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Estimation of the anterior cruciate ligament load and lower limb muscle tensions in the forward and backward stair descent
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
Statistical analysis: We calculated a coefficient of correlation between each method for measurement. We demanded the value of each physical active mass method assay and the coefficient of correlation with the body composition and regression models using IBMSPSS20. Results: The CPA and the coefficient of correlation between OPA were r = 0.948 (p = 0.014). The CPA and the coefficient of correlation between PIPA were r = 0.847 (p = 0.07). The coefficient of correlation between PIPA and OPA showed 0.635 (p = 0.24). We showed high coefficient of correlation r = 0.729 between CPA and bone quantity, and the significance was not found (p = 0.163). Similarly, we showed high coefficient of correlation r = 0.710 between OPA and bone quantity, and the significance was not found (p = 0.179). However, the offal fat and the ratio of the quantity of muscle and the coefficient of correlation between the CPA showed r = 825, p = 0.086. CPA estimation model of the ratio of visceral fat and muscle mass showed a significant effect. The ratio of muscle mass per visceral fat = CPA*−0.951 + constant. 95% CI constant = 3.163 to 14.02, CPA = −0.009 to −0.001 (except severe affected case (n = 1).) Conclusion(s): The motion capture method by wearable camera PA estimate was significantly equivalent to behavior observation method. Implications: CPA estimates the ratio of visceral fat per muscle mass related physical activities showed a significant effect. It might be useful tool to look for physical inactivity. Keywords: Physical activity; Wearable camera; Daily living Funding acknowledgements: Funding was not received for this study. Ethics approval: This study was approved by Gunma PAZ College Ethic Committee. http://dx.doi.org/10.1016/j.physio.2015.03.1437
eS1469
Research Report Poster Presentation Number: RR-PO-06-02-Mon Monday 4 May 2015 13:00 Exhibit halls 401–403 ESTIMATION OF THE ANTERIOR CRUCIATE LIGAMENT LOAD AND LOWER LIMB MUSCLE TENSIONS IN THE FORWARD AND BACKWARD STAIR DESCENT T. Takabayashi 1 , T. Inai 1 , E. Yokoyama 1 , M. Edama 1 , Y. Tokunaga 2 , M. Kubo 1 1 Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, Niigata, Japan; 2 Niigata Rehabilitation Hospital, Department of Rehabilitation, Niigata, Japan
Background: Patients with knee osteoarthritis (OA) need to decrease the anterior cruciate ligament (ACL) load in activities of daily life. Later study demonstrated that ACL has been damaged more than 50% of patients with knee OA. Furthermore, previous study reported knee OA with damaged ACL accelerates progression of damage of articular cartilage. One of activities of daily life that generates high load on joint surfaces for patients with knee OA is stair descent. As an alternative strategy to the general forward stair descent, backward stair descent has attracted attention from a view point of injury prevention. However, it is unclear whether backward stair descent leads to decreased ACL load. Purpose: The purpose of this study was to estimate anterior cruciate ligament load and lower limb muscle tensions in forward and backward stair descent. Methods: Six healthy young males participated in this study. The subjects descended the stair placed on the force platform with bare feet at comfortable speed. The stair descents were performed in forward and backward with step by step pattern. The stair complied with the barrierfree law of Japan. Descending motions were captured by a 3D motion analysis system. Surface electromyography was obtained from 7 muscles of the leading leg. Net joint moments were calculated based on ground reaction forces and trajectories of markers on bony landmarks. The muscle tensions were estimated based on calculated net joint moments and electromyography by mathematical optimization. The load to anterior cruciate ligament was estimated based on those data. Statistical analysis of this study was used statistics R. The differences between mean values of maximal ACL load, shear force calculated based on muscle tensions between two descending conditions were evaluated by Wilcoxon signed rank test. Results: The estimated maximal ACL load in backward stair descent was significantly lower compared to the forward stair descent (2.6 ± 0.6 N/kg, 3.2 ± 1.0 N/kg, respectively; p < 0.05). The estimated maximal anterior shear force in backward stair descent was significantly lower compared
eS1470
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
to the forward stair descent (1.3 ± 0.6 N/kg, 2.4 ± 0.8 N/kg respectively; p < 0.05). Conclusion(s): The most important finding of the present study was that the estimated maximal ACL load in backward stair descent was significantly lower compared to the forward stair descent. Previous study reported patients with knee OA have often damaged or ruptured ACL. Knee OA with damaged ACL accelerates abnormal motion of knee joint, damage of articular cartilage and progression of disease stage. In this study, the backward stair descent might be as one of options for patients with knee OA. Implications: Clinically, the backward stair descent might be more suitable method of descent for patients with knee OA. Since the tread of staircase might not be seen in the backward stair descent, we would recommend the use of handrail for safety. Keywords: Anterior cruciate ligament; Forward stair descent; Backward stair descent Funding acknowledgements: We acknowledge members of Institute for Human Movement and Medical Science for assistance. Ethics approval: This study was approved by the internal review board of Niigata University of Health and Welfare (No. 17324-120605). http://dx.doi.org/10.1016/j.physio.2015.03.1438 Special Interest Report Poster Presentation Number: SI-PO-19-24-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 CURRENT STATUS OF STANDARDIZATION OF THE MEDICAL REHABILITATION TECHNOLOGY IN JAPAN: ANALYSIS OF KNOWLEDGE MANAGEMENT R. Takagi 1,2 , T. Suzuki 3 1 Kiba
Hospital, Department of Rehabilitation, Higashiosaka, Japan; 2 Medical Corporation, Juzankai, The Administrative Office, Higashiosaka, Japan; 3 Graduate School of Kansai University of Health Sciences, Graduate School of Health Sciences, Kumatori, Japan Background: In Japan, the medical rehabilitation technology (MRT) has been used loosely, without scientific verification of treatment safety and efficacy. Therefore, knowledge management is necessary to standardize and improve the use of MRT. However, the obstacles to efficient knowledge management are poorly understood. Purpose: The purpose of this study was to identify the factors preventing knowledge management of medical rehabilitation and the aspects requiring improvement. Methods: We defined the optimal knowledge management framework based on some researcher’s study for
medical rehabilitation. This framework was composed of 6 infrastructures and 6 processes. The infrastructure included the following: (1) (2) (3) (4) (5) (6)
guidance on technical standardization and improvement, the knowledge manager, the information exchange location of MRT, the study system of MRT, the education system of MRT, and the evaluation system of MRT. The process included the following:
(1) (2) (3) (4) (5) (6)
the problem extraction phase of MRT, the plan phase of MRT, the study phase of MRT, the evaluation phase of MRT, the implementation phase of MRT, and the reevaluation phase of MRT.
The implementation condition of each factor was investigated at 20 rehabilitation medical institutions that cooperated with this study by conducting interviews. In the analyzing the interview contents, we checked whether there is 6 infrastructures and 6 processes in 20 rehabilitation medical institutions. The results were compiled to identify the factors preventing knowledge management. Results: All rehabilitation institutions had an infrastructure for the research and education system supporting the rehabilitation technology. Only 3 rehabilitation institutions understood the concept of technical standardization and improvement and appropriately followed the knowledge management framework. They constantly conducted organized projects on technical standardization and improvement. In the other 17 institutions, technical standardization and improvement was not a priority. These institutions conducted information exchange through numerous clinical conferences. However, the purpose of clinical conferences is to improve the tacit knowledge of therapists. Moreover, introduction of the rehabilitation technology is entrusted to the judgment of each therapist. Conclusion(s): This study identified the main obstacles to knowledge management for medical rehabilitation as (1) lack of the idea for organized technical standardization and improvement and (2) cultural barriers depending on the tacit knowledge of therapists, preventing interventions from other professions and organizations in Japan. We believe that it is essential to follow the entire framework designed in this study for organized technical standardization and improvement. Implications: Setting the idea for organized technical standardization and improvement and promoting information exchanges between the staff and organizations are essential to reduce hospitalization periods and social security cost. Keywords: Idea; Knowledge management; Rehabilitation medical technology
Statistical analysis: We calculated a coefficient of correlation between each method for measurement. We demanded the value of each physical active mass method assay and the coefficient of correlation with the body composition and regression models using IBMSPSS20. Results: The CPA and the coefficient of correlation between OPA were r = 0.948 (p = 0.014). The CPA and the coefficient of correlation between PIPA were r = 0.847 (p = 0.07). The coefficient of correlation between PIPA and OPA showed 0.635 (p = 0.24). We showed high coefficient of correlation r = 0.729 between CPA and bone quantity, and the significance was not found (p = 0.163). Similarly, we showed high coefficient of correlation r = 0.710 between OPA and bone quantity, and the significance was not found (p = 0.179). However, the offal fat and the ratio of the quantity of muscle and the coefficient of correlation between the CPA showed r = 825, p = 0.086. CPA estimation model of the ratio of visceral fat and muscle mass showed a significant effect. The ratio of muscle mass per visceral fat = CPA*−0.951 + constant. 95% CI constant = 3.163 to 14.02, CPA = −0.009 to −0.001 (except severe affected case (n = 1).) Conclusion(s): The motion capture method by wearable camera PA estimate was significantly equivalent to behavior observation method. Implications: CPA estimates the ratio of visceral fat per muscle mass related physical activities showed a significant effect. It might be useful tool to look for physical inactivity. Keywords: Physical activity; Wearable camera; Daily living Funding acknowledgements: Funding was not received for this study. Ethics approval: This study was approved by Gunma PAZ College Ethic Committee. http://dx.doi.org/10.1016/j.physio.2015.03.1437
eS1469
Research Report Poster Presentation Number: RR-PO-06-02-Mon Monday 4 May 2015 13:00 Exhibit halls 401–403 ESTIMATION OF THE ANTERIOR CRUCIATE LIGAMENT LOAD AND LOWER LIMB MUSCLE TENSIONS IN THE FORWARD AND BACKWARD STAIR DESCENT T. Takabayashi 1 , T. Inai 1 , E. Yokoyama 1 , M. Edama 1 , Y. Tokunaga 2 , M. Kubo 1 1 Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, Niigata, Japan; 2 Niigata Rehabilitation Hospital, Department of Rehabilitation, Niigata, Japan
Background: Patients with knee osteoarthritis (OA) need to decrease the anterior cruciate ligament (ACL) load in activities of daily life. Later study demonstrated that ACL has been damaged more than 50% of patients with knee OA. Furthermore, previous study reported knee OA with damaged ACL accelerates progression of damage of articular cartilage. One of activities of daily life that generates high load on joint surfaces for patients with knee OA is stair descent. As an alternative strategy to the general forward stair descent, backward stair descent has attracted attention from a view point of injury prevention. However, it is unclear whether backward stair descent leads to decreased ACL load. Purpose: The purpose of this study was to estimate anterior cruciate ligament load and lower limb muscle tensions in forward and backward stair descent. Methods: Six healthy young males participated in this study. The subjects descended the stair placed on the force platform with bare feet at comfortable speed. The stair descents were performed in forward and backward with step by step pattern. The stair complied with the barrierfree law of Japan. Descending motions were captured by a 3D motion analysis system. Surface electromyography was obtained from 7 muscles of the leading leg. Net joint moments were calculated based on ground reaction forces and trajectories of markers on bony landmarks. The muscle tensions were estimated based on calculated net joint moments and electromyography by mathematical optimization. The load to anterior cruciate ligament was estimated based on those data. Statistical analysis of this study was used statistics R. The differences between mean values of maximal ACL load, shear force calculated based on muscle tensions between two descending conditions were evaluated by Wilcoxon signed rank test. Results: The estimated maximal ACL load in backward stair descent was significantly lower compared to the forward stair descent (2.6 ± 0.6 N/kg, 3.2 ± 1.0 N/kg, respectively; p < 0.05). The estimated maximal anterior shear force in backward stair descent was significantly lower compared
eS1470
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
to the forward stair descent (1.3 ± 0.6 N/kg, 2.4 ± 0.8 N/kg respectively; p < 0.05). Conclusion(s): The most important finding of the present study was that the estimated maximal ACL load in backward stair descent was significantly lower compared to the forward stair descent. Previous study reported patients with knee OA have often damaged or ruptured ACL. Knee OA with damaged ACL accelerates abnormal motion of knee joint, damage of articular cartilage and progression of disease stage. In this study, the backward stair descent might be as one of options for patients with knee OA. Implications: Clinically, the backward stair descent might be more suitable method of descent for patients with knee OA. Since the tread of staircase might not be seen in the backward stair descent, we would recommend the use of handrail for safety. Keywords: Anterior cruciate ligament; Forward stair descent; Backward stair descent Funding acknowledgements: We acknowledge members of Institute for Human Movement and Medical Science for assistance. Ethics approval: This study was approved by the internal review board of Niigata University of Health and Welfare (No. 17324-120605). http://dx.doi.org/10.1016/j.physio.2015.03.1438 Special Interest Report Poster Presentation Number: SI-PO-19-24-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 CURRENT STATUS OF STANDARDIZATION OF THE MEDICAL REHABILITATION TECHNOLOGY IN JAPAN: ANALYSIS OF KNOWLEDGE MANAGEMENT R. Takagi 1,2 , T. Suzuki 3 1 Kiba
Hospital, Department of Rehabilitation, Higashiosaka, Japan; 2 Medical Corporation, Juzankai, The Administrative Office, Higashiosaka, Japan; 3 Graduate School of Kansai University of Health Sciences, Graduate School of Health Sciences, Kumatori, Japan Background: In Japan, the medical rehabilitation technology (MRT) has been used loosely, without scientific verification of treatment safety and efficacy. Therefore, knowledge management is necessary to standardize and improve the use of MRT. However, the obstacles to efficient knowledge management are poorly understood. Purpose: The purpose of this study was to identify the factors preventing knowledge management of medical rehabilitation and the aspects requiring improvement. Methods: We defined the optimal knowledge management framework based on some researcher’s study for
medical rehabilitation. This framework was composed of 6 infrastructures and 6 processes. The infrastructure included the following: (1) (2) (3) (4) (5) (6)
guidance on technical standardization and improvement, the knowledge manager, the information exchange location of MRT, the study system of MRT, the education system of MRT, and the evaluation system of MRT. The process included the following:
(1) (2) (3) (4) (5) (6)
the problem extraction phase of MRT, the plan phase of MRT, the study phase of MRT, the evaluation phase of MRT, the implementation phase of MRT, and the reevaluation phase of MRT.
The implementation condition of each factor was investigated at 20 rehabilitation medical institutions that cooperated with this study by conducting interviews. In the analyzing the interview contents, we checked whether there is 6 infrastructures and 6 processes in 20 rehabilitation medical institutions. The results were compiled to identify the factors preventing knowledge management. Results: All rehabilitation institutions had an infrastructure for the research and education system supporting the rehabilitation technology. Only 3 rehabilitation institutions understood the concept of technical standardization and improvement and appropriately followed the knowledge management framework. They constantly conducted organized projects on technical standardization and improvement. In the other 17 institutions, technical standardization and improvement was not a priority. These institutions conducted information exchange through numerous clinical conferences. However, the purpose of clinical conferences is to improve the tacit knowledge of therapists. Moreover, introduction of the rehabilitation technology is entrusted to the judgment of each therapist. Conclusion(s): This study identified the main obstacles to knowledge management for medical rehabilitation as (1) lack of the idea for organized technical standardization and improvement and (2) cultural barriers depending on the tacit knowledge of therapists, preventing interventions from other professions and organizations in Japan. We believe that it is essential to follow the entire framework designed in this study for organized technical standardization and improvement. Implications: Setting the idea for organized technical standardization and improvement and promoting information exchanges between the staff and organizations are essential to reduce hospitalization periods and social security cost. Keywords: Idea; Knowledge management; Rehabilitation medical technology