Publications (11)18.27 Total impact
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Article: The outcome of a novel biomechanical therapy for patients suffering from anterior knee pain.
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ABSTRACT: BACKGROUND: This study was devised to examine the effect of a novel biomechanical therapy for patients suffering from anterior knee pain (AKP). METHODS: A retrospective analysis of 48 patients suffering from AKP was performed. Patients underwent a gait evaluation, using an electronic walkway mat, and completed the SF-36 health survey and the WOMAC questionnaire at baseline and after 3 and 6months of therapy. A special biomechanical device was individually calibrated for each patient. AposTherapy is a functional, non-invasive rehabilitation therapy consisting of a biomechanical foot-worn device that is used during activities of daily living. Repeated measures analyses were performed to compare gait parameters and self-evaluation questionnaires between baseline, 3months and 6months. RESULTS: Walking velocity significantly increased by 5.7cm/s, cadence increased by 1.6 steps/minute, and stride length increased by 3.4cm in relation to pretreatment testing (p<0.001 for all). End-point evaluation revealed additional improvement of these parameters; however these did not significantly differ from that of mid-treatment. Pain decreased by 36.6% and 49.2% following 13 and 26 weeks of treatment, respectively (P<0.01) and function improved by 25.2% and 41.7% following 13 and 26 weeks of treatment, respectively (P=0.01). CONCLUSIONS: The males show significantly greater coronal dimensions of the trochlea than women which are likely to contribute to the higher prevalence of prosthetic overhang in women with some standard implants. CLINICAL RELEVANCE: Based on the current study's results it may be concluded that this therapy might have a positive effect for patients with AKP.The Knee 12/2012; · 1.74 Impact Factor -
Article: A unique foot-worn device for patients with degenerative meniscal tear.
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ABSTRACT: PURPOSE: The purpose of the current study was to assess the effects of a new foot-worn device on the gait, physical function and pain in patients suffering from knee osteoarthritis (OA) who had a low-impact injury to the medial meniscus causing a degenerative meniscal tear. METHODS: A retrospective analysis of 34 patients with knee OA and a degenerative medial meniscal tear was performed. Patients underwent a gait evaluation, using an electronic walkway mat, and completed the SF-36 health survey and the WOMAC questionnaire at baseline and after 3 and 12 months of therapy. AposTherapy is a functional, biomechanical, non-invasive rehabilitation therapy consisting of a foot-worn device that is individually calibrated to each patient and is used during activities of daily living. Repeated-measures analyses were performed to compare gait parameters and self-evaluation questionnaires between baseline, and 3 and 12 months. RESULTS: Significant improvements were found in gait velocity, step length and single-limb support of the involved knee following 12 weeks of therapy (all p < 0.01), alongside an improvement in limb symmetry. These results were maintained at the 12-month follow-up examination. Significant improvements were also found in all three domains of the WOMAC index (pain, stiffness and physical function) and in the SF-36 Physical Health Scale and the SF-36 Mental Health Scale (all p < 0.01). CONCLUSIONS: Patients with knee OA and a degenerative medial meniscal tear using a biomechanical foot-worn device for a year showed improvement in gait, physical function and pain. Based on the findings of this study, it can be postulated that this biomechanical device might have a positive effect on this population. LEVEL OF EVIDENCE: Therapeutic study, Level IV.Knee Surgery Sports Traumatology Arthroscopy 05/2012; · 2.21 Impact Factor -
Article: Gait metric profile of 157 patients suffering from anterior knee pain. A controlled study.
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ABSTRACT: PURPOSE: Gait metric alterations have been previously reported in patients suffering from anterior knee pain (AKP). Characterization of simple and measureable gait parameters in these patients may be valuable for assessing disease severity as well as for follow-up. Previous gait studies in this population have been comprised of relatively small cohorts and the findings of these studies are not uniform. The objective of the present study was to examine spatio-temporal gait parameters in patients with AKP in comparison to symptom-free controls. Furthermore, the study aimed to examine the relationship between self-reported disease severity and the magnitude of gait abnormalities. METHODS: 157 patients with AKP were identified and compared to 31 healthy controls. Patients were evaluated with a spatiotemporal gait analysis via a computerized mat, the Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire and the Short Form (SF)-36 health surveys. RESULTS: AKP patients walked with significantly lower velocity (15.9%) and cadence (5.9%), shorter step length (9.5%), stride length (9.6%), and showed significant differences in all gait cycle phases (P<0.05 for all). Study group reported higher levels of pain (96%), functional limitation (94%), and poorer perception of mental quality of life (30%) (P<0.05 for all). CONCLUSION: Significant differences were found between the spatiotemporal gait profile of AKP patients and symptom-free matched controls. In addition, an association was found between subjective disease severity and gait abnormalities. These findings suggest the usefulness of gait parameters, alongside with the use of self-evaluation questionnaires, in identifying deviations of these patients from healthy population.The Knee 04/2012; · 1.74 Impact Factor -
Article: Differences in gait pattern parameters between medial and anterior knee pain in patients with osteoarthritis of the knee.
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ABSTRACT: Patients with osteoarthritis of the knee have unique spatiotemporal gait alterations. These gait changes have not yet been differentiated according to the location of knee pain. The purpose of this study was to compare the gait patterns of patients with symptomatic knee osteoarthritis that exhibit either anterior or medial joint pain. 240 Patients with knee osteoarthritis were evaluated at one therapy center. Patients were divided into two groups according to the location of greatest pain in their worse knee. Patients underwent a computerized spatiotemporal gait analysis. Differences in gait patterns between the two knee pain locations were also examined within each gender. Compared with patients with pain in the anterior knee compartment, those with pain in the medial knee compartment exhibited a significantly slower walking speed (P<0.01), shorter step length (P<0.01), lower single-limb-support phase (P<0.01). These differences are witnessed mainly between the females in each group, whereas males differed only in single-limb-support. The results of this study suggested underlying gait differences in the nature of medial and anterior knee pain. Furthermore, gender differences in gait may exist between patients with medial knee pain compared to patients with anterior knee pain.Clinical biomechanics (Bristol, Avon) 03/2012; 27(6):584-7. · 1.76 Impact Factor -
Article: [A new non-invasive biomechanical therapy for knee osteoarthritis improves clinical symptoms and gait patterns].
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ABSTRACT: The management of knee osteoarthritis (OA) focuses on reducing the levels of pain and disability. Recently, a novel biomechanical device and treatment methodology (AposTherapy) was shown to reduce the knee adduction moment while simultaneously challenging the neuromuscular control system through perturbation. The purpose of the study was to investigate the changes in gait patterns and clinical measurements following treatment with a novel biomechanical device on patients with knee OA. A total of 745 patients with bilateral knee OA were analyzed. Patients completed a gait test, Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire and SF-36 Health Survey at baseline and after 12 weeks. The biomechanical device was individually calibrated to each patient. Shifting the center of pressure, through changes in the location of the biomechanical elements causes realignment and reduction in the knee adduction moment. Furthermore the configuration of the biomechanical element allows training under controlled perturbation. A significant decrease was found in WOMAC pain (28.6%) and WOMAC function (25.2%) following three months of therapy (p<0.001). A significant increase was found in the patients' physical quality of life (17.8%) and mental quality of life (11.0%) (p<0.001). Gait velocity, cadence step length, stance phase and single limb support phase improved significantly following three months of therapy (7.6%, 4%, 3.7% and 1.6%, respectively). Our results suggest an overall improvement in the gait patterns, level of pain, function and quality of life of patients with knee OA following three months of AposTherapy.Harefuah 10/2011; 150(10):769-73, 815. -
Article: Sex and body mass index correlate with Western Ontario and McMaster Universities Osteoarthritis Index and quality of life scores in knee osteoarthritis.
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ABSTRACT: To examine the associations of sex, body mass index (BMI), and age with knee osteoarthritis (OA) symptomatic severity. A cross-sectional retrospective analysis. Patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Data were acquired from a stored database of a private therapy center. Patients (N=1487) with symptomatic knee OA were evaluated. Not applicable. WOMAC questionnaire and SF-36. BMI correlated significantly with worse knee OA symptoms for all WOMAC and SF-36 subcategories (all P ≤.001). Age correlated significantly with worse symptoms only for WOMAC function and SF-36 physical functioning (P=.001 and P=.009, respectively). A significant difference across BMI quintiles was found for all WOMAC and SF-36 subcategories (all P ≤.01). Women showed worse knee OA symptoms in all WOMAC and SF-36 subcategories (all P ≤.001). There was a significant interaction of sex by BMI in WOMAC pain and WOMAC function (P=.01 and P=.02, respectively). Based on the results of this analysis, it can be concluded that women and patients with a higher BMI with knee OA are at a greater risk for worse symptoms.Archives of physical medicine and rehabilitation 08/2011; 92(10):1618-23. · 2.18 Impact Factor -
Article: Can single limb support objectively assess the functional severity of knee osteoarthritis?
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ABSTRACT: There is a lack in objective measurements that can assess the symptoms of knee osteoarthritis (KOA). In a previous study it was shown that pain and function are in higher correlation with the single-limb support gait parameter than with radiographic KOA stage. Single limb support represents a phase in the gait cycle when the body weight is entirely supported by one limb, while the contra-lateral limb swings forward. The purpose of this study was to further examine the relationship between single-limb support and the level of pain and function in patients with KOA. 125 adults with bilateral KOA underwent a physical and radiographic evaluation, and completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the SF-36 health survey. Patients walked barefoot at a self-selected speed on a computerized mat. Statistical analysis was used to divide the patients into quintiles based on single-limb support phase value and determine the differences in WOMAC and SF-36 scores between quintiles. Significant differences were found in WOMAC and SF-36 sub-category scores between the single-limb support quintiles. The means of the WOMAC-pain and WOMAC-function sub-categories decreased gradually over single-limb support quintiles (P<0.001), and the means of the SF-36 sub-categories increased gradually over the quintiles (P<0.001). Results show that single-limb support quintiles can help determine the level of pain, function and quality of life in patients with KOA. These results suggest that single-limb support quintiles may be added as an additional scale for generally assessing the symptomatic stage of KOA.The Knee 01/2011; 19(1):32-5. · 1.74 Impact Factor -
Article: Correlation between single limb support phase and self-evaluation questionnaires in knee osteoarthritis populations.
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ABSTRACT: To investigate the correlation between single limb support (SLS) phase (% of gait cycle) and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36 Health Survey) in patients with knee osteoarthritis (OA). A prospective observational study was employed with 125 adults with bilateral medial compartment symptomatic knee OA who underwent a physical and radiographic evaluation. Velocity, step length and SLS were assessed by a computerised mat (GAITRite). Patients completed the WOMAC and SF-36 Health Survey questionnaires. Statistical analysis examined the correlations between SLS and both questionnaires, between Kellgren & Lawrence (K&L) scores and both questionnaires and between SLS correlations and K&L correlations. We found significantly stronger correlations between SLS and WOMAC-pain, WOMAC-function, the SF-36 pain sub-category, velocity and step length than between K&L scores and these parameters (Pearson's r = 0.50 vs. 0.26, 0.53 vs. 0.34, 0.50 vs. 023, 0.81 vs. 0.33, 0.77 vs. 0.37, respectively; all p < 0.05). Significant differences in SLS were found over WOMAC-pain, WOMAC-function and SF-36 overall score quartiles (p < 0.05 for all). We recommend integrating SLS as an objective parameter in the comprehensive evaluation of patients with knee OA.Disability and Rehabilitation 01/2011; 33(13-14):1103-9. · 1.50 Impact Factor -
Article: APOS therapy improves clinical measurements and gait in patients with knee osteoarthritis.
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ABSTRACT: The purpose of the study was to investigate the changes in gait patterns and clinical measurements following treatment with a novel biomechanical device on patients with knee osteoarthritis. Forty six patients with bilateral knee osteoarthritis were analyzed. Patients completed a gait test, Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire and SF-36 Health Survey at baseline and after 12 weeks. The biomechanical device was individually calibrated to each patient at baseline to allow training under reduced pain. Gait velocity, step length and single limb support improved significantly and toe out angle decreased significantly (10%, 6%, 1% and 2%, respectively). WOMAC-Pain and WOMAC-Function significantly decreased (26% and 34%, respectively), and SF-36 score significantly increased following the 12 weeks of treatment. Our results suggest an overall improvement in the gait patterns, level of pain and level of function of patients with knee osteoarthritis following 12 weeks of treatment with the novel biomechanical device.Clinical biomechanics (Bristol, Avon) 11/2010; 25(9):920-5. · 1.76 Impact Factor -
Article: Differences in gait patterns, pain, function and quality of life between males and females with knee osteoarthritis: a clinical trial.
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ABSTRACT: The aim of this study was to gain a deeper understanding of the gender differences in knee osteoarthritis (OA) by evaluating the differences in gait spatio-temporal parameters and the differences in pain, quality of life and function between males and females suffering from knee OA. 49 males and 85 females suffering from bilateral medial compartment knee OA participated in this study. Each patient underwent a computerized gait test and completed the WOMAC questionnaire and the SF-36 health survey. Independent t-tests were performed to examine the differences between males and females in age, BMI, spatio-temporal parameters, the WOMAC questionnaire and the SF-36 health survey. Males and females had different gait patterns. Although males and females walked at the same walking speed, cadence and step length, they presented significant differences in the gait cycle phases. Males walked with a smaller stance and double limb support, and with a larger swing and single limb support compared to females. In addition, males walked with a greater toe out angle compared to females. While significant differences were not found in the WOMAC subscales, females consistently reported higher levels of pain and disability. The spatio-temporal differences between genders may suggest underlying differences in the gait strategies adopted by males and females in order to reduce pain and cope with the loads acting on their affected joints, two key aspects of knee OA. These gender effects should therefore be taken into consideration when evaluating patients with knee OA. The study is registered in the NIH clinical trial registration, protocol No. NCT00599729.BMC Musculoskeletal Disorders 10/2009; 10:127. · 1.58 Impact Factor -
Article: A novel biomechanical device improves gait pattern in patient with chronic nonspecific low back pain.
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ABSTRACT: A retrospective study on patients with chronic nonspecific low back pain (NSLBP). To describe the gait stride characteristics of patients with chronic NSLBP, and to examine the effect of a novel biomechanical device on the gait stride characteristics of these patients. Patient with NSLBP alters their gait patterns. This is considered a protective mechanism as patients try to avoid extensive hip and spine ranges of motion and minimize forces and moments acting on the body. In addition, there are changes in the neuromuscular control system in patients with LBP that could possibly be attributed to the effects of pain on motor control. Nineteen patients underwent a gait test, using an electronic walkway, at baseline and after 12 weeks of treatment. Spatiotemporal parameters were used to identify changes in gait pattern. A novel biomechanical device comprised of 4 modular elements attached to foot-worn platforms was used in the study. The modules are 2 convex shaped biomechanical elements attached to each foot, one is located under the hindfoot region and the other is located under the forefoot region. The device was individually calibrated to each patient. The patients were instructed to walk with the calibrated biomechanical device on a daily basis for a period of 12 weeks. Significant differences were found at baseline and after 12 weeks in normalized velocity (P = 0.03), cadence (P < 0.01), left normalized step length (P = 0.02), right normalized step length (P = 0.02), right swing (P < 0.01), right stance (P < 0.01), left single limb support (P = 0.01), left double limb support (P = 0.02), and right double limb support (P = 0.02). Patients with NSLBP treated with the novel biomechanical device for 3 months increased walking speed through longer step length and eliminated asymmetrical differences.Spine 08/2009; 34(15):E507-12. · 2.08 Impact Factor
Top co-authors
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Institutions
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2012
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Barzilai Medical Center Ashkelon
Ashqelon, Southern District, Israel
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2009–2011
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Assaf Harofeh Medical Center
Rishon LeẔiyyon, Central District, Israel
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