PurposeDespite the high incidence of falls in patients with OA, few studies have explored whether falls risk is affected after patients undergo total knee arthroplasty (TKA). Therefore, the aim of this systematic review was to identify the extent of the effects of TKA on balance and incidence of falls by critically reviewing the available literature.MethodsA systematic review of published literature sources was conducted up to March 2014. All studies assessing balance and incidence of falls after TKA (without physiotherapeutic intervention) were included. The methodological quality of each study was reviewed using the Critical Appraisal Skill Programme tool.ResultsThirteen studies were included, comprising of ten cohort studies (Level II) and three studies with Level of evidence III.ConclusionsFindings provide evidence that TKA improves significantly single-limb standing balance (~60%) and dynamic balance up to 1-year following surgery (Level of evidence II). Moreover, TKA influences positively fear of falling and incidence of falls by switching 54.2 % of pre-operative fallers to post-operative non-fallers (Level of evidence II–III). It is highlighted that knee extension strength, proprioception and symmetrization of postural strategies have not fully recovered post-TKA and influence balance performance. Clinically, these persistent deficits need to be mitigated by physiotherapy even before TKA takes place.

Overall, the magnitude of improvements in functional mobility and sensorimotor function endorses using focal sensorimotor training as an effective mode of rehabilitation following knee replacement.

Background: Mulligan's mobilisation techniques are thought to increase the range of movement (ROM) in patients with low back pain. The primary aim of this study was to investigate the application of the Mulligan's Sustained Natural Apophyseal Glide (SNAG) technique on lumbar flexion ROM. The secondary aim was to measure the intra-and inter-day reliability of lumbar ROM employing the same procedure.

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OBJECTIVES:The aim of this study was to assess the validity, reliability and responsiveness of the developed Greek version of the KOOS in total knee replacement (TKR) patients. METHODS:For the translation procedure, guidelines for cross-cultural adaptation were followed (Beaton et al, 2000). KOOS was translated into Greek independently by 3 Greek native raters (2 physiotherapists with > 5 years of clinical musculoskeletal experience and one Orthopedic surgeon).The 3 raters had a meeting where all translations were discussed and a consensus was achieved to a preliminary (synthesis) version. This version was utilized for a backtranslation (Greek to English) by another rater, an English native professional translator who had no prior knowledge of the KOOS. The synthesis and back translation were discussed in a second meeting and a consensus on a prefinal Greek version of KOOS was reached. This prefinal version was tested in a pilot study. It was administered to 10 total knee replacement (TKR) patients with variable educational levels, to confirm the comprehensibility and syntax of all questions. Following the pilot, a final meeting was organized, where all raters discussed the comments made by the patients within the pilot. There were only two points of discussion regarding a) question P4 & P5, the translation and comprehension of full flexion and extension by patients b) the translation of the word «extreme» , the 5th point of the Likertscale in questions S6-Q4. Thus, following this meeting the final version of Greek KOOS questionnaire was developed. Validation procedure:For exploring validity, reliability and responsiveness of KOOS Greek version, 51 consecutive TKR patients (mean age 72.2±7.2 years, 39 women) within the University Hospital of Patras, Greece participated in the study. KOOS's psychometric properties were evaluated according to the COSMIN checklist.Preoperative clinical status and postoperative outcomes at 2 occasions (at discharge and 10-12 days postoperatively) were evaluated using the Greek versions of the KOOS, KOS-ADL, and SF-12 Health Survey. Psychometric properties of both Greek versions of KOS-ADL and SF-12 have been previously tested and have been found satisfactory (Roos et al, 1998, Goncalves et al, 2009). All questionnaires were administered by one orthopedic surgeon. Questionnaires were self-filled.For the analysis, criterion-related validity was evaluated by Pearson's correlation. Internal consistency by Cronbach's alpha; Reliability, by intra-class correlation coefficient (ICC).The SEM was calculated on the basis of the error variance, whereas responsiveness was calculated by effect size, standardized response mean (SRM) and by relating the smallest detectable change (SDC) with the minimal important difference (MIC). RESULTS:Internal consistency: Internal consistency was excellent with Cronbach's a being 0.801 preoperatively, and 0.920 at discharge and at 2 weeks after TKR. Chronbach's a for the 5 subscales of KOOS was found 0.785 preoperatively, 0.822 at discharge and 0.781 at 2 wee...

Background: The precise calculation of arterial occlusive pressure is essential to accurately prescribe individualized pressures during blood flow restriction training. Arterial occlusion pressure in the lower limb varies significantly between different body positions while similar reports for the upper limb are lacking. Hypothesis: Body position has a significant effect in upper limb arterial occlusive pressure. Using cuffs with manual pump and a handheld Doppler ultrasound can be a reliable method to determine upper limb arterial blood flow restriction. Study Design: A randomized repeated measures design. Level of Evidence: Level 3. Methods: Forty-two healthy participants (age mean ± SD = 28.1 ± 7.7 years) completed measurements in supine, seated, and standing position by 3 blinded raters. A cuff with a manual pump and a handheld acoustic ultrasound were used. The Wilcoxon signed-rank test with Bonferroni correction was used to analyze differences between body positions. A within-subject coefficient of variation and an intraclass correlation coefficient (ICC) test were used to calculate reproducibility and reliability, respectively. Results: A significantly higher upper limb arterial occlusive pressure was found in seated compared with supine position ( P < 0.031) and in supine compared with standing position ( P < 0.031) in all raters. An ICC of 0.894 (95% CI = 0.824-0.939, P < 0.001) was found in supine, 0.973 (95% CI = 0.955-0.985, P < 0.001) in seated, and 0.984 (95% CI = 0.973-0.991, P < 0.001) in standing position. ICC for test-retest reliability was found 0.90 (95% CI = 0.814-0.946, P < 0.001), 0.873 (95% CI = 0.762-0.93, P < 0.001), and 0.858 (95% CI = 0.737-0.923, P < 0.001) in the supine, seated, and standing position, respectively. Conclusion: Upper limb arterial occlusive pressure was significantly dependent on body position. The method showed excellent interrater reliability and repeatability between different days. Clinical Relevance: Prescription of individualized pressures during blood flow restriction training requires measurement of upper limb arterial occlusive pressure in the appropriate position. The use of occlusion cuffs with a manual pump and a handheld Doppler ultrasound showed excellent reliability; however, the increased measurement error compared with the differences in arterial occlusive pressure between certain positions should be carefully considered for the clinical application of the method. Strength of Recommendations Taxonomy (SORT): B.