to complete its turning and narrow-space components (i.e., time to navigate [TTN]), and an adjusted TTN were examined through correlations with validated FOG severity outcomes. To facilitate clinical interpretation, the TTN cut-off was determined using scatterplot smoothing regression, whereas minimal important change was calculated using predictive modeling.

RESULTS: The FOG severity tool time, TTN, and adjusted TTN similarly demonstrated moderate correlations with the FOG questionnaire and percentage-FOG, and very high correlations with FOG severity tool-revised. The TTN was nonlinearly related to FOG severity, with a positive relationship observed in the first 300 seconds and plateauing after. minimal important change for TTN was 15.4 seconds reduction in timing (95% CI, 3.2-28.7).

CONCLUSIONS: The TTN is a feasible, interpretable, and valid test of FOG severity. In busy clinical settings, TTN can provide a viable alternative when use of existing objective FOG measures is (often) unfeasible.

OBJECTIVE: To investigate the effect of physical activity (PA) on development (motor, cognitive, social-emotional) in children 4-5 years old born <30 weeks' gestation, and to describe subgroups of children at risk of low PA in this cohort.

DESIGN: Longitudinal cohort study.

PATIENTS: 123 children born <30 weeks were recruited at birth and assessed between 4 and 5 years' corrected age.

MAIN OUTCOME MEASURES: Development was assessed using the Movement Assessment Battery for Children, Second Edition (MABC-2), Little Developmental Coordination Disorder Questionnaire (L-DCDQ), Wechsler Preschool and Primary Scale of Intelligence (Fourth Edition; WPPSI-IV), and Strengths and Difficulties Questionnaire (SDQ). To measure PA, children wore an accelerometer and parents completed a diary for 7 days. Effects of PA on developmental outcomes, and associations between perinatal risk factors and PA, were estimated using linear regression.

RESULTS: More accelerometer-measured PA was associated with better MABC-2 aiming and catching scores (average standard score increase per hour increase in PA: 0.54, 95% CI 0.11, 0.96; p=0.013), and lower WPPSI-IV processing speed index scores (average composite score decrease per hour increase in PA: -2.36, 95% CI -4.19 to -0.53; p=0.012). Higher accelerometer-measured PA was associated with better SDQ prosocial scores. Major brain injury in the neonatal period was associated with less moderate-vigorous and less unstructured PA at 4-5 years.

CONCLUSIONS: Higher levels of PA are associated with aspects of motor, cognitive and social-emotional skill development in children 4-5 years old born <30 weeks. Those with major brain injury in the neonatal period may be more vulnerable to low PA at preschool age.

OBJECTIVES: The 4-m gait speed (4mGS) and 10-m gait speed (10mGS) tests and the 30-second sit-to-stand (30sSTS) and 5-times sit-to-stand (5xSTS) tests are commonly used and advocated in consensus recommendations. We compared these tests on their predictive and clinical value concerning the risk of prefrailty/frailty and restricted life-space mobility (RLSM).

DESIGN: Cross-sectional study.

SETTING AND PARTICIPANTS: A sample of 1235 community-dwelling adults (mean ± SD, 68 ± 7 years) participated in this prospective cohort study.

METHODS: At baseline assessment, participants completed a survey and functional assessment, from which gait speed, sit-to-stand performance, self-reported mobility limitation, 40-item Frailty Index, and Life Space Assessment were measured. Participants with a 40-item Frailty Index >0.15 and a Life Space Assessment <60 points were classified as having prefrailty/frailty and RLSM, respectively. At 1-year follow-up assessment, prefrailty/frailty and RLSM were evaluated.

RESULTS: Correlations between gait speed and sit-to-stand measures were high (ρ values >0.80). In multivariable ordinal models, these measures added incremental prognostic value beyond a base model comprising demographics and self-reported mobility limitation variables in predicting baseline and 1-year outcomes. Between 10mGS and 4mGS, models with 10mGS had higher concordance indices (differences, 0.005-0.009), and these differences translated to generally greater net benefit in decision curve analyses. Between 30sSTS and 5xSTS measures, no one measure consistently outperformed the other, with small net benefit differences between measures (<0.2%).

CONCLUSIONS AND IMPLICATIONS: In community-dwelling older adults, gait speed and sit-to-stand measures meaningfully predicted prefrailty/frailty and RLSM. 10mGS provided more robust prognostic information than the 4mGS, whereas 5xSTS and 30sSTS measures showed near equivalence of performance. These findings could guide the choice of functional measures in clinical and research settings.

OBJECTIVE: To evaluate the clinical efficacy and cost-effectiveness of telemonitored self-directed rehabilitation (TR) compared with hospital-based rehabilitation (HBR) for patients with total knee arthroplasty (TKA).

DESIGN: In this randomized, non-inferiority clinical trial, 114 patients with primary TKA who were able to walk independently preoperatively were randomized to receive HBR (n = 58) or TR (n = 56). HBR comprised at least five physical therapy sessions over 10 weeks. TR comprised a therapist-led onboarding session, followed by a 10-week unsupervised home-based exercise program, with asynchronous monitoring of rehabilitation outcomes using a telemonitoring system. The primary outcome was fast-paced gait speed at 12 weeks, with a non-inferiority margin of 0.10 m/s. For economic analysis, quality-adjusted-life-years (QALY) was the primary economic outcome (non-inferiority margin, 0.027 points).

RESULTS: In Bayesian analyses, TR had >95% posterior probability of being non-inferior to HBR in gait speed (week-12 adjusted TR-HBR difference, 0.02 m/s; 95%CrI, -0.05 to 0.10 m/s; week-24 difference, 0.01 m/s; 95%CrI, -0.07 to 0.10 m/s) and QALY (0.006 points; 95%CrI, -0.006 to 0.018 points). When evaluated from a societal perspective, TR was associated with lower mean intervention cost (adjusted TR-HBR difference, -S$227; 95%CrI, -112 to -330) after 24 weeks, with 82% probability of being cost-effective compared with HBR at a willingness to pay of S$0/unit of effect for the QALYs.

CONCLUSIONS: In patients with uncomplicated TKAs and relatively good preoperative physical function, home-based, self-directed TR was non-inferior to and more cost-effective than HBR over a 24-week follow-up period. TR should be considered for this patient subgroup.

OBJECTIVE: To determine, in patients undergoing total knee arthroplasty (TKA), whether increasing context specificity of selected items of the shortened version of the Western Ontario and McMaster Universities Osteoarthritis Index function (WOMAC-F) scale (ShortMAC-F) (1) enhanced the convergent validity of the ShortMAC-F with performance-based mobility measures (ii) affected mean scale score, structural validity, reliability, and interpretability.

DESIGN: Secondary analysis of randomized clinical trial data.

SETTING: A tertiary teaching hospital.

PARTICIPANTS: Patients undergoing TKA (N=114).

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: The ShortMAC-F was modified by specifying the "ascending stairs" and "rising from sitting" items to enquire about difficulty in performing the tasks without reliance on compensatory strategies, whereas the modified "level walking" item enquired about difficulty in walking 400 m. Before and 12 weeks after TKA, patients completed the WOMAC-F questionnaire, modified ShortMAC-F questionnaire, knee pain scale questionnaire, sit-to-stand test, fast gait speed test, and stair climb test. Interpretability was evaluated by calculating anchor-based substantial clinical benefit estimates.

RESULTS: The modified ShortMAC-F correlated significantly more strongly than ShortMAC-F or WOMAC-F with pooled performance measures (differences in correlation values, 0.12-0.14). Increasing item context specificity of the ShortMAC-F did not influence its psychometric properties of unidimensionality (comparative fit and Tucker-Lewis indices, >0.95; root mean square error of approximation, 0.05-0.08), reliability (Cronbach's α, 0.75-0.83), correlation with pain intensity (correlation values, 0.48-0.52), and substantial clinical benefit estimates (16 percentage points); however, it resulted in lower mean score (4.5-4.8 points lower).

CONCLUSIONS: The modified ShortMAC-F showed sufficient measurement properties for clinical application, and it seemed more adept than WOMAC-F at correlating with performance-based measures in TKA.

PURPOSE: Hamstring spasticity is prevalent following neurological injury. The standardized assessment involves passive knee extension, in a position of 90° hip flexion. This creates passive insufficiency of the muscle and lacks ecological validity for walking, whereby the hip typically flexes to a maximum of 40° during swing phase, while the knee extends. This study compared assessment outcomes when completed in 40° and 90° hip flexion.

METHODS: The Modified Ashworth Scale and Modified Tardieu Scale, were performed on 35 adults with a neurological condition. Each participant was assessed by three assessors, resulting in 105 trials at 40° and 90°.

RESULTS: There was a significant increase in the proportion of trials rated as spastic using the Modified Ashworth Scale ( p =.012, phi=.27), and Modified Tardieu Scale ( p <.001, phi=.36), and the severity of spasticity using the Modified Ashworth Scale ( p <.001, effect size (ES)=.50), and Modified Tardieu Scale ( p <.001 ES=.47), at 90° hip flexion. The angle of reaction occurred 32° earlier at 90° hip flexion ( p <.001, ES = 1.61).

CONCLUSIONS: Completing hamstring assessments in 40° hip flexion may reduce the passive insufficiency and improve the ecological validity of assessment, for walking. This may assist in the selection of patients requiring intervention, when their goal relates to walking.

The position of the hip joint impacts hamstring spasticity assessment outcomes, regardless of the clinical outcome measure chosenThe application of bedside assessment methods in a manner reflective of functional tasks may assist in selecting individuals who require active spasticity interventionAs per international guidelines, the use of validated outcome measures in a goal directed and patient centered manner is required to maximize patient care.

BACKGROUND: Walking impairment is a common disability post acquired brain injury (ABI), with visually evident arm movement abnormality identified as negatively impacting a multitude of psychological factors. The International Classification of Functioning, Disability and Health (ICF) qualifiers scale has been used to subjectively assess arm movement abnormality, showing strong intra-rater and test-retest reliability, however, only moderate inter-rater reliability. This impacts clinical utility, limiting its use as a measurement tool. To both automate the analysis and overcome these errors, the primary aim of this study was to evaluate the ability of a novel two-level machine learning model to assess arm movement abnormality during walking in people with ABI.

METHODS: Frontal plane gait videos were used to train four networks with 50%, 75%, 90%, and 100% of participants (ABI: n = 42, healthy controls: n = 34) to automatically identify anatomical landmarks using DeepLabCut ™ and calculate two-dimensional kinematic joint angles. Assessment scores from three experienced neurorehabilitation clinicians were used with these joint angles to train random forest networks with nested cross-validation to predict assessor scores for all videos. Agreement between unseen participant (i.e. test group participants that were not used to train the model) predictions and each individual assessor's scores were compared using quadratic weighted kappa. One sample t-tests (to determine over/underprediction against clinician ratings) and one-way ANOVA (to determine differences between networks) were applied to the four networks.

RESULTS: The machine learning predictions have similar agreement to experienced human assessors, with no statistically significant (p < 0.05) difference for any match contingency. There was no statistically significant difference between the predictions from the four networks (F = 0.119; p = 0.949). The four networks did however under-predict scores with small effect sizes (p range = 0.007 to 0.040; Cohen's d range = 0.156 to 0.217).

CONCLUSIONS: This study demonstrated that machine learning can perform similarly to experienced clinicians when subjectively assessing arm movement abnormality in people with ABI. The relatively small sample size may have resulted in under-prediction of some scores, albeit with small effect sizes. Studies with larger sample sizes that objectively and automatically assess dynamic movement in both local and telerehabilitation assessments, for example using smartphones and edge-based machine learning, to reduce measurement error and healthcare access inequality are needed.

OBJECTIVE: To determine if adding lumbar neuromuscular control retraining exercises to a 12-week program of strengthening exercises had greater effect for improving disability than 12 weeks of strengthening exercises alone in people with chronic low back pain (LBP). DESIGN: Single-center, participant- and assessor-blinded, comparative effectiveness randomized controlled trial. METHODS: Sixty-nine participants (31 females; 29 males; mean age: 46.5 years) with nonspecific chronic LBP were recruited for a 12-week program involving lumbar extension neuromuscular retraining in addition to resistance exercises (intervention) or 12 weeks of resistance exercises alone (control). The primary outcome measure was the Oswestry Disability Index. Secondary outcome measures included the Numeric Rating Scale, Tampa Scale for Kinesiophobia, Pain Self-Efficacy Questionnaire, and the International Physical Activity Questionnaire. Outcomes were measured at baseline, 6 weeks, and 12 weeks. RESULTS: Forty-three participants (22 control, 21 intervention) completed all outcome measures at 6 and 12 weeks. Fourteen participants were lost to follow-up, and 12 participants discontinued due to COVID-19 restrictions. Both groups demonstrated clinically important changes in disability, pain intensity, and kinesiophobia. The difference between groups with respect to disability was imprecise and not clinically meaningful (mean difference, -4.4; 95% CI: -10.2, 1.4) at 12 weeks. Differences in secondary outcomes at 6 or 12 weeks were also small with wide confidence intervals. CONCLUSIONS : Adding lumbar neuromuscular control retraining to a series of resistance exercises offered no additional benefit over resistance exercises alone over a 12-week period. J Orthop Sports Phys Ther 2024;54(5):1-10. Epub 18 March 2024. doi:10.2519/jospt.2024.12349 .

BACKGROUND: The "gold standard" marker for freezing of gait severity is percentage of time spent with freezing observed through video analysis.

OBJECTIVE: This study examined inter- and intra-rater reliability and variability of physiotherapists rating freezing of gait severity through video analysis and explored the effects of experience.

METHODS: Thirty physiotherapists rated 14 videos of Timed Up and Go performance by people with Parkinson's and gait freezing. Ten videos were unique, while four were repeated. Freezing frequency, total duration, and percentage of time spent with freezing were computed. Reliability and variability were estimated using ICC (2,1) and mean absolute differences. Between-group differences were calculated with the one-way ANOVA.

RESULTS: Inter- and intra-rater reliability ranged from moderate to good (ICC: inter-rater frequency = 0.63, duration = 0.78, percentage = 0.50; intra-rater frequency = 0.84, duration = 0.89, percentage = 0.50). Variability for freezing frequency was two episodes. Inter- and intra-rater variability for total freezing duration was 18.8 and 12.3 seconds, respectively. For percentage of time spent with freezing, this was 15.2% and 13.5%. Physiotherapy experience had no effect.

CONCLUSION: Physiotherapists demonstrated sufficient reliability, but variability was large enough to cause changes in severity classifications on existing rating scales. Percentage of time spent with freezing was the least reliable marker, supporting the use of freezing frequency or total duration instead.

PURPOSE: This study investigated the (1) six-month outcomes of individuals with lateropulsion; (2) the relationship between baseline measures (from in-patient hospitalisation) and six-month functional abilities; and (3) recovery patterns for lateropulsion in stroke survivors.

MATERIALS AND METHODS: Forty-one individuals with lateropulsion participated in this study. Measures of lateropulsion, postural function, and weight-bearing asymmetry in standing were taken initially and fortnightly over eight weeks. Functional independence and walking abilities were assessed at six months post-stroke.

RESULTS: Compared to individuals with moderate to severe lateropulsion, those with mild lateropulsion achieved higher levels of functional outcome at six months. However, there were a wide range of scores. Baseline lateropulsion severity explained 26% of the variation in functional outcome. A stronger correlation with functional outcome was observed for lateropulsion (-0.526) than function independence at baseline (0.384). For the task of standing with arm support, patterns of asymmetry were divergent at baseline, favouring either the paretic or non-paretic leg. Over the eight-week period, asymmetry moved towards the non-paretic leg and lateropulsion reduced consistently.

CONCLUSIONS: Individuals with lateropulsion can recover from lateropulsion and make meaningful functional gains, including some individuals with more severe lateropulsion. Lateropulsion severity is a key indicator of functional outcome post-stroke.IMPLICATIONS FOR REHABILITATIONIndividuals with lateropulsion can make significant gains in terms of mobility and functional abilities by six months post-stroke, learning to compensate for their verticality impairment in standing by loading their non-paretic leg.It is important that stroke survivors with lateropulsion, including those with moderate and severe lateropulsion, are provided with adequate rehabilitation to optimise their longer-term mobility and functional abilities.Routine screening of acute stroke survivors for lateropulsion is recommended, given lateropulsion may negatively impact longer-term functional outcomes in stroke survivors.Therapists should carefully analyse the weight-bearing pattern which an individual with lateropulsion adopts in standing and subsequently tailor treatment to target this.

BACKGROUND: Although the frailty index (FI) is designed as a continuous measure of frailty, thresholds are often needed to guide its interpretation. This study aimed to introduce and demonstrate the utility of an item response theory (IRT) method in estimating FI interpretation thresholds in community-dwelling adults and to compare them with cutoffs estimated using the receiver operating characteristics (ROC) method.

METHODS: A sample of 1,149 community-dwelling adults (mean[SD], 68[7] years) participated in this cross-sectional study. Participants completed a multi-domain geriatric screen from which the 40-item FI and 3 clinical anchors were computed - namely, (i)self-reported mobility limitations (SRML), (ii)"fair" or "poor" self-rated health (SRH), and (iii) restricted life-space mobility (RLSM). Participants were classified as having SRML-1 if they responded "Yes" to either of the 2 questions regarding walking and stair climbing difficulty and SRML-2 if they reported having walking and stair climbing difficulty. Participants with a Life Space Assessment score <60 points were classified as having RLSM. Threshold values for all anchor questions were estimated using the IRT method and ROC analysis with Youden criterion.

RESULTS: The proportions of participants with SRML-1, SRML-2, Fair/Poor SRH, and RLSM were 21 %, 8 %, 22 %, and 9 %, respectively. The IRT-based thresholds for SRML-2 (0.26), fair/poor SRH (0.29), and RLSM (0.32) were significantly higher than those for SRML-1 (0.18). ROC-based FI cutoffs were significantly lower than IRT-based values for SRML-2, SRH, and RLSM (0.12 to 0.17), and they varied minimally and non-systematically across the anchors.

CONCLUSIONS: The IRT method identifies biologically plausible FI thresholds that could meaningfully complement and contextualize existing thresholds for defining frailty.