Open Access Publications
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Open access publications by faculty, staff, postdocs, and graduate students from the Biomechanics & Movement Science Program.
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- ItemComparing an Expanded Versus Brief Telehealth Physical Therapist Intervention for Knee Osteoarthritis: Study Protocol for the Delaware PEAK Randomized Controlled Trial(Physical Therapy & Rehabilitation Journal, 2023-02-01) Jakiela, Jason T.; Voinier, Dana; Hinman, Rana S.; Copson, Jennifer; Schmitt, Laura A.; Leonard, Tara R.; Aily, Jéssica B; Bodt, Barry A.; White, Daniel K.Objective The purpose of this study is to investigate whether a remotely delivered physical therapist intervention increases physical activity (PA) over 12 weeks, compared with existing web-based resources, in adults with knee osteoarthritis (OA). Methods This will be a single-center, randomized controlled trial with 2 parallel arms: (1) the Expanded Intervention (Delaware PEAK [Physical Exercise and Activity for Knee osteoarthritis]), which includes five 45- to 60-minute video conference-based sessions of supervised exercise (strengthening exercises, step goals) that are remotely delivered over 12 weeks by a physical therapist; or (2) the Brief Intervention (control group), a website that includes prerecorded videos directing participants to web-based resources for strengthening, PA, and pain management for knee OA that are freely available. The trial will enroll 100 participants who meet the National Institute for Health and Care Excellence OA clinical criteria (≥45 years old, have activity-related knee pain, and have no morning stiffness or it lasts ≤30 minutes), reside in the contiguous United States (excluding Alaska and Hawaii), and are seeking to be more physically active. Outcomes include PA (time in moderate-to-vigorous and light PA, steps per day), sedentary behaviors, treatment beliefs, and self-efficacy for exercise. Our primary outcome is moderate-to-vigorous PA. Outcomes will be measured at baseline, 12 weeks, and 24 weeks. Impact This protocol focuses on the remote delivery of physical therapy via telehealth to adults with knee OA and comes at a critical time, because the burden of inactivity is of particular concern in this population. If successful, the findings of this work will provide strong support for the broad implementation of Delaware PEAK, highlight the utility of telehealth in physical therapy, and address the critical need to utilize exercise to manage adults with knee OA through physical therapists.
- ItemKnee joint biomechanics during gait improve from 3 to 6 months after anterior cruciate ligament reconstruction(Journal of Orthopaedic Research, 2022-01-06) Neal, Kelsey; Williams, Jack R.; Alfayyadh, Abdulmajeed; Capin, Jacob J.; Khandha, Ashutosh; Manal, Kurt; Snyder‐Mackler, Lynn; Buchanan, Thomas S.Gait alterations after anterior cruciate ligament reconstruction (ACLR) are commonly reported and have been linked to posttraumatic osteoarthritis development. While knee gait alterations have been studied at several time points after ACLR, little is known about how these biomechanical variables change earlier than 6 months after surgery, nor is much known about how they differ over the entire stance phase of gait. The purpose of this study was to examine knee gait biomechanical variables over their entire movement pattern through stance at both 3 and 6 months after ACLR and to study the progression of interlimb asymmetry between the two postoperative time points. Thirty-five individuals underwent motion analysis during overground walking 3 (3.2 ± 0.5) and 6 (6.4 ± 0.7) months after ACLR. Knee biomechanical variables were compared between limbs and across time points through 100% of stance using statistical parametric mapping; this included a 2 × 2 (Limb × Time) repeated measures analysis of variance and two-tailed t-tests. Smaller knee joint angles, moments, extensor forces, and medial compartment forces were present in the involved versus uninvolved limb. Interlimb asymmetries were present at both time points but were less prevalent at 6 months. The uninvolved limb's biomechanical variables stayed relatively consistent over time, while the involved limb's trended toward that of the uninvolved limb. Statement of Clinical Significance: Interventions to correct asymmetrical gait patterns after ACLR may need to occur early after surgery and may need to focus on multiple parts of stance phase.
- ItemMarkerless motion capture: What clinician-scientists need to know right now(Journal of Science and Medicine in Sport Plus, 2022-11-14) Ito, Naoaki; Sigurðsson, Haraldur B.; Seymore, Kayla D.; Arhos, Elanna K.; Buchanan, Thomas S.; Snyder-Mackler, Lynn; Gravare Silbernagel, KarinMarkerless motion capture (mocap) could be the future of motion analysis. The purpose of this report was to describe our team of clinicians and scientists’ exploration of markerless mocap (Theia 3D) and share data for others to explore (link: https://osf.io/6vh7z/?view_only=c0e00984e94a48f28c8d987a2127339d). Simultaneous mocap was performed using markerless and marker-based systems for walking, squatting, and forward hopping. Segment lengths were more variable between trials using markerless mocap compared to marker-based mocap. Sagittal plane angles were most comparable between systems at the knee joint followed by the ankle and hip. Frontal and transverse plane angles were not comparable between systems. The data collection experience using markerless mocap was simpler, faster, and user friendly. The ease of collection was in part offset by the added data transfer and processing times, and the lack of troubleshooting flexibility. If used selectively with proper understanding of limitations, markerless mocap can be exciting technology to advance the field of motion analysis.
- ItemMetatarsophalangeal Joint Dynamic Stiffness During Toe Rocker Changes With Walking Speed(Journal of Applied Biomechanics, 2022-09-12) Nigro, Luke; Arch, Elisa S.Dynamic joint stiffness (or simply “stiffness”) is a customization criteria used to tune mechanical properties of orthotic and prosthetic devices. This study examines metatarsophalangeal (MTP) joint stiffness during the toe-rocker phase of barefoot walking and establishes baseline characteristics of MTP joint stiffness. Ten healthy individuals walked at 4 speeds (0.4, 0.6, 0.8, and 1.0 statures·s−1) over level ground. MTP sagittal plane joint angles and moments were calculated during the toe-rocker phase of stance. Least-squares linear regressions were conducted on the MTP moment versus angle curve to determine joint stiffness during early toe rocker and late toe rocker. Multilevel linear models were used to test for statistically significant differences between conditions. Early toe rocker stiffness was positive, while late toe rocker was negative. Both early toe rocker and late toe rocker stiffness increased in magnitude significantly with speed. This study establishes baseline characteristics of MTP joint stiffness in healthy walking, which previously had not been examined through a range of controlled walking speeds. This information can be used in the future as design criteria for orthotic and prosthetic ankle and ankle–foot devices that can imitate, support, and facilitate natural human foot motion during walking better than existing devices.
- ItemPredictors of non-stepping time in people with chronic stroke(Topics in Stroke Rehabilitation, 2022-08-22) Miller, Allison; McCartney, Kiersten; Wright, Tamara; Reisman, DarcyBackground: Sedentary time is an independent construct from active time. Previous studies have examined variables associated with sedentary time to inform behavior change programs; however, these studies have lacked data sets that encompass potentially important domains. Objectives: The purpose of this study was to build a more comprehensive model containing previously theorized important predictors of sedentary time and new predictors that have not been explored. We hypothesized that variables representing the domains of physical capacity, psychosocial, physical health, cognition, and environmental would be significantly related to sedentary time in individuals post-stroke. Methods: This was a cross-sectional analysis of 280 individuals with chronic stroke. An activity monitor was used to measure sedentary (i.e. non-stepping) time. Five domains (8 predictors) were entered into a sequential linear regression model: physical capacity (6-Minute Walk Test, assistive device use), psychosocial (Activities Specific Balance Confidence Scale and Patient Health Questionnaire-9), physical health (Charlson Comorbidity Index and body mass index), cognition (Montreal Cognitive Assessment), and environmental (Area Deprivation Index). Results: The 6-Minute Walk Test (β = −0.39, p < .001), assistive device use (β = 0.15, p = .03), Patient Health Questionnaire-9 (β = 0.16, p = .01), and body mass index (β = 0.11, p = .04) were significantly related to non-stepping time in individuals with chronic stroke. The model explained 28.5% of the variability in non-stepping time. Conclusions: This work provides new perspective on which variables may need to be addressed in programs targeting sedentary time in stroke. Such programs should consider physical capacity, depressive symptoms, and physical health.
- ItemReliability of Continuous Shear Wave Elastography in the Pathological Patellar Tendon(Journal of Ultrasound in Medicine, 2022-10-27) Ito, Naoaki; Sigurðsson, Haraldur B.; Pohlig, Ryan T.; Cortes, Daniel H.; Grävare Silbernagel, Karin; Sprague, Andrew L.Objectives Patellar tendon injuries occur via various mechanisms such as overuse, or due to surgical graft harvest for anterior cruciate ligament reconstruction (ACLR). Quantified patellar tendon stiffness after injury may help guide clinical care. Continuous shear wave elastography (cSWE) allows for the assessment of viscosity and shear modulus in tendons. The reliability of the measure, however, has not been established in the patellar tendon. The purpose of this study was to investigate the interrater reliability, intrarater reliability, and between-day stability of cSWE in both healthy and pathological patellar tendons. Methods Participants with patellar tendinopathy (n = 13), history of ACLR using bone-patellar tendon-bone autograft (n = 9), and with no history of patellar tendon injury (n = 13) were recruited. cSWE was performed 4 times by multiple raters over 2 days. Intraclass correlations (ICC) and minimum detectable change (MDC95%) were calculated. Results Good to excellent between-day stability were found for viscosity (ICC = 0.905, MDC95% = 8.3 Pa seconds) and shear modulus (ICC = 0.805, MDC95% = 27.4 kPa). The interrater reliability measures, however, were not as reliable (ICC = 0.591 and 0.532). Conclusions cSWE is a reliable assessment tool for quantifying patellar tendon viscoelastic properties over time. It is recommended, however, that a single rater performs the measure as the interrater reliability was less than ideal.