Principal Investigator: Michael Bade, PT, PhD
Title: Multimodal Edema Management Program Post TKA
Abstract: Currently in the United States, more than 700,000 total knee arthroplasty (TKA) surgeries are performed annually with projections of 3.5 million performed annually by 2030.1,2 Postoperative knee swelling after TKA is profound and associated with decreased muscle activation, strength, range of motion, and functional performance as well as increased pain and post-surgical complications such as deep venous thrombosis (DVT).3-7 However, to date, traditional physical therapy interventions such as cryotherapy have demonstrated minimal effectiveness in reducing swelling and its associated sequelae.8 We have developed a novel multimodal edema management (MEM) program utilizing therapeutic exercise, compression garments, and self-administered lymphatic massage to decrease postoperative swelling. This pilot cohort study will determine the variability and responsiveness of bioimpedance spectroscopy (primary outcome) in response to the MEM program in 15 participants after TKA. Secondarily, we will determine the feasibility and patient perceptions of the MEM program after TKA by assessing: 1) adherence, 2) satisfaction, and 3) safety (secondary outcomes). Finally, we will explore the potential mechanistic relationship between postoperative swelling levels and quadriceps muscle activation deficits, strength and functional performance (secondary outcomes). The MEM program will be delivered in the home setting in addition to standard of care rehabilitation over three weeks. Outcomes will be assessed preoperatively and postoperatively at day 4, day 7, week 2, and week 3. Data from this study and historical swelling data of individuals after TKA (N=40) will be utilized to guide subsequent trial planning. This study is directly related to the departmental vision of improving the health of populations seeking care from PM&R professionals as well as providing the opportunity to collect data to leverage for future funding. Finally, our study team consist of a diverse range of health care professionals from physical therapy, occupational therapy, chiropractic, physiatry, and orthopedics. The investigative team possess a range of research experience which create opportunities to mentor more junior investigators and clinicians.
Principal Investigator: Mark M. Manago, DPT, PhD
Title: Instrumented motion analysis of hip and trunk movement compensations for people with multiple sclerosis
Abstract: Difficulty walking is one of the most commonly reported problems for people with multiple sclerosis (MS) and is associated with compensatory movement patterns. Movement pattern compensations can be the result of muscle weakness and lead to painful and/or inefficient gait that affects daily walking. Movement pattern compensations for people with MS have been well-documented at the ankle and knee through instrumented motion analysis, however less is known about the hip and trunk. This is a crucial gap in knowledge, as our recent work has demonstrated that hip abduction and trunk muscle strength are key predictors of gait performance, yet few strengthening studies have targeted these muscles to improve gait. By developing a better understanding of hip and trunk movement pattern compensations during gait and understanding how these compensations relate to hip and trunk muscle weakness, we can design strength training interventions for the hip and trunk that are both targeted to the appropriate muscles and that can specifically address movement pattern compensations. In addition to improving intervention at the hip and trunk, identifying patients who might benefit from proximal strengthening is also an important priority, yet clinical assessments of proximal muscle function, such as the Trendelenburg test, have not been studied in people with MS.
Therefore, the overall aim of this proposal is to improve understanding of hip and trunk movement pattern compensations in people with MS using instrumented motion analysis to 1) identify frontal plane compensations in the hip and trunk during gait and 2) validate the Trendelenburg test. A cross-sectional design consisting of one visit will be used. We hypothesize that instrumented motion analysis will 1) identify impairments in peak hip and trunk frontal plane moments and angles during gait, and 2) correlate with Trendelenburg angles as measured with goniometry during single-limb stance.
The results from this study would 1) be the final step in our development of a novel strengthening approach that incorporated hip and trunk muscles, and 2) improve clinical assessment of proximal muscle function in people with MS. This novel approach would have the potential to set a new standard for strength training and assessment in people with MS by addressing compensatory patterns, improving gait performance, and ultimately, increasing participation and quality of life.
Principal Investigator: Maryam Tahmasbi Sohi, MD
Title: Short term Effects of Intraarticular Triamcinolone Acetonide Injection on Serum Testosterone, LH and FSH Levels in Cohort of Male Veterans with Osteoarthritic Glenohumeral Joint: A Prospective Pilot Study
Abstract: Musculoskeletal disorders are among the most frequently occurring chronic conditions affecting the US population. They have a substantial impact on quality of life, use of health care resources, and the nation's economy. Physiatry, among other specialties in medicine, is commonly involved in conservative management of musculoskeletal pain through therapy, activity modification, oral pain medications, and corticosteroid injections. Utilization of ultrasound guidance has improved the accuracy and efficacy for some of these injections, but there is relatively little data on their systemic effects with long-term and frequent use. Currently there have been no prior studies on the effects of localized corticosteroid injections on gonadal-pituitary axis. The overall objective of this pilot study is to determine the changes in gonadal-pituitary axis testosterone level after an ultrasound-guided injection of standard dosing of triamcinolone acetonide into the glenohumeral joint. To do this a before-after study, we will use a mixed effects model with a random intercept. Knowledge gained supports future, more rigorous trials that are focused on how modifications in frequency and dosing will influence adverse effects and efficacy of corticosteroid injections.
Principal Investigator: Amy Bodkin, PT, PhD, Aaron Powell, MD
Title: Validation of Gait Analysis in Children with Spina Bifida Using Plantar Pressures
Abstract: Children with spina bifida have numerous gait deviations and are heavily reliant on therapies, bracing, equipment, and surgical intervention to achieve and maintain ambulation. Objective measurement of gait is extremely helpful for clinical decision-making, but current kinematic gait studying techniques are cost prohibitive and generally uncovered by payers. Because of this, clinical decision-making is usually based on subjective bedside clinical examination and observation of gait.
Plantar pressure (PP) measurements (which visualize pressure fields between the surface of a foot and a supporting surface) can provide information on foot position, pressure distribution, and temporal-spatial parameters (gait speed, cadence, etc.) during gait. PPs are more efficient and less expensive than conventional 3-dimensional optical motion capture (OMC). These simple measures from PP gait analysis can be used to track progression of mobility impairments and assess risk for future health conditions in individuals with movement disabilities. Objective parameters obtained through PPs have been validated in typical gait patterns, but not for individuals with atypical plantar pressures and gait (the population that could benefit most from this technology).
The aim of this proposed pilot study is to establish validity and reliability of automated PP analysis to determine foot position and resultant pressure distribution during gait in children with spina bifida. Achieving the aims of this study would directly impact health outcomes of children with spina bifida by optimizing our ability to objectively evaluate multiple domains of their abnormal gait in an accurate, efficient, and economical way. It would also allow us to apply for future funding to create standardized gait measurement techniques for children with spina bifida that will decrease costs and improve the accuracy of clinical evaluation and decision-making.