Background: physical mobility testing is an essential component of the geriatric assessment. The timed up and go test measures basic mobility skills including a sequence of functional manoeuvres used in everyday life. Objectives: to create a practical cut‐off value to indicate normal versus below normal timed up and go test performance by comparing test performance of community‐dwelling and institutionalised elderly women. Setting and participants: 413 community‐dwelling and 78 institutionalised mobile elderly women (age range 65–85 years) were enrolled in a cross‐sectional study. Measurements: timed up and go test duration, residential and mobility status, age, height, weight and body mass index were documented. Results: 92% of community‐dwelling elderly women performed the timed up and go test in less than 12 seconds and all community‐dwelling women had times below 20 seconds. In contrast only 9% of institutionalised elderly women performed the timed up and go test in less than 12 seconds, 42% were below 20 seconds, 32% had results between 20 and 30 seconds and 26% were above 30 seconds. The 10^th–90^th percentiles for timed up and go test performance were 6.0–11.2 seconds for community‐dwelling and 12.7–50.1 seconds for institutionalised elderly women. When stratifying participants according to mobility status, the timed up and go test duration increased significantly with decreasing mobility (Kruskall‐Wallis‐test: p<0.0001). Linear regression modelling identified residential status (p<0.0001) and physical mobility status (p<0.0001) as significant predictors of timed up and go performance. This model predicted 54% of total variation of timed up and go test performance. Conclusion: residential and mobility status were identified as the strongest predictors of timed up and go test performance. We recommend the timed up and go test as a screening tool to determine whether an in‐depth mobility assessment and early intervention, such as prescription of a walking aid, home visit or physiotherapy, is necessary. Community‐dwelling elderly women between 65 and 85 years of age should be able to perform the timed up and go test in 12 seconds or less.

Objective: To evaluate the effect of a short preoperative exercise intervention on the functional status, pain, and muscle strength of patients before and after total joint arthroplasty.Methods: A total of 108 men and women scheduled for total hip arthroplasty (THA) or total knee arthroplasty (TKA) were randomized to a 6‐week exercise or education (control) intervention immediately prior to surgery. We assessed outcomes through questionnaires and performance measures. Analyses examined differences between groups over the preoperative and immediate postoperative periods and at 8 and 26 weeks postsurgery.Results: Among THA patients, the exercise intervention was associated with improvements in preoperative Western Ontario and McMaster Universities Osteoarthritis Index function score (improvement of 2.2 in exercisers versus decline of 3.9 in controls; P = 0.02) and Short Form 36 physical function score (decline of 0.4 in exercisers versus decline of 14.3 in controls; P = 0.003). No significant differences were seen in TKA patients. Exercise participation increased muscle strength preoperatively (18% in THA patients and 20% in TKA patients), whereas the control patients had essentially no change in strength (P > 0.05 for exercise versus education in both THA and TKA groups). Exercise participation prior to total joint arthroplasty substantially reduced the risk of discharge to a rehabilitation facility in THA and TKA patients (adjusted odds ratio 0.27, 95% confidence interval 0.074–0.998). The intervention had no effects on outcomes 8 and 26 weeks postoperatively.Conclusion: A 6‐week presurgical exercise program can safely improve preoperative functional status and muscle strength levels in persons undergoing THA. Additionally, exercise participation prior to total joint arthroplasty dramatically reduces the odds of inpatient rehabilitation.

Background: The International Knee Documentation Committee (IKDC) Subjective Knee Form is a knee-specific measure of symptoms, function, and sports activity. A modified IKDC Subjective Knee Form (pedi-IKDC) has been developed for use in children and adolescents. The purpose of this study was to determine the psychometric characteristics of the pedi-IKDC in children and adolescents with knee disorders. Hypothesis: The pedi-IKDC is a reliable, valid, and responsive patient-administered outcome instrument in the pediatric population with knee disorders. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Test-retest reliability, content validity, criterion validity, construct validity, and responsiveness to change were determined for the pedi-IKDC in patients aged 10 to 18 years with a variety of knee disorders. Test-retest reliability was measured in a group of 72 patients with a stable knee disorder. Validity was measured in a group of 589 patients with the Child Health Questionnaire to determine criterion validity. Responsiveness was measured in a group of 98 patients undergoing a variety of knee surgical procedures. Results: The overall pedi-IKDC had acceptable test-retest reliability (intraclass correlation coefficient, .91) and excellent internal consistency (Cronbach alpha, .91). The form also demonstrated acceptable floor (0%) and ceiling (6%) effects. There was acceptable criterion validity with significant (P < .01) correlation between the overall pedi-IKDC and 9 relevant domains of the Child Health Questionnaire. Construct validity was acceptable, with all 11 hypotheses demonstrating significance (P < .0001). Responsiveness to change was acceptable (effect size, 1.39; standardized response mean, 1.35). Conclusion: The pedi-IKDC demonstrated overall acceptable psychometric performance for outcome assessment of children and adolescents with various disorders of the knee.

Low back injuries are common and costly, accounting for 15 to 25 percent of injuries covered by workers' compensation and 30 to 40 percent of the payments made under that program. The high costs of injury, the lack of effective treatment, and the evidence that there are behavioral risk factors have led to widespread use of employee education programs that teach safe lifting and handling. The effectiveness of those programs, however, has received little rigorous evaluation.

Fibromyalgia is a prevalent multidimensional disorder with complex symptoms and relatively poor treatment outcomes.^1-3 Fibromyalgia is characterized by diffuse chronic pain for more than 3 months and bilateral sites of focal tenderness.⁴ It is associated with fatigue, sleep dysfunction, stiffness, depression, cognitive disruption, and exercise intolerance.³ The prevalence of fibromyalgia in the United States is estimated to be 3.4% in women and 0.5% in men⁵ and is reported to be greater in individuals with other rheumatic conditions.⁶ The causes and pathologic mechanisms of fibromyalgia are unknown. Current hypotheses center on atypical sensory processing in the central nervous system and dysfunction of skeletal muscle nociception and the hypothalamic-pituitary-adrenal axis.^7-9 Even with the recent approval of pregabalin by the Food and Drug Administration to treat fibromyalgia symptoms, pharmacotherapy is often insufficient to resolve persistent symptoms or improve functional limitations and quality of life.^10-12