Background: Osteoarthritis (OA) is the most common rheumatic disease of the musculoskeletal system, with the knee as the most affected joint. The number of people with OA of the knee is likely to increase due to the ageing society and the obesity epidemic. The predominant clinical symptom of knee OA is pain, which is described as worsening by activity and relieving by rest. Knee instability has been recognized as an important clinical feature in persons with knee OA. Pain and knee instability are associated with limitations in performing daily activities. Non-pharmacological options in the management of knee OA consist of education, weight loss, exercise, braces and physical therapy. Knee bracing has been recommended by the Osteoarthritis Research Society International (OARSI). Valgus knee braces designed to decrease loads on the medial compartment of the knee for patients with varus alignment are the most common. It has been shown however, that valgus bracing may have little or no effect on pain and physical functioning, and adherence to this treatment in patients with knee OA is low.Because of ease of use and access, lack of complications and low cost, soft knee braces are commonly used in persons with knee OA. However, the evidence for efficacy of soft knee bracing on pain and activity limitations in knee OA is limited. Therefore, it is important to strengthen the evidence of using a soft brace to reduce pain and activity limitations as well as to evaluate the efficacy of soft knee bracing on knee instability in persons with knee OA. There is also debate about the effectiveness of soft braces in other affected joints of the lower extremity and in conditions other than OA such as rheumatoid arthritis.Objectives: The aim of the study will be to evaluate the effect of wearing a soft brace on dynamic knee instability in patients with OA of the knee.Methods: Persons with knee OA and self-reported knee instability from the Amsterdam Osteoarthritis cohort participated in a single-session lab-experimental study. A within-subject design was used, comparing no brace versus brace, and comparing a non-tight versus a tight brace (standard fit). The primary outcome measure was dynamic knee instability, expressed by the Perturbation Response (PR), i.e., a biomechanics based measure reflecting deviation in the mean knee varus-valgus angle after a controlled mechanical perturbation, standardized to the mean (SD) varus-valgus angle during level walking. Linear mixed-effect model analysis was used to evaluate the effect of a brace on dynamic knee instability.Results: The wearing of a soft brace reduced the knee instability significantly during perturbed walking. Results will also be presented from the literature search and from the lab-experimental study.Conclusion: Wearing a soft brace reduces dynamic knee instability in patients with knee OA. However, longitudinal studies are needed to evaluate the clinical implications of wearing a soft brace.
BackgroundIn adolescents with non-pathological and pathological joint hypermobility, gait deviations have been associated with pain and fatigue. It remains unclear what distinguishes the non-pathological form of joint hypermobility (JH) from pathological forms (i.e. hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorders (HSD). Our objective was to identify discriminative clinical characteristics and biomechanical gait features between adolescents with hEDS/HSD, JH, and healthy controls (HC).MethodsThirty-two adolescents were classified into three subgroups (hEDS/HSD=12, JH=5, HC=15). Clinical characteristics (e.g. pain intensity and surface, fatigue, functional disability) were inventoried.The gait pattern was assessed using a three-dimensional, eight-camera VICON MX1.3 motion capture system, operating at a sample rate of 100 Hz (VICON, Oxford, UK). Spatiotemporal parameters, joint angles (sagittal plane), joint work, joint impulse, ground reaction force and gait variability expressed as percentage using Principal Component Analysis (PCA) were assessed and analysed using multivariate analysis. Multivariate analysis data is expressed in mean differences(MD), standard error(SE) and P-values.ResultsThe hEDS/HSD-group had significantly higher fatigue score (+51.5 points, p = <0.001) and functional disability (+1.6, p < .001) than the HC-group. Pain intensity was significantly higher in the hEDS/HSD-group than the other subgroups (JH; +37 mm p = .004, HC; +38 mm, p = .001). The hEDS/HSD-group showed significantly more gait variability (JH; +7.2(2.0)% p = .003, HC; + 7.8(1.4)%, p = <0.001) and lower joint work (JH; −0.07(0.03)J/kg, p = .007, HC; − 0.06(0.03)J/kg, p = .013) than the other subgroups. The JH-group showed significantly increased ankle dorsiflexion during terminal stance (+5.0(1.5)degree, p = .001) compared to hEDS/HSD-group and knee flexion during loading response compared to HC-group (+5.7(1.8) degree, p = .011).SignificanceA distinctive difference in gait pattern between adolescents with non-pathological and pathological joint hypermobility is found in gait variability, rather than in the biomechanical features of gait. This suggests that a specific gait variability metric is more appropriate than biomechanical individual joint patterns for assessing gait in adolescents with hEDS/HSD.
Background and purposeWithin Northwest European Welfare states, there is a growing need for all social work professions to substantiate their work with research. The earliest notions of social street work origins from the end of the18th century by the British Salavation Army (Mikkonen et al., 2007). In the Netherlands it’s introduced from the United States (1960s), as a response to individuals and groups hanging around. Social street work is a low threshold and professional form of being there, performed in surroundings and situations where the target group is. It focusses on contact-making and staying in contact with individuals and marginalised groups, who otherwise are hard to reach, have lost their connection with society and have multiple problems. It’s a high appreciated practice, but it lacks a method that is substantiated with research (Morse et all, 1996; Kirkpatrick, 2000). In this paper we will present conceptual model of the method of social street work, that’s substantiated with experiences from professionals and the target group.MethodThis paper is based on a combination of literature review, document analysis, Delphi Method and an online questionnaire among the target group. The research is conducted at Streetcornerwork in Amsterdam. Streetcornerwork is the only organization in the Netherlands that provides social street work, since WWII. They employ 175 professional social street workers and has 43 years of experience in social street work.First, a theoretical model of social street work is developed bases on literature review, analyses of documents of the establishment (1970-1990)of social street work (Netherlands) and different attempts to describe the method (1991-2017). Second, the explanation model is strengthened with data from the online questionnaire among 1600 clients of Streetcornerwork. Third, the Delphi Method is used to validate the model with the tacit knowledge of 24 professionals.ResultsThe result is a conceptual model of the method of social street work that is substantiated with experiences from professionals and the target group. Characteristic is that it’s an open approach in contact with the target group which is highly dependent on context and has unpredictable character (Metz, 2016 , Andersson, 2011).The method social street work consists of 14 methodic principles,. Social street work contributesto the development of self-insight and general life skills, the restoration of the social network and the improvement of living conditions and the well-being of the target group. We also gain insight in the experienced contribution of social street work from persons in the environment of the target group (client system, neighborhood and institutional environment). This experienced contribution of social street work at theenvironment is divided into the direct contribution and the implicated contribution through the target group.Conclusions and implicationsThis conceptual model of the method of social street work contributes to a body of knowledge. We made tacit knowledge explicit and we can legitimize the profession of social street work. Because research is done in close collaboration with street workers, it also contributes to the development of their work.
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