Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Thesis (M.S.)--University of Wisconsin--Madison, 1983. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 67-70).

Osteoarthritis (OA) is a group of diseases entailing degradation of joints, and has been designated as one of the key conditions for special attention during the World Health Organization’s Bone and Joint Decade (2000-2010) (Brooks & Hart, 2000). Research has demonstrated that body weight is the number one modifiable risk factor associated with the onset and progression of knee OA (Felson, 1996). However, exercise programs that aim to initiate weight loss and improve pain and function in knee OA often increase loading on the knee joint, contributing to degeneration of the knee and progression of the disease (Miyazaki et al, 2002). The introduction of a new anti-gravity treadmill, which utilizes a technology called Lower Body Positive Pressure (LBPP), allows the examination of the relationship between weight, knee pain and knee loading via knee acceleration during exercise. The null hypothesis states that there will be no significant difference in knee pain, knee function and knee joint acceleration when comparing full weight bearing and LBPP treadmill walking exercise in a young knee OA population. Twenty-two overweight/obese patients with mild or moderate early-onset knee OA were recruited to complete two 25 minute treadmill walking sessions (one full weight-bearing and one LBPP walking session) one week apart and two walkway walking sessions. Knee pain and knee acceleration were recorded. Paired t-tests and ANOVAs were used to compare conditions. On average, an LBPP of 12.3% body weight reduction reduced knee pain in our population. Knee pain was significantly lower during LBPP walking than during full weight-bearing walking. Knee acceleration decreased with increasing LBPP. Heel strike and toe-off data from walkway walking trials illustrated significantly different knee acceleration about the knee (slow walking loads were lower / fast walking were higher), as compared to treadmill walking sessions. This study illustrates that treadmill walking at a minimal level of LBPP can decrease knee pain and attenuate knee joint loads while allowing patients to complete exercise programs aimed at initiating weight loss and improving pain and function in knee OA. LBPP appears to be a promising tool for rehabilitation for those with painful knee OA and other lower body musculoskeletal conditions.

Knee osteoarthritis (OA) is a degenerative joint condition characterized by progressive joint pain, swelling, and loss of muscle and joint function for which there is no known cure. Current research indicates that the most important modifiable risk factor for the development and progression of knee OA is obesity, a condition that is increasingly common in older adults. Established treatment guidelines for knee OA recommend regular exercise for disease management. However, for obese patients weight-bearing exercise elicits large joint forces that can exacerbate symptoms and influence disease progression. Using a new anti-gravity treadmill capable of generating a lifting force called lower body positive pressure (LBPP), obese patients with knee OA can engage in regular physical activity while minimizing joint loading. The aim of this study was to assess the effect of a 12-week, anti-gravity treadmill walking (AGTW) program on knee pain and function in obese older adults with knee OA. The alternate hypothesis was that there would be a difference between Knee Injury and Osteoarthritis Outcome Score (KOOS) results before and after the anti-gravity treadmill walking program. A group of 25 participants with a mean (SD) age of 64.2 (6.1) years and BMI of 33.0 (6.8) kg/m2 completed AGTW twice per week for 12 weeks at a body weight percentage that minimized knee pain. Knee symptoms and function (KOOS), knee pain during full weight-bearing treadmill walking (FTW), isokinetic quadriceps and hamstring muscle strength, cardiovascular fitness (YMCA submaximal cycle ergometer test), general health status (SF-12), and activity level (average daily pedometer readings) were assessed at baseline and following the completion of the 12-week program using paired t-tests and Wilcoxon signed rank sum tests (α = 0.05). Improvements between baseline and outtake were found in all KOOS subscales, as well as hamstring and quadriceps thigh muscle strength. Knee pain during full FWB and AGTW decreased following the 12-week program. No significant differences were found in cardiovascular fitness, SF-12 scores, or average daily pedometer readings. The results of this study suggest that anti-gravity treadmill walking increases thigh muscle strength, reduces knee pain, and increases functional capacity during daily activities, including FTW in older, obese individuals with knee OA. Anti-gravity treadmill technology has the potential to improve the health and functional capacity of at-risk knee OA individuals, and advance current methods of rehabilitation and long-term management of chronic symptomatic knee OA.

Osteoarthritis (OA) is a group of diseases entailing degradation of joints, and has been designated as one of the key conditions for special attention during the World Health Organization’s Bone and Joint Decade (2000-2010) (Brooks & Hart, 2000). Research has demonstrated that body weight is the number one modifiable risk factor associated with the onset and progression of knee OA (Felson, 1996). However, exercise programs that aim to initiate weight loss and improve pain and function in knee OA often increase loading on the knee joint, contributing to degeneration of the knee and progression of the disease (Miyazaki et al, 2002). The introduction of a new anti-gravity treadmill, which utilizes a technology called Lower Body Positive Pressure (LBPP), allows the examination of the relationship between weight, knee pain and knee loading via knee acceleration during exercise. The null hypothesis states that there will be no significant difference in knee pain, knee function and knee joint acceleration when comparing full weight bearing and LBPP treadmill walking exercise in a young knee OA population. Twenty-two overweight/obese patients with mild or moderate early-onset knee OA were recruited to complete two 25 minute treadmill walking sessions (one full weight-bearing and one LBPP walking session) one week apart and two walkway walking sessions. Knee pain and knee acceleration were recorded. Paired t-tests and ANOVAs were used to compare conditions. On average, an LBPP of 12.3% body weight reduction reduced knee pain in our population. Knee pain was significantly lower during LBPP walking than during full weight-bearing walking. Knee acceleration decreased with increasing LBPP. Heel strike and toe-off data from walkway walking trials illustrated significantly different knee acceleration about the knee (slow walking loads were lower / fast walking were higher), as compared to treadmill walking sessions. This study illustrates that treadmill walking at a minimal level of LBPP can decrease knee pain and attenuate knee joint loads while allowing patients to complete exercise programs aimed at initiating weight loss and improving pain and function in knee OA. LBPP appears to be a promising tool for rehabilitation for those with painful knee OA and other lower body musculoskeletal conditions.

Knee osteoarthritis (OA) is a degenerative joint condition characterized by progressive joint pain, swelling, and loss of muscle and joint function for which there is no known cure. Current research indicates that the most important modifiable risk factor for the development and progression of knee OA is obesity, a condition that is increasingly common in older adults. Established treatment guidelines for knee OA recommend regular exercise for disease management. However, for obese patients weight-bearing exercise elicits large joint forces that can exacerbate symptoms and influence disease progression. Using a new anti-gravity treadmill capable of generating a lifting force called lower body positive pressure (LBPP), obese patients with knee OA can engage in regular physical activity while minimizing joint loading. The aim of this study was to assess the effect of a 12-week, anti-gravity treadmill walking (AGTW) program on knee pain and function in obese older adults with knee OA. The alternate hypothesis was that there would be a difference between Knee Injury and Osteoarthritis Outcome Score (KOOS) results before and after the anti-gravity treadmill walking program. A group of 25 participants with a mean (SD) age of 64.2 (6.1) years and BMI of 33.0 (6.8) kg/m2 completed AGTW twice per week for 12 weeks at a body weight percentage that minimized knee pain. Knee symptoms and function (KOOS), knee pain during full weight-bearing treadmill walking (FTW), isokinetic quadriceps and hamstring muscle strength, cardiovascular fitness (YMCA submaximal cycle ergometer test), general health status (SF-12), and activity level (average daily pedometer readings) were assessed at baseline and following the completion of the 12-week program using paired t-tests and Wilcoxon signed rank sum tests (α = 0.05). Improvements between baseline and outtake were found in all KOOS subscales, as well as hamstring and quadriceps thigh muscle strength. Knee pain during full FWB and AGTW decreased following the 12-week program. No significant differences were found in cardiovascular fitness, SF-12 scores, or average daily pedometer readings. The results of this study suggest that anti-gravity treadmill walking increases thigh muscle strength, reduces knee pain, and increases functional capacity during daily activities, including FTW in older, obese individuals with knee OA. Anti-gravity treadmill technology has the potential to improve the health and functional capacity of at-risk knee OA individuals, and advance current methods of rehabilitation and long-term management of chronic symptomatic knee OA.

Diss. (sammanfattning) Uppsala : Univ., 2001. / Härtill 5 uppsatser.

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UA Open Access Publishing Fund / Background: Noninvasive positive-pressure ventilation (NIPPV) use has increased in the treatment of patients with respiratory failure. However, despite decreasing the need for intubation in some patients, there are no data regarding the risk of intubation-related complications associated with delayed intubation in adult patients who fail NIPPV. The objective of this study is to evaluate the odds of a composite complication of intubation following failed NIPPV compared to patients intubated primarily in the medical intensive care unit (ICU). Methods: This is a single-center retrospective cohort study of 235 patients intubated between 1 January 2012 and 30 June 2013 in a medical ICU of a university medical center. A total of 125 patients were intubated after failing NIPPV, 110 patients were intubated without a trial of NIPPV. Intubation-related data were collected prospectively through a continuous quality improvement (CQI) program and retrospectively extracted from the medical record on all patients intubated on the medical ICU. A propensity adjustment for the factors expected to affect the decision to initially use NIPPV was used, and the adjusted multivariate regression analysis was performed to evaluate the odds of a composite complication (desaturation, hypotension, or aspiration) with intubation following failed NIPPV versus primary intubation. Results: A propensity-adjusted multivariate regression analysis revealed that the odds of a composite complication of intubation in patients who fail NIPPV was 2.20 (CI 1.14 to 4.25), when corrected for the presence of pneumonia or acute respiratory distress syndrome (ARDS), and adjusted for factors known to increase complications of intubation (total attempts and operator experience). When a composite complication occurred, the unadjusted odds of death in the ICU were 1.79 (95% CI 1.03 to 3.12). Conclusions: After controlling for potential confounders, this propensity-adjusted analysis demonstrates an increased odds of a composite complication with intubation following failed NIPPV. Further, the presence of a composite complication during intubation is associated with an increased odds of death in the ICU.