Background Lower limb osteoarthritis (OA) causes high levels of individual pain and disability and is an increasing socio-economic burden to global healthcare systems. Physical Activity interventions are commonly provided by physiotherapists to help patients with lower limb OA manage their clinical symptoms. Objective To identify and evaluate the effectiveness of behavioural change techniques (BCTs) within physiotherapy interventions to increase physical activity (PA) adherence in patients with lower limb OA. Design A systematic review was conducted, following Cochrane guidelines according to a published and registered protocol (CRD42016039932). Two independent researchers conducted searches, determined eligibility, assessed risk of bias (Cochrane tool), intervention fidelity (NIHBCC checklist), and coded randomised controlled trials (RCTs) for BCTs (V1 taxonomy). BCT effectiveness ratios were calculated and RCT risk of bias and intervention fidelity were summarised narratively. Data sources A highly sensitive search strategy was conducted on Medline, Embase, PsycINFO, CENTRAL, CINAHL and PEDro and grey literature databases from inception to January 2 nd , 2018. Reference lists of included RCTs and relevant articles were reviewed, and a citation search was conducted using Web of Science. Eligibility criteria for selecting studies RCTs that evaluated the effectiveness of a physiotherapy intervention that incorporated ≥1 BCT that promoted home or community-based PA adherence in patients with lower limb osteoarthritis. Results Twenty-four RCTs (n = 2366 participants) of variable risk of bias (RoB) (5 low; 7 moderate; 12 high) and poor intervention reporting from 10 countries were included. Heterogeneity of intervention BCTs and PA adherence outcome measures precluded meta-analysis. Thirty-one distinct BCTs were identified in 31 interventions across RCTs. In general, BCTs demonstrated higher effectiveness ratios for short-term and long-term PA adherence compared with medium-term outcomes. The BCTs ‘behavioural contract’, ‘non-specific reward’, ‘patient-led goal setting’ (behaviour), ‘self-monitoring of behaviour’, and ‘social support (unspecified) demonstrated the highest effectiveness ratios across time points to promote PA adherence. Conclusions BCTs demonstrate higher short and long-term than medium-term effectiveness ratios. Further research involving low RoB RCTs incorporating transparently reported interventions with pre-specified BCTs aimed at optimising lower limb OA patient PA adherence is required.

IntroductionOsteoarthritis (OA) is a common degenerative articular disease, the highest cause of individual level disability and a significant socioeconomic burden to healthcare services. Patient education and physical activity (PA) prescription are recommended components of interventions in several healthcare guidelines and are commonly provided by physiotherapists. However, these interventions lack long-term clinical effectiveness. Patient adherence to PA prescription requires patients to modify their PA behaviour and appears critical in maintaining symptomatic improvements. This systematic review aims to evaluate the effectiveness of behavioural change techniques (BCTs) used in physiotherapy interventions to improve PA adherence.Methods and analysisMedline, Cochrane and PEDro registers of Controlled Trials, EMBASE, CINAHL and PsycInfo databases, and key grey literature sources will be rigorously searched for randomised controlled trials that compared a physiotherapy intervention incorporating BCTs with other therapies, placebo interventions, usual care or no-treatment. Two independent researchers will conduct literature searches, assess trial eligibility, extract data, conduct risk of bias assessment (using Cochrane risk of bias tool), classify BCTs and evaluate the quality of the body of literature following Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. Narrative synthesis of key outcomes will be presented and meta-analysis will be performed if included trials are clinically homogenous, based on their intervention and comparator groups and outcome measures. This review will be reported in line with the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines.Ethics and disseminationResearch ethics approval is not required. This review will help inform clinicians and researchers on the most effective behavioural change techniques used in physiotherapy interventions to enhance adherence to PA prescription for patients with lower limb OA. The findings will be disseminated through publication in a peer-reviewed journal and conference presentations.Trial registration numberPROSPERO CRD42016039932.

There appears to be no differences in muscle activation and movement between CAI and healthy control groups. However, participants with CAI exhibited increased inversion patterns during the stance phase of gait in their affected limb compared to their unaffected limb. This may predispose those with CAI to episodes of giving way and further ankle sprains.

The aim of this study was to investigate the reliability of fatigue indicators calculated from peak torque and total work during isokinetic speeds of 60, 90, 120 and 180° · s-1 during a hip fatigue protocol. 10 males suffering from a history of unilateral functional ankle instability and 10 male healthy controls performed 5 maximal concentric contractions on an isokinetic dynamometer. Following a 4 min rest period subjects were instructed to perform repeated maximal concentric contractions to fatigue, which was defined as 3 consecutive repetitions below 50% of the maximum peak torque value. Each testing speed was randomised with 24 h between speeds. The subjects were asked to return to the laboratory 7 days later to repeat the 4 speeds, with 24 h between speeds. Muscle fatigue was determined for each testing speed by the fatigue index, the percent decrease in performance and the slope of the regression equation. The most reliable fatigue determination method was the slope of the regression equation, when testing at a speed of 120° · s-1. It is recommended that future investigators examine and plot their data before choosing the slope of the regression equation as their fatigue indicator, as a linear model is required.

The purpose of this study was to quantify the components of acceleration, load range and deceleration through a velocity spectrum during concentric hip abduction and adduction isokinetic exercise, and to investigate the effect of load range on peak torque and work done. 16 male healthy subjects performed 3 maximal concentric reciprocal hip abduction and adduction gravity corrected repetitions in a fixed order at 60, 120, 180, 240, 300, 360 and 420° · s-1, with a 30 s rest between velocities. Hip abduction and adduction results revealed that load range significantly decreased while acceleration and deceleration ROM significantly increased (p<0.05) with each increase in velocity. When the total peak torque data was corrected for load range there was a significant decrease (p<0.05) in peak torque at velocities of 300° · s-1 and above, for both hip abduction and adduction. Load range correction also resulted in a significant decrease (p<0.05) in work done at velocities of 120° · s-1 and above, for both hip abduction and adduction. The results demonstrate an inverse relationship between isokinetic velocity and load range during concentric hip abduction and adduction, and suggest a need for the clinician to carefully consider velocity selection when performing exercise on an isokinetic device.