Objective. To compare the time-varying behavior of maximum toe-out angle, lateral trunk lean (over the stance leg), and pelvic obliquity (rise and drop on the swing leg) during prolonged walking in participants with and without medial compartment knee osteoarthritis (OA), and to explore correlations between these gait characteristics and pain. Methods. Twenty patients with knee OA and 20 healthy controls completed 30 minutes of treadmill walking. Toe-out, trunk lean, pelvic obliquity, and pain were measured at 5-minute intervals. Results. The mean ؎ SD toe-out angle was significantly smaller (P ؍ 0.04) in patients with knee OA (6.7 ؎ 2.5 degrees) than in controls (10.3 ؎ 2.2 degrees). Toe-out changed significantly over time (P ؍ 0.002), but not in a systematic way, and there was no interaction between group and time. The mean ؎ SD trunk lean was higher (P ؍ 0.03) in patients with knee OA (2.0 ؎ 1.0 degrees) than in controls (0.7 ؎ 0.5 degrees). Trunk lean did not change over time and there was no interaction between group and time. There were no differences for pelvic drop. The mean ؎ SD pelvic rise was higher (P ؍ 0.01) in patients with knee OA (2.8 ؎ 0.9 degrees) than in controls (1.2 ؎ 0.8 degrees), but did not change over time and there was no interaction. Patients experienced a small increase in pain (P < 0.001). Trunk lean and pelvic drop were correlated with pain (r ؍ 0.49, P ؍ 0.03 and r ؍ 0.47, P ؍ 0.04, respectively). Conclusion. Toe-out and trunk lean are consistently different between individuals with and without medial compartment knee OA during prolonged walking, and patients with greater pain have greater trunk lean. However, over 30 minutes of walking, these gait characteristics remain quite stable, suggesting they are not acute compensatory mechanisms in response to repetitive loading with subtle increases in pain.
Although results are variable among patients, and may be related to individual technique, these overall findings suggest that walking poles do not decrease knee adduction moments, and therefore likely do not decrease medial compartment loads, in patients with varus gonarthrosis. Decreases in knee joint loading should not be used as rationale for walking pole use in these patients.
Total kinetic energy (TKE) was calculated for 28 Canadian national team Olympic rowers during training on water, comparing low-stroke rates (18-22 stroke/min) and high-stroke rates (32-40 stroke/min), using video analysis. Stroke duration was normalized to 100%, beginning and ending at the "catches", with the drive phase occurring first and recovery second. Two discrete points were identified during the stroke, both occurring when the fingers had the same horizontal position as the ankles (i.e., mid-drive and mid-recovery). The ratios of recovery-to-drive TKE at these points for the entire body at low and high-stroke rates were 0.36 +/- 0.34 and 1.26 +/- 0.54 respectively. Significant differences were found for the lower leg, upper arm and forearm segments, and within the female groups. Low-stroke rate is a typical training pace and high-stroke rate is analogous to a race pace. This study demonstrates that TKE production during recovery in a race was not replicated during training. While training at low-stroke rates is vital for technique refinement, this study stresses the importance of training appropriately for the energy expenditure during high-stroke rate recovery. This is commonly overlooked by coaches and athletes.
Background: This study explored whether medical students at a Canadian university conceptualize health and disability from a biomedical or biopsychosocial perspective. The World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) served as the theoretical basis for this exploration.Methods: A written survey was administered to capture medical students' conceptualizations of health and disability. The survey included questions explicitly related to the constructs of universalism, nonlinearity, social and environmental factors, personal factors, participation, aspects of language and biopsychosocial health perspectives. The survey was also designed to include both theoretical and scenario-based questions related to biopsychosocial concepts of disability. The survey was distributed to and completed by a senior medical school class at a Canadian university.Results: In total, 82 out of 131 medical students completed the survey. Observed trends suggested that for theory-based questions, respondents exhibited close agreement with biopsychosocial perspectives of health and disability. Scenariobased questions resulted in more variability among respondents compared to theory-based questions. When students who previously had been introduced to the ICF were compared with students who had not, those familiar with the ICF more consistently exhibited a biopsychosocial perspective of health and disability; however these differences were not statistically significant.Conclusion: Overall, senior medical students in this study were generally found to conceptualize disability using a biopsychosocial orientation. This result was more pronounced among students who were previously familiar with the ICF. Interestingly, a biopsychosocial orientation was not consistently maintained for scenario-based questions for all respondents. Our current healthcare climate requires that the concept of health move beyond a biomedical perspective to a more holistic biopsychosocial perspective. This change in perspective is of particular importance as movement towards team-based models of care continues to gain momentum. Closing conceptual and language-based gaps related to concepts of health and disability among all healthcare professionals is pertinent to improvinginterprofessional collaboration and service provision. The ICF presents a framework and language that is relevant across all health professions. Increased use of the ICF in health professional education and training could significantly contribute to increased interdisciplinary success.
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