[Purpose] To determine patient satisfaction after total hip arthroplasty in a Japanese cohort and to identify factors that significantly influence patient satisfaction. [Participants and Methods] This study included 285 patients who underwent primary total hip arthroplasty for osteoarthritis. Postoperative satisfaction, Oxford hip score, short form-12 mental component summary score, and University of California Los Angeles activity score were investigated. Muscle strength and daily step counts were determined using a hand-held dynamometer (μ-Tas F1) and activity monitor (ActivPAL) in 89 and 26 patients, respectively. Factors associated with postoperative satisfaction, Oxford hip score-activities of daily living, and University of California Los Angeles activity score were identified. The relationship between the Oxford hip score-activities of daily living and daily step counts was examined. [Results] Overall, 94.7% of the patients reported satisfaction with total hip arthroplasty. The Oxford hip score-activities of daily living and University of California Los Angeles activity score were significantly associated with patient satisfaction. Younger age and hip abductor strength were significantly associated with a higher Oxford hip score-activities of daily living and University of California Los Angeles activity score. The average daily step count was significantly correlated with the Oxford hip score-activities of daily living. [Conclusion] Self-reported physical activity levels significantly influenced patient satisfaction and were correlated with objective muscle strength and daily step count measurements. These findings can guide total hip arthroplasty patient counseling on the importance of muscle strength and activity levels.

[Purpose] Patients with chronic unilateral vestibular hypofunction show decreased postural stability and low levels of physical activity and also experience much anxiety. Physical activity is known to improve these symptoms; however, no study has reported any positive effects of physical activity, such as symptom reduction or improvement in function in these patients. In this study, we investigated the role of a walking program in improvement of dizziness, anxiety, and postural stability in this patient population. [Participants and Methods] This study included 21 patients with unilateral vestibular hypofunction and chronic dizziness. Patients were instructed to walk 30 min daily for 3 months. Physical activity levels and questionnaires for clinical symptoms, anxiety, and postural stability were evaluated before and after intervention. [Results] We observed significant differences in the amount of moderate-to-vigorous physical activity, clinical symptoms, and self-perceived handicap before and after the intervention. Additionally, anxiety levels were significantly reduced and postural stability was significantly improved in these patients. [Conclusion] A walking program improved physical activity levels, clinical symptoms, and postural stability and reduced self-perceived handicap and anxiety in patients with chronic unilateral vestibular hypofunction. These results highlight the effectiveness of a walking program for these patients and emphasize its role as a complementary vestibular rehabilitation strategy.

[Purpose] The purpose of this study was to elucidate changes in flexibility and muscle strength during the menstrual cycle in detail and to investigate the relationship between flexibility and muscle strength. [Participants and Methods] Sixteen healthy young female and eight male participants were measured during the follicular, ovulation and luteal phases. Range of motion, passive torque at the onset of pain, passive stiffness and muscle strength were measured using an isokinetic dynamometer. Additionally, electromyography was measured during muscle strength measurement. [Results] In the female group, range of motion and passive torque at the onset of pain were significantly increased during the ovulatory and luteal phases compared with the follicular phase. Passive stiffness decreased significantly during the ovulatory phase compared with the follicular phase. Isometric muscle force and electromyographic activity were significantly increased during the luteal phase compared with the ovulation phase. There was no correlation between stiffness and muscle strength. However, there was a positive correlation between electromyographic activity and muscle strength. [Conclusion] Our findings suggest that changes in flexibility during the ovulatory and luteal phases are influenced by fluctuations in sex hormones. However, the changes in muscle strength showed little relation to flexibility, suggesting the involvement of neural mechanisms.

[Purpose] This study aimed to compare the inter- and intra-examiner reliabilities of toe grip strength measurements obtained just above the first interphalangeal joint with those of toe grip strength measurements obtained in the most comfortable position for the participant. The study also aimed to calculate the minimal detectable change for the more reliable method. [Participants and Methods] The participants for each test included 20 healthy adult males and females. Intra-class correlation coefficient (1,1) and (2,1) values were calculated for both tests. Bland–Altman analysis was used to determine the systematic error and calculate the minimal detectable change. [Results] The intra- and inter-examiner reliabilities of measurements obtained by setting the position of the toe-grasping bar to the first interphalangeal joint were better than those obtained in the most comfortable position for the participant. Measurement of the minimal detectable change showed a random error of 4.97 kg. [Conclusion] We considered that toe grip strength measurements just above the first interphalangeal joint were better. The minimal detectable change was 4.97 in healthy adults.

[Purpose] Patellar tendinopathy is a common sports injury. The risk factors for this injury can be categorized as intrinsic, extrinsic, and dynamic. We examined the dynamic factors in this study. [Participants and Methods] The participants were volleyball players who were assigned to a patient group (n=6) if they had medial patellar tendinopathy in the left knee or to a control group (n=7) otherwise. The participants performed spike jumps, and their ground reaction force and three-dimensional kinematic data were recorded. Knee angle and moment data were extracted at the peak extension moment of take-off and landing. [Results] The two groups showed no differences in knee angles. A tendency for abduction/external rotation moments at take-off and landing on both sides was observed in the control group, while the patient group showed adduction and internal rotation moments at take-off and adduction moment at landing in the left (injured) knee. [Conclusion] The observed knee joint moments in the left (injured) knee of the patient group may have been involved in the pathophysiological mechanism underlying the development of patellar tendinopathy.

[Purpose] To verify the effect of a 12-week additional resistance training intervention in patients on hemodialysis who had been performing supine ergometer exercises alone during dialysis. [Participants and Methods] Overall, 18 patients undergoing hemodialysis were included. A 12-week intervention with additional resistance training was conducted in hemodialysis patients who had been performing supine ergometer exercise for 30 min during dialysis for over >3 months. Physical function before and after the period of bicycle ergometer exercise alone and before and during the additional intervention was compared. Resistance training consisted of 1–3 sets per day of five different exercises for the large muscle groups of the upper and lower limbs. [Results] The results of the 6-min walk test improved significantly after the additional intervention. The average driving distance in the supine ergometer exercise during the additional intervention was identified as an associated factor. [Conclusion] The addition of the resistance training to long-term supine ergometer exercisers improved walking endurance. When supine ergometer exercise alone does not change physical function, the additional use of resistance training subsequently may have a positive effect on walking endurance.

[Purpose] To assess if the instrumented Timed Up and Go (iTUG) task score calculated with an iPhone application can detect gait changes under dual-tasking conditions. [Participants and Methods] Twenty participants (age 38.30 ± 12.54, 12 females) were asked to complete the TUG as a single task and under two dual-tasking conditions: 1) verbal fluency and 2) mental calculation. We used a smartphone, stopwatch, digital camera, and wearable sensor to calculate the dependent variables which included time, step count, gait speed, and iTUG score and, the dual-tasking cost (DTC) of those variables. We used Friedman analyses of variance and Wilcoxon tests for statistical analyses. [Results] the iTUG score, step count, gait speed, and the time measured by the stopwatch and wearable sensor differed significantly for all tasks, but the smartphone time did not. [Conclusion] We conclude that the iTUG score could be used as a sensitive measure for identifying gait changes under dual-tasking conditions. With the growing demands of telehealth, using technology as an objective tool for movement analysis is needed for clinicians and payers. Our findings demonstrate the potential value of the iTUG score to assess and track patient’s progress.

[Purpose] This study aimed to investigate the absolute intra-rater and inter-rater reliabilities during the measurement of muscle hardness, which is used to evaluate physical therapy. Moreover, we examined the effects of using different equipment types and their positioning on the intra-rater and inter-rater reliabilities. [Participants and Methods] Participants of this study comprised 12 healthy adult male individuals. Two experts and two beginners measured the muscle hardness of the lumbar erector spinae and rectus femoris using three types of hardness meters at two positions, including when the muscle was relaxed and stretched. [Results] Intra-rater fixed bias was observed during some measurements by both experts and beginners. Inter-rater fixed bias was observed during measurements by some experts and not the beginners. [Conclusion] In this study, the measurement of muscle hardness demonstrated a need to reconsider the measurement position and acclimation time. These examinations require the consideration of relative and absolute reliabilities.

[Purpose] This study investigated the association between generalized joint laxity and knee joint movement in female university students. [Participants and Methods] The study included 21 female university students. Generalized joint laxity was measured using the Beighton criteria for joint hypermobility. Acceleration and angular velocities of the tibia during knee extension were measured along three axes using a triaxial accelerometer. Sampling data were expressed as root mean squares. The Mann–Whitney U test was used to determine differences in the acceleration and angular velocities along each axis between the generalized joint laxity and non-generalized joint laxity groups. Spearman’s rank correlations were used to confirm the association between these parameters. [Results] The rotational angular velocity was greater in the generalized joint laxity than in the non-generalized joint laxity group, and we observed a significant correlation between Beighton scores and the X-axis angular velocity. Furthermore, rotational angular velocity was positively correlated with anterior–posterior acceleration and extension angular velocity. [Conclusion] These findings suggest that rotational angular velocity of the tibia during knee extension is associated with generalized joint laxity in female university students.

[Purpose] To characterize the foot arch height, toe flexor strength, and dynamic balance ability of collegiate female dancers and age-matched non-dancers. [Participants and Methods] This study included 20 healthy college-aged female dancers (21.6 ± 0.8 years) and 20 age-matched females (19.7 ± 1.0 years) with no previous experience in sports as non-dancers. Foot arch height was determined by measuring the height of the navicular tuberosity in the standing position using a ruler. Toe flexor strength was measured while seated on a chair using a toe grip dynamometer. Dynamic balance ability was evaluated based on the reach distance measured using a professional Y-balance test kit. [Results] The collegiate dancers had higher foot arches, greater toe flexor strength, and longer Y-balance test reach distance than the non-dancers. [Conclusion] The foot arch height, toe flexor strength, and dynamic balance ability of collegiate female dancers were adapted through years of training and were superior to those of non-dancers.

[Purpose] Knee osteoarthritis can alter gait variability; however, few studies have investigated the associating factors with gait cycle time variability. The first objective was to compare gait cycle variability between female patients with knee osteoarthritis and healthy elderly females and to determine gait characteristics in patients with knee osteoarthritis. The second objective was to identify the associating factors with gait cycle time variability. [Participants and Methods] The participants included 24 female patients diagnosed with knee osteoarthritis and 12 healthy elderly females. Gait cycle variability (coefficient of variation of gait cycle time), knee extension range of motion, knee extension strength, 5-m walk test, Timed Up & Go Test, and Western Ontario and McMaster Universities Osteoarthritis Index were measured. All assessment results were compared between the knee osteoarthritis and healthy groups. [Results] Gait cycle time variability was significantly higher in the knee osteoarthritis group than in the healthy group. Further, it showed a significant positive correlation with the 5-m walk test and the Western Ontario and McMaster Universities Osteoarthritis Index. [Conclusion] Patients with knee osteoarthritis presented greater gait cycle variability than that of healthy individuals. Therefore, rehabilitation to improve gait variability might enhance the quality of life of patients with knee osteoarthritis.

[Purpose] This study aimed to identify the factors associated with exercise behavior in patients with peripheral arterial disease. [Participants and Methods] The study included 43 patients with peripheral arterial disease (mean age, 75.2 ± 5.6 years) who were admitted for endovascular treatment from January 2020 to June 2021. Participants were surveyed through questionnaires to assess their physical function for determining their exercise behavior and the presence of physical, personal, and environmental factors that might have affected their stage of change regarding exercise behavior. [Results] A comparison of physical, personal, and environmental factors between the two groups classified by the presence or absence of exercise behavior showed that subjective health and exercise self-efficacy were significantly lower in the group without exercise. Furthermore, a difference was noted in the presence or absence of work. The adjusted binomial logistic regression analysis results using each of the factors differing between the groups, plus the walking impairment questionnaire total score as explanatory variables, showed a significant relationship with exercise self-efficacy only. [Conclusion] The results of this study showed that exercise self-efficacy presented a useful predictive relationship with the presence of exercise behavior in patients with peripheral arterial disease.

[Purpose] To investigate if joint mobilization in patients with subacromial pain syndrome has additional benefits to a home training program on shoulder function and pain, and to compare home training to no physical therapy. [Participants and Methods] Eighty-nine primary care patients (mean age 45 years) with subacromial pain syndrome during an average of 23 weeks. Home training was performed twice a day during a 12 week period. One of the intervention groups received add-on shoulder joint mobilization to the home training. A third group did not receive any physical therapy. Constant-Murley score, pain and active range of motion was evaluated at baseline, 6 weeks, 12 weeks and 6 months. [Results] The total Constant-Murley score revealed no significant differences between groups at any time point. All groups improved over time. The add-on joint mobilization group reached clinical important change at 12 weeks. The subscale pain showed that both intervention groups reported less pain after 12 weeks compared to the reference group. [Conclusion] Home training is not superior to no treatment evaluated with the total Constant-Murley score. However, home training with or without add-on joint mobilization may decrease pain compared to no treatment.

[Purpose] To investigate the effects of a seven-week quadriceps stretching program on the muscle fibre orientation of the vastus medialis oblique and vastus lateralis in the lower limbs by ultrasound imaging. [Participants and Methods] Twenty-seven healthy, physically fit, asymptomatic females and males (age 21.5 ± 1.3, Tegner activity level score ≥4) were recruited. Their initial vastus medialis oblique and vastus lateralis fibre angles were determined using ultrasound. They then undertook a seven-week quadriceps stretching program, 3 sets of stretches to be performed on both lower limbs, 3 times a week on 3 separate days. One volunteer was assigned as an intra-rater control and did not take part in the stretching program. The vastus lateralis and vastus medialis oblique fibre angles were measured again on completion of the exercise regime. [Results] A statistically significant decrease in muscle fibre angle was observed in both the right and left vastus medialis oblique, and the right and left vastus lateralis. [Conclusion] A 7-week stretching program can result in a significant decrease in muscle fibre angle in both the vastus medialis oblique and the vastus lateralis. This can help in understanding the effects of prescribed stretching exercises on athletic patients with PFP.

[Purpose] To present the successful structural improvement in cervical lordosis in a patient suffering from cervicogenic headache having cervical kyphosis. [Participant and Methods] A 26 year old female presented with the primary complaint of headache. Radiography demonstrated a cervical kyphosis. Chiropractic BioPhysics^® methods were used to restore the cervical spine alignment. Twenty-five treatments were given over 8 weeks. A 2.5 year follow-up was also reported. [Results] Radiography showed a dramatic increase in cervical lordosis following initial treatment. The patient also reported substantial reductions in headache frequency and severity as well as other bodily improvements, reduced disability and improved quality of life. The long-term follow-up showed a maintenance of lordosis correction and patient wellness. [Conclusion] A cervical kyphosis was reversed back to a normal lordosis in 8 weeks and coincided with dramatic resolution of cervicogenic headache in a young female. The cervical lordosis may be a key biomechanical biomarker in cervicogenic headache.