Background: Studies have reported the subtypes of individuals with knee osteoarthritis (OA) attempting to cluster this heterogonous condition. Activity limitations are commonly used to set goals in knee OA management and better identify subgroups based on level of disability in this patient population. Therefore, the objective of this study was to identify those activity limitations which could classify the disability phenotypes of knee OA. The phenotypes were also validated by comparing impairments and participation restrictions. Methods: Participants comprised individuals with symptomatic knee OA. They were interviewed and undertook physical examination according to a standard evaluation forms based on the International Classification of Functioning, Disability and Health (ICF) model. Cluster analysis was used to determine those activity limitations which could best classify the phenotypes of knee OA. To validate the clustered variables, comparisons and regression analysis were performed for the impairments consisting of pain intensity, passive range of motion and muscle strength, and the participation restrictions included the difficulty level of acquiring goods and services and community life. Results: In all, 250 participants with symptomatic knee OA were enrolled in the study. Three activity limitations identified from data distribution and literature were used as the cluster variables, included the difficulty level of maintaining a standing position, timed stair climbing and 40-m self-paced walk test. The analysis showed four phenotypes of individuals with knee OA according to the levels of disability from no to severe level of disability. All parameters of impairment and participation restrictions significantly differed among phenotypes. Subgroups with greater disability experienced worse pain intensity, limited range of motion (ROM), muscle power and participation restriction levels. The variance accounted for of the subgroups were also greater than overall participants. Conclusion: The results of this study emphasized the heterogeneous natures of knee OA. Three activity limitations identified could classify the individuals with symptomatic knee OA to homogeneous subgroups from no to severe level of disability. The management plan, based on these homogeneous subgroups of knee OA, could be designated by considering the levels of impairments and participation restrictions.
Abstract. [Purpose] This study investigated the effects of passive stretching (STR) and strain counter-strain (SCS) techniques in subjects with myofascial pain syndrome (MPS) as measured by a visual analogue scale (VAS), pressure pain threshold (PPT), displacement pain threshold (DPT), active range of motion (AROM), and patients perception of change (PPC).[Subjects] Twenty volunteers with active MPS in the upper trapezius muscle participated in the study.[Methods] The subjects were randomly allocated to either a STR or SCS treatment group. Evaluations were performed at before, immediately, one hour, and one day after treatment. [Results] No significant difference between groups were found. However, there was a significant improvement of VAS an hour after SCS treatment. The improvement seemed to be maintained after treatment. The STR group showed a significant decrease of DPT between immediately and a day after treatment, indicating less tissue compliance.[Conclusion] The SCS treatment helps relieve the pain one hour after treatment in subjects with active MPS.
Background: Evidence suggests patients with non-speci¯c low back pain (NSLBP) have altered lumbar and pelvic movement patterns. These changes could be associated with altered patterns of muscle activation. Objective: The study aimed to determine: (1) di®erences in the relative contributions and velocity of lumbar and pelvic movements between people with and without NSLBP, (2) the di®erences in lumbopelvic muscle activation patterns between people with and without NSLBP, and (3) the association between lumbar and pelvic movements and lumbopelvic muscle activation patterns. Methods: Subjects (8 healthy individuals and 8 patients with NSLBP) performed 2 sets of 3 repetitions of active forward bending, while motion and muscle activity data were collected simultaneously. Data derived were lumbar and pelvic ranges of motion and velocity, and ipsilateral and contralateral lumbopelvic muscle activities (internal oblique/transverse abdominis (IO/TA), lumbar multi¯dus (LM), erector spinae (ES) and gluteus maximus (GM) muscles). Results: Lumbar and pelvic motions showed trends, but exceeded 95% con¯dence minimal detectable difference (MDD 95 ), for greater pelvic motion (p ¼ 0:06), less lumbar motion (p ¼ 0:23) among patients with NSLBP. Signi¯cantly less activity was observed in the GM muscles bilaterally (p < 0:05) in the NSLBP group. A signi¯cant association (r ¼ À0:8, p ¼ 0:02) was found between ipsilateral ES muscle activity and
The objective of this study was to develop an extensive assessment list for individuals with knee osteoarthritis based on the International Classification of Functioning, Disability and Health (ICF) osteoarthritis comprehensive Core Set. Ten experienced physical therapists including five lecturers and five clinicians were purposively nominated to form an expert panel. Consensus among the experts was obtained through a four-iteration Delphi technique. A list of ICF categories and their third- and fourth-level categories were selected and matched with outcome measures associated with knee osteoarthritis. The expert panel agreed that 26 out of 38 second-level categories of the comprehensive ICF core set for osteoarthritis were relevant to identify problems related to knee osteoarthritis. The information relevant to the specific categories for knee osteoarthritis was obtained from self-reported, subjective observation and physical examination. The extensive assessment list for knee osteoarthritis based on the comprehensive ICF core set for osteoarthritis was assembled. This assessment tool can be used to expansively identify the multidimensional disabilities of impairment, activity limitation and participation restriction in individuals with knee osteoarthritis.
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