Evidence of Improvement in Various Impairments by Exercise Interventions in Patients with Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Purpose: To investigate improvement in various impairments by exercise interventions in patients with knee osteoarthritis (OA). Methods: We collected data on randomized controlled trials (RCTs) comparing the effects of exercise intervention with those of either nonintervention or psychoeducational intervention in patients with knee OA. Data on pain, stiffness, muscle strength, range of motion, flexibility, maximal oxygen uptake, and position sense were synthesized. The Grading of Recommendations Assessment, Development, and Evaluation system was used to determine the quality of the evidence. Results: Thirty-three RCTs involving 3,192 participants were identified. Meta-analysis provided highquality evidence that exercise intervention improves maximal oxygen uptake, and moderate-quality evidence that exercise intervention also improves pain, stiffness, knee extensor and flexor muscle strength, and position sense. The evidence that exercise intervention improves knee extension and flexion range of motion was deemed as undetermined-quality. Conclusion: In patients with knee OA, improvement in pain, stiffness, muscle strength, maximal oxygen uptake, and position sense with the use of exercise intervention can be expected. Although the quality of evidence of the effect of exercise intervention on range of motion was inconclusive, exercise intervention should be recommended for patients with knee OA to improve various impairments.     

Gait-related Self-efficacy is Low in Older Adults with Knee Osteoarthritis: A Preliminary Study

Objective: To investigate the differences in self-efficacy (SE) for walking tasks between older patients with knee osteoarthritis (OA) and older adults without knee OA. Methods: A cross-sectional design was employed. Older patients with radiographic knee OA and community-dwelling older adults without knee OA as controls were enrolled in the study. SE for the walking task was assessed using the modified gait efficacy scale (mGES). A Wilcoxon rank-sum test was used to compare the mGES between the groups of participants. A Tobit regression model was used to estimate the difference in mGES. The presence of radiographic knee OA was used as an independent variable. Sex (women), age, and body mass index were used as potential confounding variables in the model. Results: After exclusion, 78 participants (n=40 with knee OA, n=38 controls) were included. The mGES was lower in patients with knee OA than in controls. In the Tobit regression model adjusted for confounding factors, mGES in patients with knee OA was estimated to be 26.8 (95% confidence interval [CI]: 15.8-37.8) points lower than in controls. Conclusion: This study demonstrated that mGES was lower in older patients with knee OA than in older adults without knee OA.     

Effect of Intradialytic Supine Ergometer Exercise on Hemodialysis Patients with Different Nutritional Status

Objective: It is important for hemodialysis patients to exercise while their nutritional status is being monitored. This study aimed to examine the difference in physical exercise function and the effect of exercise intervention in hemodialysis patients who were divided into two groups (high-nutrition and low-nutrition groups) based on the serum albumin levels. Method: A total of 26 outpatients (18 men and 8 women) undergoing hemodialysis (age: 66 ± 10 years) were included in this study. The patients'' body composition data (weight, body mass index, percentage of body fat, fat-free mass, and total body water) and physical functions (grip strength, knee extensor strength, open-eyed one-legged standing time, long sitting trunk anteflexion, and 6-minute walking distance [6MWD] test) were measured. The intervention was supine ergometer exercise during hemodialysis, and the patients exercised for 30 minutes during hemodialysis thrice a week. The intervention period was three months. Results: Compared to the high-nutrition group, the low-nutrition group showed a significant decrease in muscle strength. Furthermore, long sitting trunk anteflexion in the high-nutrition group and 6MWD in the low-nutrition group improved significantly after the intervention. Conclusion: The result of this study may indicate that 6MD can be improved by exercise during dialysis, regardless of nutritional status. It is said that low nutritional status has a negative impact on survival rate; thus, considering the impact on survival rate, it is hemodialysis patients with a low nutritional status that should be considered to introduce more active exercise during dialysis.     

Association of objectively measured physical activity with combined bilateral knee and low-back pain in older adults with knee osteoarthritis: A cross-sectional study

Objective: Knee pain (KP) and low-back pain (LBP) are common sites of pain and major public health issues among older adults. We investigated the combined association of bilateral KP and LBP with objectively measured physical activity (PA) among adults with knee osteoarthritis (OA). Methods: We recruited 150 knee OA adults and measured steps and PA intensity, including sedentary behavior (SB), low PA (LPA), and moderate-to-vigorous PA, using an accelerometer. KP and LBP were measured using a numerical rating scale. They were classified into 4 groups based on the presence of KP and LBP: with the only unilateral KP (UKP), with the combined UKP and LBP (UKP and LBP), with the bilateral KP (BKP), and with the combined bilateral KP and LBP (BKP and LBP). One-way analysis of covariance was performed to compare physical activity variables (intensity or steps) between the four groups. Results: Overall, 126 patients were enrolled. The prevalence of UKP, BKP, UKP and LBP, and BKP and LBP were 29.4%, 23.8%, 18.3%, and 28.6%. The proportion of SB was higher in the BKP and LBP group than in the other groups (F = 6.51, p < 0.01). The proportion of LPA was lower in the BKP and LBP group than in the other groups (F = 6.21, p < 0.01). Conclusions: The proportions of SB and LPA were significantly worse in knee OA adults with BKP and LBP than in those with UKP. Our findings may be a basis for considering knee OA adults for improving PA.     

Effect of Interventions for Improving Lumbar Motor Control on Low Back Pain in Sedentary Office Workers: A Randomized Controlled Trials

Objective: To clarify the effect of intervention with dynamic motor control exercise (DMCE) for the lumbar region on low back pain in sedentary office workers (SOWs). Methods: The participants comprised 32 SOWs with low back pain who were randomly categorized into two groups: the DMCE group and the normal trunk exercise (NTE) group. Both groups performed each exercise for three days per week for 8 weeks. The primary endpoints were evaluated for the lumbar and hip flexion angles during trunk forward bending, effect of low back pain on activities of daily living (using the Oswestry Disability Index), and intensity of low back pain (using the Visual Analog Scale) pre- and post-intervention. The extent of changes was calculated by subtracting the pre-intervention value from the post-intervention value and was compared between the two groups using an unpaired t-test. Results: The extent of changes in the lumbar flexion and hip flexion angles at 10° of trunk forward bending were significantly greater in the DMCE group than in the NTE group, and no significant differences were noted between the two groups at other angles of trunk forward bending. The extent of changes in the Oswestry Disability Index and the Visual Analog Scale scores were significantly greater in the DMCE group than in the NTE group. Conclusion: DMCE is effective in improving motor control in the lumbar region and hip joints, thereby ameliorating low back pain in SOWs.     

Effect of a Combined Exercise and Cognitive Activity Intervention on Cognitive Function in Community-dwelling Older Adults: A Pilot Randomized Controlled Trial

Objective: The purpose of this study is to investigate the effect of an intervention combining exercise and cognitive activity on cognitive function in healthy older adults. Methods: This pilot randomized controlled trial recruited 33 eligible, healthy communitydwelling older adults (mean age, 77.1 years old; women, 51.5%), who were divided into intervention and waitlist control groups. The intervention group was engaged weekly in a group activity comprising exercise and discussions of homework, which included reading aloud, simple arithmetic, and simple activities, like spotting differences, for cognitive stimulation. They were also required to complete cognitive activity homework twice a week. The waitlist control group received no intervention. The main outcomes were cognitive function assessed using the Mini-Mental State Examination, delayed recall score on the Logical Memory IIA of the Wechsler Memory Scale Revised, Trail Making Test, and digit symbol substitution test. Results: According to the results, Mini-Mental State Examination scores were maintained in the intervention group but declined in the control group [Mean change in outcomes in control group (95% confidence interval): -1.68 (-2.89 to -0.48)]. Additional mean change in outcomes in intervention group were found [1.68 (0.02 to 3.35)]. Conclusions: Interventions combining exercise and cognitive activity can be helpful for preserving cognitive function in healthy older adults.     

Effect of Home-based Exercise Therapy for Peripheral Arterial Disease Patients Underwent Endovascular Treatment: A Clinical Controlled Design

Objective: This study aimed to clarify the effect of home-based exercise therapy on physical activity in peripheral arterial disease (PAD) patients after EVT. Methods: Study design was controlled clinical design. The subjects were 30 patients (76.6% men) who underwent EVT in the Sakakibara Heart Institute of Okayama. Patients with EVT meeting the inclusion criteria were divided into two groups, intervention group (Home-based exercise) and control group. Patients'' basic characteristics, the number of steps walked and QOL questionnaire (WIQ, SEPA, Vascu QOL) were assessed before surgery and, at the 3 month after discharge. A two-way analysis of variance (ANOVA) was performed to compare number of steps walked and QOL questionnaire. Results: Interaction effect were observed in the number of steps walked (F (1,28) =13.89, p<0.01). A multiple comparison test confirmed a significant increase between results of before surgery and at three months after surgery in the intervention group (p<0.01). An interaction between the presence and absence of intervention was found for the WIQ pain score (F(1,28) = 5.86, p=0.01), speed score (F(1,28) = 3.80, p=0.04) and SEPA (F(1,28) = 4.99, p=0.03). In a multiple comparison study, there was a significant increase in WIQ pain and speed scores in both groups before and 3 months after discharge from the hospital. Conclusion: Home-based exercise therapy using physical activity indices has the potential to improve number of steps and quality of life in patients with PAD after EVT.     

The Effect of Toe-grasping Exercises on Balance Ability in Home-based Rehabilitation: A Randomized Controlled Trial by Block Randomization

Objective: The purpose of the study was to clarify the causal effect of toe-grasping exercises on the improvement of static or dynamic balance ability in home-based rehabilitation users. Method: Our study included 34 subjects who met the criteria and were evaluable out of 98 rehabilitation service users at home nursing stations. This study was a randomized controlled trial. The intervention group performed towel gathering exercises in addition to the regular home-based rehabilitation program. The primary outcome was one-leg standing time, and the secondary outcomes were two-step test and toe grip strength. Results: Seventeen subjects were assigned to the intervention group and seventeen to the control group by block randomization. Data from 15 and 12 subjects in the intervention group and control group, respectively, who were able to complete the initial evaluation and the evaluation after 3 months, were analyzed. We compared the amount of change after 3 months of evaluation in the intervention group with the change in the control group. The results showed that the left/right mean value of oneleg standing time in the intervention group was significantly greater than that in the control group. In terms of the amount of change in the intervention period (T2-T1) within each assessment, there were significant improvements in both the toe-grip strength and the two-step values in the intervention group. Conclusion: We found that toe-grasping exercises could improve the balance ability of home-based rehabilitation users. This suggests the clinical significance of toe function in rehabilitation programs.     

Voice Quality in Laryngeal Cancer Patients: A Randomized Controlled Study of the Effect of Voice Rehabilitation

ObjectivesThe study aimed to investigate the short-term and long-term effects of voice rehabilitation in patients treated with radiotherapy for laryngeal cancer as measured by both the acoustic measure smoothed cepstral peak prominence (CPPS) and perceptual measures. A secondary aim was to investigate the relationship between acoustic and perceptual measures.MethodsIn total, 37 patients received voice rehabilitation post-radiotherapy and 37 patients constituted the irradiated control group. Outcome measures were mean CPPS for connected speech and ratings with the auditory-perceptual Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Outcome measures were analyzed 1 (baseline), 6, 12, and 24 months post-radiotherapy, where voice rehabilitation was conducted between the first two time-points. Additional recordings were acquired from vocally healthy participants for comparison.ResultsCPPS values of the voice rehabilitation group and vocally healthy group were not significantly different at 24 months post-radiotherapy. Ten out of 19 patients who received voice rehabilitation yielded a CPPS value above the threshold for normal voice 24 months post-radiotherapy, compared to 11 out of 26 in the irradiated control group. No statistically significant correlations were found between CPPS and perceptual parameters of GRBAS.ConclusionVoice rehabilitation for irradiated laryngeal cancer patients may have positive effects on voice quality up to 24 months post-radiotherapy. The relationship between CPPS and GRBAS as well as the applicability of CPPS for evaluation over several points of measurement needs to be studied further.     

Effects of Massage Therapy and Occlusal Splint Usage on Quality of Life and Pain in Individuals with Sleep Bruxism: A Randomized Controlled Trial

Purpose: The aim of the present study was to investigate the effects of massage therapy on the masticatory muscles and occlusal splint usage on quality of life and pain in individuals with sleep bruxism. Method: A randomized, controlled, blinded, clinical trial was conducted involving 78 volunteers aged 18 to 40 years with sleep bruxism. Quality of life and pain assessments were performed. Results: Significant differences (p < 0.05) were found on the physical functioning, general health state, vitality, role emotional and mental health subscales. A large effect size was found for all treatment protocols with regard to pain. The largest effect was found in the combined treatment group. Conclusions: The findings of the present study reveal that the occlusal splint usage alone led to improvements in components of quality of life among individuals with sleep bruxism. Moreover, both treatments (occlusal splint usage and massage therapy on the masticatory muscles) led to a reduction in pain.     

Relationship between Echo Intensity of Vastus Lateralis and Knee Extension Strength in Patients with Type 2 Diabetes Mellitus

Objective: This study aimed to determine the association between echo intensity (EI) of vastus lateralis and knee extension strength (KES) in patients with type 2 diabetes mellitus (T2DM). Methods: This retrospective study included a total of 304 patients (189 males and 115 females) with T2DM who were hospitalized for treatment or care. EI and muscle thickness (MT) of the right vastus lateralis were assessed from transverse ultrasound images. Maximal isometric KES was evaluated using a dynamometer and normalized for body weight (%KES). Results: %KES was significantly positively correlated with MT and stages of change for exercise behavior, and significantly negatively correlated with age, T2DM duration, and EI. %KES was significantly higher in male than in female. %KES was significantly higher in non-diabetic peripheral neuropathy (DPN) than in DPN. Stepwise multiple regression analysis showed that sex, age, T2DM duration, EI, and stages of change for exercise behavior were significant determinants of %KES. Conclusion: The study results suggest that EI is associated with %KES in patients with T2DM.     

Effect of Ward-dedicated Physical Therapy Staffing on Outcomes among General Medical Patients in an Acute Hospital: A Difference-in-difference Analysis

Objective: The study aimed to examine the effect of dedicated physical therapy (PT) staffing on the outcomes of patients admitted to a general medical ward with acute cholangitis. Methods: This retrospective observational study was conducted in an 865-bed tertiary-care hospital in Japan. Patients with acute cholangitis between September 2015 and August 2017 were enrolled. Patients admitted to a ward with dedicated PT staffing were included in the dedicated group, while those admitted to a ward without dedicated PT staffing were included in the non-dedicated group. Each group was further divided into pre-dedicated and post-dedicated period based on September 1, 2016, at which PT staffing was implemented. The primary outcome was absolute functional gain (AFG), which was defined as the difference between Barthel index at discharge and that at admission. A difference-in-difference analysis was conducted to examine the changes in AFG associated with ward-dedicated PT staffing. Results: We identified 456 patients with acute cholangitis. Complete case analysis was applied, resulting in 252 patients in the final analysis. Patients were assigned to the dedicated group in the pre-dedicated period (n = 66) and post-dedicated period (n = 52), and to the non-dedicated group in the pre-dedicated period (n = 60) and post-dedicated period (n = 74). The adjusted difference-in-difference estimator was 17.1 (95% confidence interval: 5.6 to 28.5, p = 0.003) for AFG. Conclusion: Ward-dedicated PT staffing may improve the AFG of general medical patients in an acute hospital. Ward-dedicated PT staffing should be among the strategies utilized in the acute care process.     

Effects of back extensor strengthening exercises on postural alignment,physical function and performance,self-efficacy,and quality of life in Japanese community-dwelling older adults: A controlled clinical trial

Objective: To examine the changes in postural alignment and kyphosis-correlated factors after 6 months of back extensor strengthening exercise in a group of community-dwelling older adults aged ≥65 years. Methods: We quasi-randomized 29 subjects into an intervention group treated with a back extensor strengthening program and a control group treated with a full-body exercise program. These groups completed 20-30 minutes of exercise directed by a physical therapist one or more times per week and were instructed to exercise at home as well. The participants were assessed prior to and after the intervention using the following criteria: postural alignment of “usual” and “best” posture, physical function, physical performance, self-efficacy, and quality of life. The differences between two factors (group and period) were compared for each of the measurement variables. Results: Subjects who adequately completed the exercises were analyzed. A reduced knee flexion angle was noted in the “best” posture of both groups, as were improved physical function and performance with the exception of one-leg standing time. Verifying the effect size in the post-hoc analysis, the body parts that showed changes to postural alignment after the intervention differed between groups. Conclusions: Back extensor strengthening exercises improved physical function and performance, but did not improve spinal alignment. The changes due to these interventions were not significantly different from changes observed in the full-body exercise group. However, post-hoc analysis revealed that the effect size of posture change was different, possible indicating that the two groups experienced different changes in the postural alignment.     

Effect of electric field and magnetic field on spin transport in bilayer graphene armchair nanoribbons: A Monte Carlo simulation study

In this article we study the effect of external magnetic field and electric field on spin transport in bilayer armchair graphene nanoribbons (GNR) by employing semiclassical Monte Carlo approach. We include D'yakonov-Perel' (DP) relaxation due to structural inversion asymmetry (Rashba spin-orbit coupling) and Elliott-Yafet (EY) relaxation to model spin dephasing. In the model we neglect the effect of local magnetic moments due to adatoms and vacancies. We have considered injection polarization along z-direction perpendicular to the plane of graphene and the magnitude of ensemble averaged spin variation is studied along the x-direction which is the transport direction. To the best of our knowledge there has been no theoretical investigation of the effects of external magnetic field on spin transport in graphene nanoribbons. This theoretical investigation is important in order to identify the factors responsible for experimentally observed spin relaxation length in graphene GNRs.     

Effect of temperature,electric and magnetic field on spin relaxation in single layer graphene: A Monte Carlo simulation study

In this article, we employ the semiclassical Monte Carlo approach to study the spin polarized electron transport in single layer graphene channel. The Monte Carlo method can treat non-equilibrium carrier transport and effects of external electric and magnetic fields on carrier transport can be incorporated in the formalism. Graphene is the ideal material for spintronics application due to very low Spin Orbit Interaction. Spin relaxation in graphene is caused by D'yakonov-Perel (DP) relaxation and Elliott-Yafet (EY) relaxation. We study effect of electron electron scattering, temperature, magnetic field and driving electric field on spin relaxation length in single layer graphene. We have considered injection polarization along z-direction which is perpendicular to the plane of graphene and the magnitude of ensemble averaged spin variation is studied along the x-direction which is the transport direction. This theoretical investigation is particularly important in order to identify the factors responsible for experimentally observed spin relaxation length in graphene.     

Molecular basis of structural make-up of feeds in relation to nutrient absorption in ruminants,revealed with advanced molecular spectroscopy: A review on techniques and models

Progress in ruminant feed research is no more feasible only based on wet chemical analysis, which is merely able to provide information on chemical composition of feeds regardless of their digestive features and nutritive value in ruminants. Studying internal structural make-up of functional groups/feed nutrients is often vital for understanding the digestive behaviors and nutritive values of feeds in ruminant because the intrinsic structure of feed nutrients is more related to its overall absorption. In this article, the detail information on the recent developments in molecular spectroscopic techniques to reveal microstructural information of feed nutrients and the use of nutrition models in regards to ruminant feed research was reviewed. The emphasis of this review was on (1) the technological progress in the use of molecular spectroscopic techniques in ruminant feed research; (2) revealing spectral analysis of functional groups of biomolecules/feed nutrients; (3) the use of advanced nutrition models for better prediction of nutrient availability in ruminant systems; and (4) the application of these molecular techniques and combination of nutrient models in cereals, co-products and pulse crop research. The information described in this article will promote better insight in the progress of research on molecular structural make-up of feed nutrients in ruminants.     

Exploring acetylene chemistry in superbasic media: A theoretical study of the effect of water on vinylation and ethynylation reactions with acetylene in KOH/DMSO and NaOH/DMSO systems

A rapidly developing approach adding new dimensions to acetylene chemistry relying on employment of high basicity media such as alkali metal hydroxide suspensions in dimethyl sulfoxide (DMSO) has been, for the first time, investigated theoretically using ab initio models. Extending our recently introduced model of superbase catalysis with a nondissociated KOH (or NaOH) participation, we present here a model for a superbasic reaction center with the first solvation shell explicitly included. The alkali metal hydroxides in a DMSO solution were found to form KOH·5DMSO and NaOH·4DMSO complexes that are stabilized due to the interligand interaction. Our present MP2/6‐311++G**//B3LYP/6‐31+G* computations show that 1 and 2 water molecules can build themselves into the MOH close surrounding without substantially perturbing the DMSO ligands and easily travel between different insertion positions. Our results predict that the activation energies in the series of reactions of nucleophilic addition to a triple bond with water, methanol, methanethiol, sodium hydrosulfide, and acetone in the presence of dihydrated complexes should be larger than those obtained with the participation of monohydrated ones, which is in fair agreement with the experimental findings. The present model also explains an increase in the ethynylation reaction yield in the presence of water by suppression of the competitive enolization reaction.     

Comprehensive studies on dielectric properties of p-methoxy benzylidene p-decyl aniline with function of temperature and frequency in planar geometry: A potential nematic liquid crystal for display devices

The dielectric properties of the nematic mesophase, p-methoxy benzylidene p-decyl aniline(MBDA), measured in planar geometry with a function of frequency and temperature are investigated in detail. The complex dielectric permittivity(ε' and ε') is also studied at a bias voltage of 10 V for planar aligned sample cell of nematic mesophase. The dielectric permittivity with bias voltage attains a higher( 2 times) value than that without bias voltage at a temperature of 56℃,which is due to the fact that the linking group of nematic molecules is internally interacted with an applied bias voltage.This is supported by observing an enhanced dielectric permittivity of nematic liquid crystal(LC) in the presence of bias voltage, which can be fully explained as the increasing of the corresponding dipole moment. The dielectric relaxation behaviors of nematic LC are also demonstrated for planar aligned sample cell. The remarkable results are observed that the relaxation frequency shifts into low frequency region with the increase of the bias voltage applied to the planar aligned sample cells. The dielectric relaxation spectra are fitted by Cole–Cole nonlinear curve fitting for nematic mesophase in order to determine the dielectric strength.