Purpose: This study aimed to examine the reproducibility and validity of a new quantitative method for measuring spinal kyphosis using a small gyro sensor. Method: Subjects were 96 community-dwelling middle-aged and elderly (mean age, 72.7 ± 6.2 years) people who performed a gymnastic exercise. We measured spinal kyphosis using 2 methods: (1) the kyphosis angle (KA) using a small gyro-embedded posture-measuring device and (2) the kyphosis index using a flexible ruler. We examined the reproducibility of the new method by obtaining 2-3 consecutive measurements and adequate number of measurements for KA. We also assessed the validity of KA measurement using the device. Statistical analysis: We used interclass correlation coefficients (ICCs) of KA reproducibility and a Pearson's product-moment correlation coefficient between KA and kyphosis index for determining the validity of KA measurement. Results: ICC (1,1): the reproducibility of repeated measurements was 0.967 (95% confidence interval [95% CI], 0.951-0.978) for 2 measurements and 0.956 (95% CI, 0.941-0.970) for 3 measurements, suggesting a high reproducibility for KA measurement using this method. The result of more than 0.95 for ICC (1,1) suggests that a single measurement of KA is sufficient. For the validity of KA measurement, a statistically significant correlation was shown between KA and kyphosis index. Conclusion: Thus, KA measurement using a small gyro-embedded posture-measuring device is highly reproducible in consecutive measurements as well as highly valid; this may be a useful quantitative method for measuring spinal kyphosis in the research or clinical environment.

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Purpose: This study was undertaken to develop a Home-Exercise Barrier Self-Efficacy Scale (HEBS) for elderly people, to evaluate the reliability and validity of HEBS, and to clarify the relation between HEBS and obtained data. Methods: Study participants were 114 elderly people (mean 80.0 ± 9.2 years) requiring support and care. This study assessed their gender, age, primary disease, level of long-term care need, stage of change for home exercise modification, 8-Item Short-Form Health Survey (SF-8) responses, and HEBS. Results: A HEBS with six items was created with one factor structure. Cronbach's alpha for this subscale in this study was 0.86. The HEBS score showed excellent test-retest reliability (r=0.94). We conducted an analysis of variance with independent variables of construct validity and stage of change for home exercise modification. The dependent variable was the HEBS score. Results clarified that the HEBS score increased significantly as the stage progressed. Scores shown by people under age of 75 were significantly higher than those of people 75 or older. No significant difference was found between gender, primary disease, level of long-term care needed, or HEBS score. Conclusion: The HEBS was confirmed to be reliable and valid for measuring confidence in performing Home Exercise for elderly people requiring support and care.

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Purpose: The purpose of this study was to clarify factors affecting the ability for gait using a cane and walking speed in patients with hip fractures. Methods: The subjects were 104 patients with unilateral hip fractures. These included 61 patients who were able to independently walk using a cane and 43 patients who were unable to walk without any assistance. We investigated age, gender, standing height, fracture type, postoperative day, fractured and non-fractured isometric hip abductor strength, fractured and non-fractured isometric knee extensor strength, pain, leg length discrepancy, and 10-m walking speed. Results: A multiple logistic regression analysis and a multiple regression analysis revealed that fractured isometric hip abductor strength and pain were significantly related to the ability for gait using a cane (corrected discriminate rate, 74.0%). In addition, fractured isometric knee extensor strength and age were significantly related to 10-m walking speed (coefficient of determination, 0.48). Conclusion: The results suggest that factors determining the ability for gait using a cane are different from those determining 10-m walking speed. Improving fractured hip abductor strength and pain relief were important for the ability for gait using a cane. Our results suggest that improvement of fractured knee extensor strength is important for increasing 10-m walking speed.

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Objective: The purpose of the present study was to examine the kinetic and kinematic effects of wearing a trunk brace with joints that provides a resistive force to modify pelvic alignment during level walking in the elderly. Methods: Twenty-seven healthy elderly people participated in the study. The study compared kinetic and kinematic variables among three different conditions of level walking: (1) with no orthosis, (2) with a trunk brace with joints, and (3) with a lumbosacral corset. Statistical analysis was performed using repeated measures ANOVA. Variables showing a significant difference were analyzed further with multiple comparisons using the Bonferroni correction. The significance level was set at 0.05. Results: Use of the trunk brace with joints and lumbosacral corset increased the walking speed compared to the no orthosis condition. Furthermore, use of the trunk brace with joints significantly increased the pelvic anterior tilt angle, trunk extension angle, and hip abductor moment in the early stance phase of one gait cycle compared to the other two conditions. Conclusions: Wearing the trunk brace with joints provided a resistive force that effectively modified pelvic alignment in the elderly and increased their walking speed and hip abductor moment during level walking.

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Purpose: The purpose of this study was to analyze the effect of different pelvic alignment and voluntary contraction strength on electromyographic activity of the lumbar multifidus (LM) and erector spinae muscles (ES). In addition, we examined the activity of the LM in the absence of overactive ES. Methods: Ten healthy men participated in this study. We studied the back muscles at 3 pelvic positions (moderate anterior tilt, neutral, and moderate posterior tilt) and 6 different voluntary contraction strengths (0%, 10%, 25%, 50%, 75%, and 100% maximum voluntary contraction: MVC). The participants performed a task that involved isometric contraction of the back muscles during pelvic anterior tilt in a prone position at the edge of the bed with the legs hanging. The main outcome measure was the normalized LM/ES ratio assessed by using surface electromyography for the right ES and right LM. Results: The LM/ES ratio was more activated in the neutral position than in the moderate anterior and moderate posterior pelvic tilt position at 10% MVC. In neutral position, it was more activated at 10% MVC than 100% MVC. Conclusions: The present findings suggest that the neutral pelvic positions with mild resistance facilitated lumbar multifidus activity in the absence of overactive ES.

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Purpose: The aim of this study was to clarify factors that can affect lower extremity muscle strength in stable interstitial pneumonia (IP). Methods: We examined the relationship between lower extremity muscle strength and respiratory function, dyspnea, and exercise tolerance in 107 patients with stable IP. Result: Isometric knee extension strength was associated with % DLco, the modified Medical Research Council (mMRC) dyspnea scale, and the 6-minute walk test. Moreover, logistic regression analysis to determine an dependent variable for whether a value of 0.50 kgf/kg of isometric knee extension strength caused movement impairment revealed the mMRC dyspnea scale grade as a factor that affected isometric knee extension strength (odds ratio 0.480, 95% CI 0.242-0.953). In addition, when the mMRC scale was Grade 1 or more, the results indicated that more than one half of the IP patients had a level of lower extremity muscle strength that fell below the level at which movement impairment begins. Conclusion: Lower limb muscle strength in IP patients was related to the level of respiratory failure, exercise tolerance, and dyspnea. Especially, it was revealed that when dyspnea is exacerbated in daily life, it can lead to a reduction in lower extremity muscle strength that may impair mobility.

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Purpose: We investigated skin extensibility around surgical wounds in patients after total knee arthroplasty (TKA) to determine the relationship between skin extensibility and knee range of motion. Methods: Twenty patients treated with TKA (mean age: 78.1±7.4 years) and ten age-matched healthy subjects (mean age, 71.8±8.7 years) participated in this study. To evaluate skin extensibility, we marked the surface of the skin over the knee and measured changes in the location of these marks using vertical and horizontal reference points as the knee was positioned in various degrees of flexion(60°, 90°, and full flexion). We further divided TKA patients into two groups based on a knee flexion angle of 120° (above or below 120° knee flexion), and compared skin extensibility among TKA patients and healthy subjects. Results: In TKA patients, skin extensibility was significantly lower than that in healthy subjects, as determined using the vertical line reference around the suprapatellar region. There was no significant difference between the two groups of TKA patients. Conclusion: Our results reveal that skin extensibility around surgical wounds in TKA patients is lower than that in healthy subjects. However, skin extensibility is not a limiting factor for knee flexion after TKA.

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