Herzliyya, Israel
Herzliyya, Israel

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McCarthy I.,Royal National Orthopaedic Hospital | Hodgins D.,European Technology for Business Ltd. | Mor A.,AposTherapy Research Group | Elbaz A.,AposTherapy Research Group | Segal G.,AposTherapy Research Group
BMC Musculoskeletal Disorders | Year: 2013

Background: The purpose of this study was to examine the differences in gait profile between patients with knee osteoarthritis (OA) and healthy control and to create motion characteristics that will differentiate between them. Methods. Twenty three patients diagnosed with knee OA and 21 healthy matched controls underwent a gait test using a sensor system (gaitWALK). Gait parameters evaluated were: stride duration, knee flexion range of motion (ROM) in swing and stance. T-Test was used to evaluate significant differences between groups (P < 0.05). Results: Patients with knee OA had significant lower knee flexion ROM (10.3° ± 4.0°) during stance than matched controls (18.0° ± 4.0°) (p < 0.001). Patients with knee OA had significant lower knee flexion ROM (54.8° ± 5.5°) during swing than matched controls (61.2° ± 6.1) (p = 0.003). Patients with knee OA also had longer stride duration (1.12 s ± 0.09 s) than matched controls (1.06 s ± 0.11 s), but this was not statistically significant (p = 0.073). Motion characteristics differentiate between a patient with knee OA and a healthy one with a sensitivity of 0.952 and a specificity of 0.783. Conclusions: Significant differences were found in the gait profile of patients with knee OA compared to matched control and motion characteristics were identified. This test might help clinicians identify and evaluate a knee problem in a simple gait test. © 2013 McCarthy et al.; licensee BioMed Central Ltd.


Elbaz A.,AposTherapy Research Group | Debbi E.M.,AposTherapy Research Group | Segal G.,AposTherapy Research Group | Haim A.,Tel Aviv Sourasky Medical Center | And 4 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2011

Elbaz A, Debbi EM, Segal G, Haim A, Halperin N, Agar G, Mor A, Debi R. Sex and body mass index correlate with Western Ontario and McMaster Universities Osteoarthritis Index and quality of life scores in knee osteoarthritis. Objective: To examine the associations of sex, body mass index (BMI), and age with knee osteoarthritis (OA) symptomatic severity. Design: A cross-sectional retrospective analysis. Setting: 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. Participants: Patients (N=1487) with symptomatic knee OA were evaluated. Interventions: Not applicable. Main Outcome Measures: WOMAC questionnaire and SF-36. Results: 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). Conclusions: 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. © 2011 American Congress of Rehabilitation Medicine.


Elbaz A.,AposTherapy Research Group | Mor A.,AposTherapy Research Group | Segal G.,AposTherapy Research Group | Debi R.,Barzilay Medical Center | And 2 more authors.
Osteoarthritis and Cartilage | Year: 2014

Objective: To describe a novel classification method for knee osteoarthritis (OA) based on spatiotemporal gait analysis. Methods: Gait analysis was initially performed on 2911 knee OA patients. Females and males were analyzed separately because of the influence of body height on spatiotemporal parameters. The analysis included the three stages of clustering, classification and clinical validation. Clustering of gait analysis to four groups was applied using the kmeans method. Two-thirds of the patients were used to create a simplified classification tree algorithm, and the model's accuracy was validated by the remaining one-third. Clinical validation of the classification method was done by the short form 36 Health Survey (SF-36) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires. Results: The clustering algorithm divided the data into four groups according to severity of gait difficulties. The classification tree algorithm used stride length and cadence as predicting variables for classification. The correct classification accuracy was 89.5%, and 90.8% for females and males, respectively. Clinical data and number of total joint replacements correlated well with severity group assignment. For example, the percentages of total knee replacement (TKR) within 1 year after gait analysis for females were 1.4%, 2.8%, 4.1% and 8.2% for knee OA gait grades 1-4, respectively. Radiographic grading by Kellgren and Lawrence was found to be associated with the gait analysis grading system. Conclusions: Spatiotemporal gait analysis objectively classifies patients with knee OA according to disease severity. That method correlates with radiographic evaluation, the level of pain, function, number of TKR. © 2014 Osteoarthritis Research Society International.


Assa T.,Tel Aviv University | Elbaz A.,AposTherapy Research Group | Mor A.,AposTherapy Research Group | Chechik O.,Sourasky Medical Center | And 4 more authors.
Knee | Year: 2013

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. © 2012 Elsevier B.V.


Debi R.,Assaf Harofeh Medical Center | Mor A.,AposTherapy Research Group | Segal G.,AposTherapy Research Group | Segal O.,AposTherapy Research Group | And 5 more authors.
Disability and Rehabilitation | Year: 2011

Purpose: 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). Method. 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. Results. 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). Conclusion. We recommend integrating SLS as an objective parameter in the comprehensive evaluation of patients with knee OA. © 2011 Informa UK, Ltd.


Elbaz A.,AposTherapy Research Group | Mor A.,AposTherapy Research Group | Segal O.,AposTherapy Research Group | Agar G.,Assaf Harofeh Medical Center | And 5 more authors.
Knee | Year: 2012

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. © 2010 Elsevier B.V..


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.


PubMed | AposTherapy Research Group, Assaf feh Medical Center, Sourasky Medical Center and Barzilai Medical Center
Type: | Journal: SAGE open medical case reports | Year: 2016

Conservative treatments for anterior cruciate ligament (ACL) tears may have just as good an outcome as invasive treatments. These include muscle strengthening and neuromuscular proprioceptive exercises to improve joint stability and restore motion to the knee. The Purpose of the current work presents was to examine the feasibility of a novel non-invasive biomechanical treatment to improve the rehabilitation process following an ACL tear. This is a single case report that presents the effect of this therapy in a patient with a complete ACL rupture who chose not to undergo reconstructive surgery.A 29-year old female athlete with an acute indirect injury to the knee who chose not to undergo surgery was monitored. Two days after injury the patient began AposTherapy. A unique biomechanical device was specially calibrated to the patients feet. The therapy program was initiated, which included carrying out her daily routine while wearing the device. The subject underwent a gait analysis at baseline and follow-up gait analyses at weeks 1, 2, 4, 8, 12 and 26.A severe abnormal gait was seen immediately after injury, including a substantial decrease in gait velocity, step length and single limb support. In addition, limb symmetry was substantially compromised following the injury. After 4 weeks of treatment, patient had returned to normal gait values and limbs asymmetry reached the normal range.The results of this case report suggest that this conservative biomechanical therapy may have helped this patient in her rehabilitation process. Further research is needed in order to determine the effect of this therapy for patients post ACL injuries.


PubMed | ek Medical Center, AposTherapy Research Group, Barzilai Medical Center and Assaf Harofeh Medical Center
Type: Journal Article | Journal: Journal of orthopaedic surgery and research | Year: 2016

The purpose of the current study was to examine the effect of a non-invasive, home-based biomechanical treatment program for patients with spontaneous osteonecrosis of the knee (SONK).Seventeen patients with SONK, confirmed by MRI, participated in this retrospective analysis. Patients underwent a spatiotemporal gait analysis and completed the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Short-Form-36 (SF-36). Following an initial assessment, patients commenced the biomechanical treatment (AposTherapy). All patients were reassessed after 3 and 6months of treatment.A significant reduction in pain and improvement in function was seen after 3months of therapy with additional improvement after 6months of therapy. Pain was reduced by 53% and functional limitation reduced by 43%. Furthermore, a significant improvement was also found in the SF-36 subscales, including the summary of physical and mental scores. Significant improvements were found in most of the gait parameters including a 41% increase in gait velocity and a 22% increase in step length. Patients also demonstrated improvement in limb symmetry, especially by increasing the single limb support of the involved limb.Applying this therapy allowed patients to be active, while walking more symmetrically and with less pain. With time, the natural course of the disease alongside the activity of the patients with the unique biomechanical device led to a significant reduction in pain and improved gait patterns. Therefore, we believe AposTherapy should be considered as a treatment option for patients with SONK.Assaf Harofeh Medical Center Institutional Helsinki Committee Registry, 141/08; ClinicalTrials.gov NCT00767780 .


PubMed | AposTherapy Research Group, Meir Medical Center and University College London
Type: Journal Article | Journal: The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons | Year: 2016

The present study examined the differences in the lower extremity gait kinematic profile of patients recovering from ankle fracture compared with healthy controls. In addition, we inquired whether the profile would differ among fracture severity groups. A total of 48 patients participated in the present prospective, case-control study. The gait of 24 patients recovering from an ankle fracture injury and 24 healthy matched controls was examined using an inertial measurement unit sensor system. The following gait parameters were evaluated: knee range of motion (ROM) during the swing phase, maximum knee flexion angle during stance, thigh and calf ROM, and stride duration. Statistically significant differences were found between the ankle fracture group and the control group for all parameters. The patients with ankle fracture had a lower knee ROM during swing phase compared with the control group (meanstandard deviation 43.0 15.5 compared with 66.7 5.1, respectively; p <.001). The maximum knee flexion angle during stance was lower in the patients with ankle fracture than in the control group (meanstandard deviation 10.5 6.1 compared with 21.2 4.5, respectively; p <.001). Patients with ankle fracture also had lower gait cycle thigh and calf ROM angles (p <.001) and a longer stride duration (p <.001) compared with the control group. No statistically significant differences were found among the severity groups. These results suggest that the gait kinematic characteristics vary between healthy people and patients recovering from an ankle fracture injury during the short-term period after injury.

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