There are many research reports showing that the effect of plantar plate on medial knee OA is effective in the short term, but there are few reports that it is effective for a long period of 6 months or longer. Also although there are many studies on plantar plate in the varus type of the subtalar joint, there are few studies in the valgus type of the subtalar joint. In this study, we investigated the long-term effect of wearing a plantar plate that guides the subtalar joint to a neutral position in patients with the subtalar joint valgus type. The case is an elderly female diagnosed with bilateral knee osteoarthritis. The case is an elderly female diagnosed with bilateral knee osteoarthritis. X-ray evaluation was right III, left III in KL grade.The plantar plate was evaluated by comparing the 10 m maximum effort walking time and pain evaluation VAS, the total consumption and the number of steps in one week without and immediately after wearing the plantar plate. In order to examine the long-term effects, functional evaluation was performed 3 months, 6 months, and 12 months after the installation of the plantar plate.As a result, 10m walking time and walking pain improved, suggesting improvement in long-term walking ability after 3 months, 6 months, and 12 months. In addition, SF36.v2, a health-related QOL evaluation scale, total consumption, and number of steps improved, and a weight loss effect was obtained. Based on the above, it is suggested that the manufactured plantar plate is effective for a long period of time. I thought For cases in which the subtalar joint is valgus, a plantar plate that induces varus to the subtalar joint is more suitable than a lateral wedge-shaped plantar plate that induces valgus to the subtalar joint.

変形性膝関節症内側型の後足部に着目して, 後足部アライメントと膝関節の関係を調査した. まず床面から垂直に立てた踵骨の傾き (踵骨二等分線角) にて後足部の回内と回外の2群に分類し, Femorotibial Angleとの関係およびKellgren-Lawrence分類の関係を調査した. 次に後足部と内側裂隙率との関係の調査を行い, 最後に後足部と疼痛の関係の調査を行った. その結果, 後足部とFemorotibial Angleの相関は得られなかった. 後足部はFemorotibial Angleの角度の影響を受けないことが分かった. また後足部はKellgren-Lawrence分類や内側裂隙率, 歩行時痛や階段昇降時痛との相関が得られた. この結果から後足部を回内することで膝内側裂隙の負担を減らす防御反応が働いていることが推察された. 後足部回内により疼痛が軽減していると考えるならば外側楔型足底装具は後足部を回内方向へ誘導するため, 既に後足部回内により疼痛軽減が得られている状態からの外側楔型足底装具の効果は期待できないと考えられた. さらに後足部の過度な回内は逆スクリューホームムーブメントを引き起こす可能性があり, 後足部の回内外を考慮して足底装具を製作することが重要と思われた.

AIMTo examine the intervention effects of a physical function improvement program for community-dwelling frail elderly subjects.METHODSThe subjects included 309 participants (108 males, 224 females) who took part in "Iki Iki Health Classes," an exercise training program for frail elderly individuals conducted over three years from April 2008 to March 2011. The average participant age was 75.4±5.8 years in the males and 74.6±5.6 years in the females.RESULTSMany participants had bone and joint disease with hypertension. The proportion of those with a history of falls (49.0%) was high. Significant improvements from the program were seen in the motor function and in the total scores for the Kihon checklist, grip strength, standing on one leg, timed up-and-go test (TUG), 5-m walking time and 5-m walking maximum time, fear of falling (77.5→70.1%) and subjective health ("good/well good/usually," increased from 73.6% to 89.1%). A new care-needs certification was issued in 21.6% of the subjects during the period spanning to March 31, 2013. A logistic regression analysis revealed that the deterioration of subjective health was significantly related to the presence of risk factors for new care-needs certification (odds ratio and 95% confidence interval: 4.99 (1.04-23.9), p=0.04).CONCLUSIONSThese results suggest that the interventions used in the program to improve the physical function contributed to improving the subjects' mental and physical functions. We speculate that whether improvements in subjective health are linked to roles in normal life and/or social activity participation is important for care prevention.

Aim: The aims of the present study were to investigate the effectiveness of exercise intervention provided by a medical support team specializing in lifestyle‐related diseases in the treatment of elderly lower extremity osteoarthritis and to examine the influence of bodyweight decrease on changes in the evaluation indexes.Methods: Participants were 61 patients (57 women and 4 men, aged 68.3 ± 9.6 years) with lower extremity osteoarthritis (109 total diseased joints) and either one or more of the following diseases: obesity, metabolic syndrome and type 2 diabetes. Indexes relating to metabolic diseases, orthopedic disorders, lifestyle activity level and health‐related quality of life (HRQOL) were obtained before and after exercise intervention.Results: The numbers of patients with obesity, metabolic syndrome, type 2 diabetes, gonarthrosis and coxarthrosis were 56, 49, 32, 56 and 9, respectively. The mean intervention period was 4.7 ± 1.6 months (2–10.8 months). Indexes relating to metabolic diseases and orthopedic disorders, activity level and HRQOL were all significantly improved after intervention (P < 0.05). Bodyweight decreased by 10.3% and showed a correlation with other evaluated items. Five explanatory variables were extracted through multiple regression analysis that bodyweight reduction rate was set as the criterion variable: changes of bodyweight, body mass index, percent body fat, glycated hemoglobin and total energy expenditure per bodyweight.Conclusion: The exercise intervention provided by our medical support team clearly improved indexes relating to metabolic diseases and orthopedic disorders. In addition, decreased bodyweight was related to improvements in metabolic factors, motor function and HRQOL. Geriatr Gerontol Int 2012; 12: 446–453.

Diminished range of motion (ROM) of the knee joint after total knee arthroplasty (TKA) is thought to be related to reduced patellar mobility. This has not been confirmed clinically due to a lack of quantitative methods adequate for measuring patellar mobility. We investigated the relationship between patellar mobility by a reported quantitative method and knee joint ROM after TKA. Forty-nine patients [osteoarthritis--OA: 29 knees; rheumatoid arthritis--RA: 20 knees] were examined after TKA. Respective medial and lateral patellar mobility was measured 1 and 6 months postoperatively using a patellofemoral arthrometer (PFA). Knee joint ROM was also measured in each of those 2 sessions. Although the flexion and extension of the knee joints improved significantly from 1 to 6 months after TKA, the medial and lateral patellar displacements (LPDs) failed to improve during that same period. Moreover, only the changes in knee flexion and medial patellar displacement (MPD) between the two sessions were positively correlated (r = 0.31, p < 0.05). However, our findings demonstrated that medial and lateral patellar mobility had no sufficient longitudinal relationship with knee ROM after TKA.

multifactorial fall prevention programs. It has to be stressed that our study was an effectiveness study and not a randomized clinical trial. The aim of the program was to disseminate and implement fall prevention in the majority of nursing homes in a complete federal state, which means that the program had to be feasible within the daily routine considering limited personal and financial resources. Participating homes committed themselves to offer the strength and balance training at least once a week. There was no funding for hip protectors. There were no direct financial incentives. The fall prevention liaison nurses were instructed to introduce the program in their nursing homes to all staff members who spend time with residents. Nursing assistants or aides were considered to be major target groups of the inhouse teaching sessions. If nursing homes employed occupational therapists, they were usually involved in the program as exercise instructors and members of the fall prevention team. It was not possible to assign a larger role. A large percentage of German homes do not employ occupational therapists as staff members. Therefore, the program had to respect these limitations. We absolutely agree that fall prevention measures might have other benefits than fracture reduction. Examples are the reduction of the number of falls and the increase of mobility. Both can contribute to better quality of life. Since the reported trial, the implementation has been modified in several ways. The exercise is now being delivered twice weekly, a hip protector learning tool has been introduced, nursing staff has played a more active role in the recruiting process, a national guideline on fall prevention in nursing homes was published in 2005, and the intervention has been transferred to other federal states. It remains to be seen whether these changes will be successful at increasing physical activity, reducing falls and fractures in this vulnerable group.

AIM:We examined the influence of high fall-related self-efficacy on falls due to dissociation with activities of daily living (ADL) among elderly women in nursing homes.METHODS:We enrolled 72 female nursing home residents who were 70 years old or over and who scored 18 or higher on the Mini-Mental State Examination (MMSE). Subjects were classified into three groups based on the relationship between ADL and fall-related self-efficacy derived from a scattergram of the Functional Independence Measure (FIM) motor items and Falls Efficacy Scale (FES). The three groups were: group I which had low ADL and high fall-related self-efficacy (n=25); group II which had high ADL and low fall-related self-efficacy (n=30); and group III which had a correlation of ADL and fall-related self-efficacy in the 95% confidence interval (n=17). Then, we investigated the incidence of falls and the number of falls after 6 months in the three groups. The risk factor of falls was also investigated using multiple logistic regression analysis.RESULTS:The incidence and number of falls were significantly different in the three groups after 6 months. Moreover, the incidence of those falling was significantly different between group I and group III. The occurrence of falls was also significantly related with a past history of falls, FES, and group I which had low ADL and high fall-related self-efficacy.CONCLUSION:These findings suggest that the risk of falling increases in the presence of excessive fall-related self-efficacy dissociated from ADL.

The magnitude of mechanical stress at the shoulder and elbow appears to be directly correlated with the degree of maximum shoulder external rotation (MER) during throwing. Therefore, it is very important to prevent excessive MER to minimize the risk of throwing injuries. The purpose of this study was to investigate the relationships between MER during throwing and the kinematic parameters of throwing mechanics, shoulder muscle strength, and shoulder range of motion in high school baseball players. The subjects were 40 male high school baseball players with no elbow or shoulder joint problems. Three-dimensional analysis was performed to calculate the MER angle. Then, the shoulder and elbow angles at initial foot contact (IFC) were computed. ROM and muscle strength of shoulder joint were also measured in each subject. Multiple linear regression analysis was used to relate the MER angle to these factors. Significant correlations were observed between the MER angle and the external rotation (ER) angle (r= -0.51, p< 0.001) at IFC, and the ER range of motion (r=0.84, p<0.0.1). The MER angle significantly correlated with shoulder internal rotation (IR) at IFC. This finding suggests that stress on the shoulder and elbow could be increased by the degree of shoulder IR angle at the moment of IFC. Further, excessive ER range of motion may also be a risk factor.

The purpose of this study was to investigate the relation of the Falls Efficacy Scale (FES) to quality of life (QOL) among nursing home residents. The subjects were 133 institutionalized women aged 70 years or older. They had comparatively intact cognitive function, with a Mini-Mental State Examination (MMSE) score of 15 or more, and could provide sufficient informed consent for a questionnaire survey. We evaluated their age, height, weight, body-mass index, history of hip fracture, history of fall(s) within the past year, complicating conditions, MMSE, Medical Outcomes Study 8-Item Short-Form Health Survey (SF-8), FES, and their subscores for Functional Independence Measure (FIM) motor items (self care, sphincter control, transfer, locomotion). There was a significant relationship between the Physical Component Summary (PCS) of SF-8 and FES. In each subscale, FES showed significant relations that were especially close in physical functioning (PF) and role physical (RP), with those relations proving stronger than those of the subscores of transfer and locomotion. In conclusion, the present results suggested that taking account of mental confidence is important for physical QOL, and that falls self-efficacy, including not only physical activity per se but also mental confidence, should be given prominence in the physical QOL of the institutionalized elderly.

肥満症を伴う末期変形性関節症で人工関節の手術適応である患者に対して，術前に，減量，歩行能力・体力・筋力などの運動機能改善，生活習慣病改善，患者教育を目的として入院または外来でリハビリテーションを行った．対象は11 名で，9名 でメタボリックシンドロームを認めた．運動は関節可動域訓練，筋力増強訓練に加え，1 回30 分の平行棒内歩行訓練を入院では1 日4 回，外来では2 回行った．また食事療法も併用した．結果は，平均体重は開始時73.5 kgから終了時64.7 kg，body mass indexは31から27，ウエスト周囲径は106 cmから94 cmへ減少した．血液検査は中性脂肪219 mg／dlから127 mg／dl，空腹時血糖146 mg／dlから94 mg／dlに改善した．1 日の歩数は2840 歩から6953 歩へ改善し，SF36は全ての項目で改善した．術前リハビリテーションにより減量，生活習慣病の改善，下肢痛軽減，活動量増大，quality of life向上を図れ，術中高血圧症や術後の静脈血栓塞栓症などの周術期のリスク軽減に寄与できた可能性がある．

The amount of stress imposed on shoulder and elbow appears to be directly correlated with the degree of maximum shoulder external rotation (MER) during throwing motions. Therefore, identifying risk factors contributing to the increase of MER angle may help to decrease the throwing injuries occurrence in baseball players. The purpose of the present study was to demonstrate the correlation between MER and the kinematic variables at stride foot contact (SFC) during the early cocking phase, the passive range of motion (ROM), and the shoulder strength. The subjects were 40 high school baseball players. Each subject carried out five throwing tasks with his maximum effort. A three-dimensional analysis was performed to obtain the MER, and the shoulder angles of external rotation (ER), extension and abduction at SFC in the early cocking phase. The ROM and muscle strength of the shoulder ER and internal rotation (IR) were also measured. Significant moderate linear correlations were found between the MER and the ER (r = -0.32, p = 0.04) at SFC, extension angle ( r= 0.35, p = 0.03) at SFC, IR strength (r = -0.30, p = 0.04) and passive ROM of ER (r = 0.46, p = 0.01). The shoulder IR and extension angles at SFC may determine the degree of the MER angle. Furthermore, weak IR muscle strength and excessive ROM of ER might be risk factors for shoulder and elbow injuries. The finding will enable us to establish better prevention and rehabilitation strategies for throwing injuries in baseball players. Key pointsIt has been reported that the amount of stress imposed on shoulder and elbow joints is correlated with the degree of maximum shoulder external rotation angle (MER) during throwing. Therefore, controlling MER within a normal range plays a key role in the prevention for throwing-related injuries in baseball players.Physical and biomechanical factors related to the degree of MER must be addressed to advance the current prevention and rehabilitation strategies for the shoulder and elbow injuries.The current finding demonstrated that there was a significant moderate leaner correlation between shoulder internal rotation angle at the initial foot contact in the early cocking phase and MER.

The objective of the present study was to examine whether the passive range of shoulder external rotation (ER), the maximum shoulder external rotation angle (MER) during throwing, and the ratio of MER to ER are related to the incidence of the elbow injury. A mixed design with one between-factor (a history of the elbow injury) and two within-factors (ER and MER) was used to analyze the difference between baseball players with and without a history of medial elbow pain. Twenty high school baseball players who had experienced the medial elbow pain within the previous month but who were not experiencing the pain on the day of the experiment were recruited (elbow-injured group). Another twenty baseball players who had never experienced the medial elbow pain were also used for testing (control group). MER during throwing, ER, and the ratio of MER to ER were obtained in both of the group. A Mann-Whitney test was used for the group comparison (p < 0.05). The ratio of MER to ER was significantly greater in the elbow-injured group (1.52 ± 0.19) than that in the control group (1.33 ± 0.23) (p = 0.008). On the other hand, there was no statistical significance in MER and ER between two groups. The findings of the study indicate that MER/ER relation could be associated with the incidence of the elbow injury in baseball players. Key pointsIt is accepted that the greatest elbow valgus stress appears at the position of shoulder maximum external rotation (MER) in the acceleration phase of the throwing movement. As a consequence, shoulders with restricted range of motion of external rotation (ER) compensate with a valgus stress on their elbow joints.In this study, we evaluated the relation between MER and ER of shoulder in players with/without elbow injuries.The result of this study demonstrated that the elbow injured group showed significantly greater MER/ER relation than the control group.The current finding suggests that great MER combined with the ROM restriction may be one of the risk factors to cause medial elbow pain in baseball players.

STUDY DESIGN: Case control study.OBJECTIVE: To compare the patellar mobility of female adult subjects with and without patellofemoral pain (PFP).BACKGROUND: Although abnormal patellar mobility is believed to be one of the causes of PFP there is currently no published evidence to support this contention. In part, this lack of evidence is because a reliable clinical measurement method to measure patellar mobility and objective criteria to define abnormal patellar mobility have not been established.METHODS AND MEASURES: The study sample was comprised of 22 females with PFP (PFP group) and 22 females who had no knee pain (control group), matched by age, height, and body mass index to the subjects with PFP. Patellar mobility was measured objectively using a specially designed apparatus. Measurements of lateral and medial patellar displacement, patellar mobility balance (lateral minus medial patellar displacement), lateral patellar mobility index (lateral patellar displacement divided by patellar width), and medial patellar mobility index (medial patellar displacement divided by patellar width) were used.RESULTS: Lateral and medial patellar mobility values were not significantly different between the individuals in the PFP and control groups. When normal patellar mobility was arbitrarily defined as the average mobility +/- 2 SDs, based on the data from the control group, normal lateral patellar displacement was within a range of 72 to 176 mm and normal medial patellar displacement was within a range of 6.8 to 14.0 mm. The intraclass correlation coefficient for intratester and intertester reliability of lateral and medial patellar displacement measurements varied from 0.80 to 0.97.CONCLUSION: Although there were no significant differences in patellar mobility between females with and without PFP, these measurements give reference information about normal patellar mobility for this group.

J Shoulder Elbow Surg 2001;10:493-5.

寛骨臼回転骨切り術後の下肢筋力が荷重位での運動能力に与える影響を検討する目的で，術後患者7名（RAO群），健常者8名（健常群）を対象に，10m最大歩行速度および膝関節伸展，股関節外転の等速性筋力の測定を行った。RAO群は，健常群に比べ10m最大歩行速度（p<0.01），歩行率，膝関節伸展筋力，股関節外転筋力（p<0.05）で有意な低値を示した。また，RAO群では10m最大歩行速度と身長（r=0.84），重複歩距離（r=0.79）に，重複歩距離と膝関節伸展筋力（r=0.80）に相関関係を認めた。このことから，RAO群の歩行能力を規定する要因として膝関節伸展，股関節外転筋力の重要性が見出された。