Background The Knee valgus brace is one of the accepted conservative interventions for patients with medial compartment knee osteoarthritis to correct the knee varus and increase functional activity level. Nevertheless, comprehensive overview of the effects of using this brace on self-reported pain activity level over time is not available. Thus, this study aimed to systematically review the effect of using this brace on pain and activity levels in the last 20 years in patients with medial compartment knee osteoarthritis. Methods Five databases were searched to find articles from the year 2000 to the end of November 2020: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PubMed, Web of Science, and Scopus. Two reviewers independently evaluated the available articles for eligibility and assessed quality. The risk of bias in each study was assessed by two reviewers independently according to the Strengthening the Reporting of Observational Studies in Epidemiology tool (STROBE) for the non-randomized controlled studies and the Cochrane risk-of-bias tool for the randomized controlled studies. Results Seven randomized controlled studies and 17 cohort studies (in total 579 participants) were included in the systematic review. Most of these studies found using a knee valgus brace effective in reducing pain and improving activity level over different time intervals. The majority of the included studies (14 studies) evaluated the impact of the brace for a considerably short-term (less than 6 months). Thus, limited evidence is available on the long-term use of the knee valgus brace and its associated complications. Conclusion The knee valgus brace is an effective conservative intervention to improve the quality of life and reduce pain during daily activities for some patients. However, the long term of using this brace is still not very convenient, and the patients who benefit most from using the brace should be identified with high methodological quality studies.

Background: The knee replacement (KR) surgery is done to restore the activity level and reduce the risk of experiencing disabilities. The outcomes of this surgery is evaluated mainly with subjective tools or low validity objective tools. However, the effect of the surgery on activity level using high validity objective accelerometer is still in question. Methods: A systematic review and meta-analysis were conducted to find out if the knee replacement surgery alone could enhance the physical activity based on high validity accelerometer, ActivPAL, after at least six months of the surgery. Two independent reviewers evaluated five electronic databases (Cochrane-Central-Register-of-Controlled Trials, EMBASE, PubMed, and Web of Science, and Scopus) to find relative studies between January 2000 and October 2021. The quality assessments and risk of bias assessments were examined.Results: Three articles were included with 202 participants (86 males, 116 females), with an average age of 64 years and an average 32 kg/m² body mass index. The results found that the number of steps was significantly improved up to 36.35% and 45.5% after six-months and one-year of the surgery, respectively. However, these changes did not meet the recommended activity level guideline and could be related to the patients' health status and their activity level before the surgery. No significant changes were seen in sedentary time, standing time, and upright time after six-months and one-year follow-up. Heterogeneity among studies was low to moderate (0%- 57%).Conclusion: The knee replacement surgery is an effective treatment to improve the quality of life in patients with severe knee injuries; however, to achieve the maximum benefit of the surgery the sedentary time should be reduced. Various factors have impacts on surgical success. Thus, further studies are needed to add these factors using high validity monitors.

Objectives: Duchenne muscular dystrophy (DMD) is a progressive, severe genetic disease. Most patients with DMD lose the ability to walk by their early teenage years and rarely survive beyond their 20s. Due to the physical symptoms of DMD, patients experience reduced quality of life (QoL) that hinders their abilities to work. DMD impacts not only the patient, but the loss of functional independence also affects QoL and work productivity for family members. A patient's loss of ambulation is reported as the most emotionally difficult time for parents. Methods: A lifetime cost model was constructed based on a state transition cohort model (adapted from Landfeldt et al.) containing four disease stages of DMD: early ambulatory, late ambulatory, early non-ambulatory, and late non-ambulatory. DMD treated with corticosteroids and symptom management acts as the base case in the model, and the impact of a hypothetical treatment given in the early ambulatory stage, which reduces the risk of progression to later disease stages, is shown. The model predicts work years gained and increases in work productivity. Results: In the base case, loss of ambulation occurs at age 13 (median). Reducing the risk of disease progression from early to later disease stages by 80-100% increases this to age 42-80. Compared to the base case, this results in a gain of 19-37 work years. Conclusions: Delaying progression into a non-ambulatory disease stage may improve the opportunity for DMD patients to maintain functional independence and attain future employment. This could in turn improve the QoL and work productivity for both patients and their family. Further research is needed to understand the broader impact of treatments that could delay the loss of ambulation in DMD on patients, family members, and society.

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Background: Knee osteoarthritis (OA) is a very common disease in Hungary. Knee replacement surgery is the last-stage intervention for severe cases to reduce pain and improve the quality of life. Nevertheless, there is no information about the activity level of Hungarian before and after the surgery based on objective monitor. Thus, this study aims to evaluate the improvement in activity level and quality of life pre-post surgery among Hungarian patients.Methods: 10 participants (70±4 years,30.7±3.4 kg/m2) were included with knee osteoarthritis undergoing total unilateral knee replacement. The activity level was evaluated with the ActivPAL and Short form-36 before and one year after surgery.Results: Out of 10 patients, eight patients were followed up after one year of the surgery. After one year of the surgery, the activity level based on ActivPAL including the number of steps, the time of standing, the time of sitting, and the time of stepping improved between 12.3%-69.4%. The standing time and number of steps improved the most among the patients by 69.4% (p=0.041) and 12.3% (p=0.051), respectively. Requiring the questionnaire, also the overall score and the pain improved after one year by 58.3% (p=0.050) and 26.6%(p=0.47), respectively. In contrast, the physical function based on the questionnaire insignificantly improved by up to 17.6% (p=0.89).Conclusion: This is the first study in Hungary that used objective and subjective tools. The objective tool showed more improvement in physical activity than the subjective. Nevertheless, the surgery is effective in reducing pain and enhancing the activity level.