Purpose: The purpose of this study was to examine the association of walking function and physical activity with community ambulation in people with chronic stroke, and to investigate whether walking function is a predictor of community ambulation. Methods: The study included 54 subjects with chronic stroke who were living at home. The subjects were classified according to the level of ambulation using the Functional Ambulation Classification of the Hospital at Sagunto (FACHS). Comfortable walking speed (CWS), maximal walking speed (MWS), and 6-minute walking distance (6MWD) were used to determine walking function, and the life-space assessment (LSA) was used to determine physical activity. Linear correlations were calculated between clinical measurements, and a multiple comparison procedure was used to compare the means of each outcome variables between the three groups classified using the FACHS. Furthermore, receiver operating characteristic curve analysis was performed to obtain cut-off points of the walking tests for discriminating between community ambulators and non-community ambulators. Results: There were moderate correlations between the FACHS and CWS, MWS, and 6MWD. Additionally, a significant strong correlation was found between the FACHS and the LSA score. CWS, MWS, and 6MWD were significantly higher for community ambulators compared with neighborhood and household ambulators. Moreover, the LSA score was significantly different between the groups. The optimal cut-off values for community ambulators were 0.61m/s for CWS, 0.71m/s for MWS, and 213m for 6MWD. Conclusion: Community ambulation was associated with walking function, and was related to physical activity. Walking speed and distance could predict independent community ambulation in people with chronic stroke.

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Purpose: This study examined the factors influencing the life space in patients with severe knee osteoarthritis. Methods: One hundred six patients with severe knee osteoarthritis participated in this study. Life space assessment (LSA), International Physical Activity Questionnaire Environmental Module (IPAQ-E), and visual analog scale measurement of confidence about going out were measured. In addition, range of motion of the knee, quadriceps strength, 10-m walking time, walking pain, and the Timed Up & Go test (TUG) were measured. To determine whether any of those factors could affect the life space, a step-wise regression analysis was performed with LSA as the dependent variable and age, confidence about going out, IPAQ-E, quadriceps strength, 10-m walking time, walking pain, TUG, gender, and employment status as independent variables. Results: The multiple regression analysis demonstrated that TUG, confidence about going out, and "The sidewalks in my neighborhood are well maintained (paved, with few cracks) and not obstructed" were significant contributors to LSA. Conclusions: The mobility capacity, confidence about going out, and condition of the sidewalks in the neighborhood affected LSA in patients with severe knee osteoarthritis. It is important to improve these factors to improve life space in patients with severe knee osteoarthritis.

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Purpose: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effects of preoperative or postoperative exercise interventions on physical function and activity in patients with hip osteoarthritis (OA) undergoing total hip arthroplasty (THA). Subjects and Methods: This search was applied to Medline, Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, and the Cumulative Index to Nursing and Allied Health Literature. We generated data comparing the effect of exercise intervention on physical function or activity in the experimental group and control group through this search. The Grading of Recommendations Assessment, Development, and Evaluation system was used to determine the quality of the evidence. Results: Thirteen RCTs were identified. Meta-analysis indicated that preoperative exercises were effective for improving physical function, as assessed by the Harris Hip score (HHS) and the first days of re-starting activities (walking, walking up and down stairs, using the toilet, sitting on the chair). Furthermore, the effect of postoperative exercises, especially that of exercises performed in addition to the standard rehabilitation program, on hip abductor muscle strength, maximal oxygen uptake, and cadence was also observed. The quality of evidence for most outcomes was moderate, except that for the outcome assessed by the HHS (high) and the first days of re-starting walking (low). Conclusion: We confirmed that physical function and activity improved in patients with hip OA undergoing THA by preoperative or post-operative exercise interventions.

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Purpose: To report the performance of range of motion exercises based on ultrasonographic assessment of heterotopic ossification after supracondylar fracture of the femur. Methods: The subject was a woman in her sixties with a supracondylar fracture of the femur. We performed ultrasonography to investigate a mass that developed medial to the patella postoperatively. Results: No ossification was detected by radiographic examination at 1 month postoperatively. Ultrasonography showed that the mass was a hematoma with hyperechoic and hypoechoic regions. The hyperechoic regions seemed to be callus. The hematoma was located in the pre-femoral fat pad between the femur and the vastus medialis muscle, and was adherent to vastus medialis. Ossification was detected by radiography at 2 months postoperatively. Ultrasonography showed that the ossification was continuous with the femur and there was breakdown of the adhesions with vastus medialis. Range of motion exercises were continued until knee flexion of 155 degrees were achieved. Conclusions: We could assess the progression and extent of heterotopic ossification and could judge the performance of range of motion exercises by ultrasonography.

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