The PAR Index has been developed to provide a single summary score for all the occlusal anomalies which may be found in a malocclusion. The score provides an estimate of how far a case deviates from normal alignment and occlusion. The difference in scores between the pre- and post-treatment cases reflects the degree of improvement and, therefore, the success of treatment. Excellent reliability was exhibited within and between examiners (Intraclass Correlation Coefficient, R greater than 0.91). The components of the PAR Index have been weighted to reflect current British orthodontic opinion and is flexible in that the weightings could be changed to reflect future standards and standards currently being achieved in other countries. The PAR Index offers uniformity and standardization in assessing the outcome of orthodontic treatment.

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BackgroundBoth increased knee muscle co-contraction and alterations in central pain processing have been suggested to play a role in knee osteoarthritis pain. However, current interventions do not target either of these mechanisms. The Alexander Technique provides neuromuscular re-education and may also influence anticipation of pain. This study therefore sought to investigate the potential clinical effectiveness of the AT intervention in the management of knee osteoarthritis and also to identify a possible mechanism of action.MethodsA cohort of 21 participants with confirmed knee osteoarthritis were given 20 lessons of instruction in the Alexander Technique. In addition to clinical outcomes EMG data, quantifying knee muscle co-contraction and EEG data, characterising brain activity during anticipation of pain, were collected. All data were compared between baseline and post-intervention time points with a further 15-month clinical follow up. In addition, biomechanical data were collected from a healthy control group and compared with the data from the osteoarthritis subjects.ResultsFollowing AT instruction the mean WOMAC pain score reduced by 56 % from 9.6 to 4.2 (P < 0.01) and this reduction was maintained at 15 month follow up. There was a clear decrease in medial co-contraction at the end of the intervention, towards the levels observed in the healthy control group, both during a pre-contact phase of gait (p < 0.05) and during early stance (p < 0.01). However, no changes in pain-anticipatory brain activity were observed. Interestingly, decreases in WOMAC pain were associated with reductions in medial co-contraction during the pre-contact phase of gait.ConclusionsThis is the first study to investigate the potential effectiveness of an intervention aimed at increasing awareness of muscle behaviour in the clinical management of knee osteoarthritis. These data suggest a complex relationship between muscle contraction, joint loading and pain and support the idea that excessive muscle co-contraction may be a maladaptive response in this patient group. Furthermore, these data provide evidence that, if the activation of certain muscles can be reduced during gait, this may lead to positive long-term clinical outcomes. This finding challenges clinical management models of knee osteoarthritis which focus primarily on muscle strengthening.Trial registrationISRCTN74086288, 4th January 2016, retrospectively registered.

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These considerations represent the first international consensus on the conduct of interventional studies following acute knee joint trauma.

During both tasks, within-day ICC values for joint angles (ICCrun=0.63-0.94 and ICCcut=0.63-0.96) were higher than between days (ICCrun=0.51-0.72 and ICCcut=0.42-0.83). Out of five moments tested in each task, within-day ICC values (ICCrun=0.64-0.89 and ICCcut=0.79-0.94) were higher than between days (ICCrun=0.58-0.91 and ICCcut=0.83-0.92). During running task, within and between-day SEM values for joint moments ranged between (0.07-0.39Nmkg) and between (0.98°-5.14°) for joint angles. While during cutting, SEM values for moments ranged between (0.13-0.56Nmkg) and between (1.73-5.15) for joint angle measurement. The GRF data, in both tasks, were more reliable (ICCrun⩾0.84 and ICCcut⩾0.88) as compared to angles (ICCrun⩾0.51 and ICCcut⩾0.42), and moments (ICCrun⩾0.58 and ICCcut⩾0.79) data. These findings are relevant to those undertaking intervention studies because of the potential for large measurement variability when examining certain variables, which would then require considerable changes in these variables to show "real" effects of the interventions beyond measurement error.

Background: Understanding motion in the normal healthy foot is a prerequisite for understanding the effects of pathology and thereafter setting targets for interventions. Quality foot kinematic data from healthy feet will also assist the development of high quality and research based clinical models of foot biomechanics. To address gaps in the current literature we aimed to describe 3D foot kinematics using a 5 segment foot model in a population of 100 pain free individuals. Methods: Kinematics of the leg, calcaneus, midfoot, medial and lateral forefoot and hallux were measured in 100 self reported healthy and pain free individuals during walking. Descriptive statistics were used to characterise foot movements. Contributions from different foot segments to the total motion in each plane were also derived to explore functional roles of different parts of the foot.Results: Foot segments demonstrated greatest motion in the sagittal plane, but large ranges of movement in all planes. All foot segments demonstrated movement throughout gait, though least motion was observed between the midfoot and calcaneus. There was inconsistent evidence of movement coupling between joints. There were clear differences in motion data compared to foot segment models reported in the literature. Conclusions:The data reveal the foot is a multiarticular structure, movements are complex, show incomplete evidence of coupling, and vary person to person. The data provide a useful reference data set against which future experimental data can be compared and may provide the basis for conceptual models of foot function based on data rather than anecdotal observations.

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