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Background To improve the goal-directedness of strength exercises for patients with knee osteoarthritis (KOA), physical rehabilitation specialists need to know which muscle-groups are most substantially weakened across the kinetic chain of both lower extremities. The purpose was to improve the knowledge base for strength exercise therapy. The objective was to explore the relative differences in muscle strength in the main directions bilaterally across the hip, knee, and ankle joints between patients with light-to-moderate symptomatic and radiographic KOA and people without knee complaints. Methods The design was an exploratory, patient vs. healthy control, and cross-sectional study in primary/secondary care. Twenty-eight patients with mild to moderate KOA (18 females, mean age 61) and 31 matched healthy participants (16 females, mean age 55), participated. Peak strength was tested concentrically or isometrically in all main directions for the hip, knee, and ankle joints bilaterally, and compared between groups. Strength was measured by a Biodex Dynamometer or a Commander II Muscle Tester (Hand-Held Dynamometer). Effect sizes (ES) as Cohen’s d were applied to scale and rank the difference in strength measures between the groups. Adjustment for age was performed by analysis of covariance. Results The most substantial muscle weaknesses were found for ankle eversion and hip external and internal rotation in the involved leg in the KOA-group compared to the control-group (ES [95% CI] −0.73 [−1.26,-0.20], − 0.74 [−1.26,-0.21], −0.71 [−1.24,-0.19], respectively; p  < 0.01). Additionally, smaller but still significant moderate muscle weaknesses were indicated in four joint–strength directions: the involved leg’s ankle inversion, ankle plantar flexion, and knee extension, as well as the uninvolved leg’s ankle dorsal flexion ( p  < 0.05). There was no significant difference for 17 of 24 tests. Conclusions For patients with KOA between 45 and 70 years old, these explorative findings indicate the most substantial weaknesses of the involved leg to be in ankle and hip muscles with main actions in the frontal and transverse plane in the kinetic chain of importance during gait. Slightly less substantial, they also indicate important weakness of the knee extensor muscles. Confirmatory studies are needed to further validate these exploratory findings.

Background To raise the effectiveness of interventions, clinicians should evaluate important biopsychosocial aspects of the patient’s situation. There is limited knowledge of which factors according to the International Classification of Function, Disability, and Health (ICF) are most deviant between patients with knee osteoarthritis (KOA) and healthy individuals. To assist in measures’ selection, we aimed to quantify the differences between patients with KOA and healthy controls on various measures across the ICF dimensions of body function, activity, and participation. Methods We performed an exploratory cross-sectional case-control study. In total, 28 patients with mild-to-moderate KOA (mean age 61 years, 64% women) referred by general physicians to a hospital’s osteoarthritis-school, and 31 healthy participants (mean age 55 years, 52% women), volunteered. We compared between-group differences on 27 physical and self-reported measures derived from treatment guidelines, trial recommendations, and trial/outcome reviews. Independent t-test, Chi-square, and Mann-Whitney U test evaluated the significance for continuous parametric, dichotomous, and ordinal data, respectively. For parametric data, effect sizes were calculated as Cohen’s d . For non-parametric data, d s were estimated by p -values and sample sizes according to statistical formulas. Finally, all d s were ranked and interpreted after Hopkins’ scale. An age-adjusted sensitivity-analysis on parametric data validated those conclusions. Results Very large differences between patients and controls were found on the Pain numeric rating scale 1 , the Knee Injury and Osteoarthritis Scale (KOOS, all subscales) 2 , as well as the Örebro Musculoskeletal psychosocial scale 3 ( P  < 0.0001). Large differences were found on the Timed 10-steps-up-and-down stair climb test 4 and Accelerometer registered vigorous-intensity physical activity in daily life 5 ( P  < 0.001). Respectively, these measures clustered on ICF as follows: 1 body function, 2 all three ICF-dimensions, 3 body function and participation, 4 activity, and 5 participation. Limitations The limited sample excluded elderly patients with severe obesity. Conclusions Very large differences across all ICF dimensions were indicated for the KOOS and Örebro questionnaires together for patients aged 45–70 with KOA. Clinicians are suggested to use them as means of selecting supplementary measures with appropriate discriminative characteristics and clear links to effective therapy. Confirmative studies are needed to further validate these explorative and partly age-unadjusted conclusions.

Sensorimotor synchronization is hypothesized to arise through two different processes, associated with continuous or discontinuous rhythmic movements. This study investigated synchronization of continuous and discontinuous movements to different pacing signals (auditory or visual), pacing interval (500, 650, 800, 950 ms) and across effectors (non-dominant vs. non-dominant hand). The results showed that mean and variability of asynchronization errors were consistently smaller for discontinuous movements compared to continuous movements. Furthermore, both movement types were timed more accurately with auditory pacing compared to visual pacing and were more accurate with the dominant hand. Shortening the pacing interval also improved sensorimotor synchronization accuracy in both continuous and discontinuous movements. These results show the dependency of temporal control of movements on the nature of the motor task, the type and rate of extrinsic sensory information as well as the efficiency of the motor actuators for sensory integration.

This study investigated aspects of individual differences in timing of continuous and discontinuous movements to different pacing signals (auditory or visual), pacing intervals (500, 650, 800, 950 ms), and across effectors (dominant versus non-dominant hand). Correlation and principal component analysis demonstrated that a single statistical dimension accounted for up to 60 % of the explained variance in discontinuous tasks and 25 % of the variance in continuous tasks, when applied to performance obtained from tasks conducted with different effectors and at different pacing rates. Correlation analysis of factor scores representing effector and rate independent task performances showed that timing of discrete or continuous movements can be associated with modality independent mechanisms. Timing variability from discrete and continuous trials was not significantly correlated. This study goes beyond previous correlational work on individual differences in discrete and continuous movements, demonstrating that individual differences in discrete (event-based) or continuous (emergent) motor timing tasks can be modeled as distinctive statistical components with dissimilar capability to capture effector, rate, and modality independent variance.

This paper aimed to investigate motor proficiency in fine and gross motor function, with a focus on reaction time (RT) and movement skill, in patients with fibromyalgia (FM) and chronic fatigue syndrome (CFS) compared to healthy controls (HC). A total of 60 individuals (20 CFS, 20 FM, and 20 HC), age 19-49 years, participated in this study. Gross motor function in the lower extremity was assessed using a RT task during gait initiation in response to an auditory trigger. Fine motor function in the upper extremity was measured during a precision task (the Purdue Pegboard test) where the number of pins inserted within 30 s was counted. No significant differences were found between FM and CFS in any parameters. FM and CFS groups had significantly longer RT than HC in the gait initiation ( =0.001, and =0.004 respectively). In the Purdue Pegboard test, 20% in the FM group, 15% in the CFS groups, and 0% of HC group, scored below the threshold of the accepted performance. However, there were no significant differences between FM, CFS, and HC in this task ( =0.12). Compared to controls, both CFS and FM groups displayed significantly longer RT in the gait initiation task. Generally, FM patients showed the worst results in both tests, although no group differences were found in fine motor control, according to the Purdue Pegboard test.

Background Evidence-based recommendations have the potential to improve the quality of health care by promoting interventions of proven benefit and discouraging unnecessary, ineffective, or harmful interventions. Osteoarthritis (OA) treatment recommendations are generally addressing strength training and training to increase aerobic capacity together with referral to, or treatment by, physiotherapists. Previous research has revealed that treatment of patients with OA by medical doctors show low adherence with recommendations (1). Little is not known about the treatment provided by physiotherapists in Norway and whether the treatment provided is in concordance with general recommendations for OA treatment. Objectives To investigate knee OA treatment performed by physiotherapists in Norway and its concordance with EULAR recommendations for non-pharmacological treatment modalities. Methods Patient records in the hospital region of middle Norway were searched to identify patients with knee OA. A letter was sent to the identified patients (N=87) asking for information about which physiotherapist they had seen for treatment. A letter was sent to the physiotherapists asking for the discharge summary, in which they are obliged to send to the referring doctor. A survey of the discharge summaries was conducted independently by 3 health professionals (two physiotherapists, one physician) to categorise and group the treatment given. Results Response rate from patients was 93% (N=81). Of the 81, 13 (15%) had not been referred to physiotherapy treatment. Response rate from physiotherapists (N=68) was 38 (56%). Of the treatment described in the discharge summaries 7 (10%) was partly in line with EULAR recommendations; of these, all 7 used strengthening exercises and 0 used improvement of aerobic capacity as their choice of therapeutic modality. Conclusions According to our findings it may seem that physiotherapy treatments are not always in line with recommendations for knee OA treatment. The incidence of total knee replacement is increasing, raising costs personal and societal. Physiotherapy treatment in line with recommendations may help prevent OA from progression and prevent prosthesis operations to further increase. There seems to be a need for further work to make physiotherapists implement the EULAR guidelines in their day to day work with knee OA patients. References Østerås N, Garratt A, Grotle M, Natvig B, Kjeken I, Kvien TK, Hagen KB. Patient-reported quality of care for osteoarthritis: development and testing of the osteoarthritis quality indicator questionnaire. Arthritis Care Res (Hoboken). 2013 Jul;65(7):1043-51. Acknowledgements This study was given economic support from the central norway regional heath authority. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5148

The authors investigated whether the discrepancy noted in the literature regarding delayed and decreased activity in vastus medialis obliquus (VMO) in people with patellofemoral pain (PFP) depends on the nature of the open kinetic chain (OKC) and the closed kinetic chain (CKC) in the experimental task. They hypothesized that activity in VMO would be more delayed and decreased in CKC tasks than in OKC tasks. Women with PFP (n = 17) and healthy controls (n = 17) performed isometric quadriceps contractions in CKC and OKC tasks. The authors manipulated only the application of resistance. Electromyographs (EMGs) showed that participants with PFP reacted later and activated the quadriceps more in the CKC task but had intramuscular quadriceps coordination similar to that of controls. The nature of the OKC task or the CKC task does not seem to explain contradictory findings regarding VMO activation.

Viral and bacterioplankton dynamics were investigated, together with the temporal variation of phage-infected bacterioplankton in two oligotrophic lakes, one humic and the other clearwater. Bacterial abundance was significantly higher in the humic lake, while the abundance of virus-like particles (VLP) was significantly higher in the clearwater lake. There were no differences in either the frequency of infected bacterial cells (FIC), or in burst size between the lakes. Because of the higher bacterial abundance in the humic lake, a larger number of bacteria were lyzed in this lake. FIC showed large seasonal changes, varying between 9 and 43%, which covers almost the entire range of previously published data from both lacustrine and marine environments. The temporal changes in VLP abundance and FIC were slow in both the humic and clearwater lakes. The burst size was low in both lakes (average value, nine in each case), probably because of the oligotrophic status of the lakes. The chlorophyll a concentrations were higher and positively correlated with VLP numbers in the clearwater lake, indicating that a significant proportion of the viruses in this lake may be phytoplankton viruses.

This article summarizes a series of experiments involving low-dose additions of phosphorus, nitrogen, and organic carbon, performed to test hypotheses concerning the oligotrophication of acidified and limed lakes. Gradual fertilization of a whole lake stimulated productivity, via chrysophytes and cladoceran zooplankton, through the entire pelagic food chain without causing structural damage to the system. Although P is considered the primary limiting nutrient for phytoplankton growth in acidified and limed lakes, in two out of four lakes we found a close balance between P and N limitation. In acidified Lake Njupfatet, phytoplankton community structure changed depending on the form in which nitrogen, added together with phosphorus, was supplied. A cyanophyte was favored with ammonium, whereas a dinoflagellate dominated when nitrate was the nitrogen source. Chrysophytes, the desired \"edible\" phytoplankton, were only stimulated when organic carbon was added together with N and P. Many flagellates are mixotrophic and they may have responded to an increase in heterotrophic bacterial growth. Nutrient additions during late summer, when cyanophytes dominated, did not improve the growth of any component of the plankton community. Liming of Lake Njupfatet resulted in decreases both in phosphorus concentration and in standing stock of phytoplankton. The phytoplankton community after liming changed markedly, the cyanophytes disappeared, while the zooplankton community composition remained typical of acidified lakes. Nutrient additions during late summer resulted in increased growth of both phyto- and zooplankton. We argue that controlled nutrient additions may be a necessary complement to liming in order to restore acidified lakes.