Panagiotis Koulouvaris

Introduction: Chronic non-specific low back pain (CNLBP) is associated with altered lumbopelvic mechanics and impaired hip mobility. This study examined whether changes in pain-provoking hip flexion are associated with changes in low back pain and assessed agreement between inertial measurement units (IMUs) and a markerless motion capture system. Methods: Thirty-six patients with CNLBP completed a longitudinal repeated-measures rehabilitation protocol consisting of approximately 13 physiotherapy sessions over a period of up to 6 weeks. Active hip flexion was assessed in the symptomatic limb (the limb provoking lumbar pain). Hip flexion was recorded during the same movement trial using IMUs and a markerless system. Pain and disability were assessed using the Visual Analogue Scale and Oswestry Disability Index. Results: Improvements in hip flexion were moderately associated with pain reduction (markerless: r = −0.52; IMU: r = −0.57), with negligible associations with disability. Markerless and IMU measurements showed a strong correlation (r = 0.87), while Bland–Altman analysis showed consistent underestimation by the markerless system (bias = −3.67°). Conclusions: Symptom-specific hip mobility is associated with pain reduction in CNLBP, highlighting the role of lumbopelvic biomechanics. IMUs demonstrated higher consistency, while markerless systems offered a more accessible alternative for clinically meaningful movement assessment.

Background: Type 2 diabetes mellitus (T2DM) is linked to accelerated losses in muscle function. The aim of the present investigation was to evaluate the effect of chronic higher-protein intake on isokinetic knee performance in the older adults with type 2 diabetes mellitus (T2DM). Methods: Thirty adults (15 men and 15 women) aged 60–80 years with non-insulin-treated T2DM and sarcopenia-related deficits were randomized for 12 weeks to a higher-protein diet (1.2–1.5 g·kg⁻¹·day⁻¹) or a recommended protein diet (0.8–1.0 g·kg⁻¹·day⁻¹), with meal plans designed to maintain body mass. Protein was increased mainly through Mediterranean-style protein sources while diet was monitored using repeated 3-day recalls. Isokinetic knee extensors and flexors peak torque (angular velocity 60°/s) was assessed at baseline and at week 6 and at the end of the 12th week of intervention. Fatigability (20 maximal contractions at an angular velocity at 180°/s) and DXA body composition were assessed at baseline and at the end of the 12th week of intervention. Data were analyzed using two-way repeated-measures ANOVA with repeated measures on time (2 groups × 3 time points), followed by post hoc analysis when significant difference was occurred. Results: Thirty participants completed the trial. Energy intake and body mass remained stable in both groups. At the end of week 12, peak torque declined in the control group (p < 0.05) but remained stable in the higher-protein group. The fatigue index worsened over time in controls but was preserved in the higher protein group, resulting in a significant group d7 time interaction at week 12 (p < 0.05) (post hoc between-group difference at week 12, p < 0.05). Fat-free mass and blood pressure did not change. In fat mass, a decrease was observed with higher protein intake, whereas it remained stable in the control group. Conclusions: Higher protein intake for 12 weeks preserved knee muscle performance in older adults with T2DM without weight gain, supporting dietary protein optimization to counter functional decline.

Physical activity (PA) is widely recognized as a therapeutic intervention for numerous non-communicable diseases. This study assessed Greek medical students’ knowledge and education on PA across seven medical schools. A structured questionnaire was distributed electronically to all medical schools across Greece, with 135 students responding (67.4% female). Among respondents, 78.5% reported being taught about PA benefits, and 77.8% felt prepared to discuss them with patients. However, 30.2% had received less than two hours of formal PA education. Only 25.2% were aware of the World Health Organization (WHO) and Greek Central Board of Health (KESY) recommendations, while 81.5% expressed the need for additional education on PA and its role in health. Students who were taught about PA were more likely to address exercise physiology (42.5% vs. 17.2%, p = 0.013, OR = 16.4), cardiopulmonary exercise testing (52.8% vs. 24.1%; p = 0.006, OR = 3.5), and PA benefits (89.6% vs. 34.5%; p < 0.001, OR = 3.5). Although most medical students have been taught about PA’s health benefits, only a small proportion have sufficient knowledge for effective prescription.

Purpose: This study aimed to cross-culturally adapt the second version of the Oslo Sports Trauma Research Center Questionnaires on Overuse Injuries (OSTRC-O2) and Health Problems (OSTRC-H2) into Greek. Materials and Methods: The questionnaires were translated using the back-translation method in accordance with international guidelines. The OSTRC-O2 was administered to 56 female volleyball players, focusing on shoulder injuries, while the OSTRC-H2 was delivered to 52 adolescent and young adult male and female volleyball and soccer players. Validity was assessed through content validity (Content Validity Index – CVI), face validity (using additional questions on comprehensibility, difficulty, relevance, and completeness), and concurrent validity (correlations between the OSTRC-O2 severity score and the numeric pain rating scale [NPRS], as well as between the OSTRC-H2 severity score with days of time loss [DL] and NPRS). Reliability was evaluated using internal consistency (Cronbach's α) and the test-retest method (intraclass correlation coefficient – ICC). The study was conducted for a two-week period and the test-retest was performed with a two-day interval. Results: Twenty-three athletes (41%) reported shoulder problems using the OSTRC-O2, while 28 injury events and 5 cases of illness were reported with the OSTRC-H2. Face and content validity were excellent (CVI = 0.925 and 0.975 for OSTRC-O2 and OSTRC-H2). A strong correlation was observed between the OSTRC-O2 severity score and the NPRS (ρ = 0.819, p < 0.001), while the OSTRC-H2 severity score demonstrated significant correlations with both the NPRS (ρ = 0.72, p < 0.001) and days of time loss (ρ = 0.625, p < 0.001). Both questionnaires demonstrated excellent reliability and internal consistency, with the OSTRC-O2 showing an ICC of 0.90 (95% CI: 0.82–0.94) and Cronbach's alpha of 0.84, and the OSTRC-H2 showing an ICC of 0.93 (95% CI: 0.89–0.97) and Cronbach's alpha of 0.93. Conclusions: The Greek versions of the OSTRC questionnaires are valid and reliable tools for injury surveillance among Greek volleyball and soccer players.

Purpose: Bone mineral measurements and their association with peak impact and sport-specific, persistent muscle loads were examined in 10 elite artistic swimmers age 15–19 years. Methods: Bone mineral density (BMD) and bone mineral content (BMC) of total body, total body less head, spine, and dominant and nondominant limbs were assessed by dual-energy X-ray absorptiometry. Peak ground-reaction forces of 2 dry jumps (countermovement jump and frog jump) were measured on a force plate. Peak forces applied during in-water exercises (vertical scull, barracuda push, and kick pull) were measured. Results: On average, artistic swimmers’ total-body BMD (1.12 [0.08] g/cm²) was similar to values reported for young swimmers and nonathletic females, and total-body BMC (2359 [399] g) was higher than previously reported in race swimmers. Based on previously published reference curves, 9 out of 10 artistic swimmers had total-body less head BMD and BMC at or above the 90th percentile, with average to above average z scores and height-adjusted z scores for their age. Countermovement jump and frog jump exhibited moderate peak ground-reaction forces (2.61 [0.46] and 1.93 [0.42] N/kg, respectively). In water, greater force was exerted in kick pull (60.4 [4.8] N) compared with vertical skull (45.5 [6.4] N) and barracuda push (40.6 [4.8] N). Bone measurements were correlated with the peak ground-reaction forces exerted in both dry jumps (r = .61–.83, P ≤ .05) and the peak force output of the in-water exercises (r = .63–.80, P ≤ .05). Conclusion: These results imply robust bone health among artistic swimmers, partially associated with the high muscle forces regularly applied during their sport-specific training that seem to counteract the low-impact nature of the sport.

Background and Objectives: Tenosynovial giant cell tumor (TGCT) is a rare, locally aggressive, benign neoplasm arising from the synovium of joints, tendon sheaths, and bursa. There are two main subtypes of TGCT: localized-type TGCT(L-TGCT) and diffuse-type TGCT (D-TGCT). While surgical excision is still considered the gold standard of treatment, the high recurrence rate, especially for D-TGCT, may suggest the need for other treatment modalities. Materials and Methods: This study reviews current literature on the current treatment modalities for refractory-relapsed TGCT disease. Results: The gold standard of treatment modality in TGCT remains surgical excision of the tumor nevertheless, the elevated recurrence rate and refractory disease, particularly in D-TGCT indicates and underscores the necessity for additional treatment alternatives. Conclusions: TGCT is a benign tumor with inflammatory features and a potential destructive and aggressive course that can lead to significant morbidity and functional impairment with a high impact on quality of life. Surgical resection remains the gold standard current treatment and the optimal surgical approach depends on the location and extent of the tumor. Systemic therapies have been recently used for relapsed mainly cases.

Introduction Hip osteoarthritis (OA) is a common joint pathology that significantly constrains functional capacity. Assessing the impact of hip OA on functionality is crucial for research and clinical practices. The study aimed to assess hip OA patients’ functionality using the Timed Up and Go (TUG) test and to evaluate its diagnostic ability to differentiate between different grades of hip OA. We hypothesized that the severity of hip OA would impact the time required to complete the TUG test. Materials and Methods Patients (Ν = 606) with unilateral, primary hip OA were selected from de-identified data and divided according to the radiographic Kellgren–Lawrence classification system (groups: Grade 2, Grade 3, and Grade 4). Groups’ differences were assessed using the X² test of independence and the one-way ANOVA model. Correlations between dependent and independent variables were assessed using Pearson’s correlation coefficient (r). A receiver operating characteristic (ROC) analysis was conducted to assess the TUG test’s ability to differentiate between the hip OA grades. Results Statistically significant differences were found among the three groups in age, gender distribution, TUG test, and occasional cane use (all p-values < 0.001). The correlation analysis shows a significant and strong positive correlation between TUG performance time and hip OA grades (r = .78, p < .001). The adjusted odds ratios (OR) were: Grade2-3=(2.29[95%CI: 1.89, 2.77], p < .001) and Grade3-4=(1.47[95%CI: 1.34, 1.62], p < .001). The TUG cut-off points from the ROC analysis were: Grades 2–3 = 10.25 s, Grades 2–4 = 11.35 s, and Grades 3–4 = 12.8 s. Conclusions This study provides evidence that the duration of the TUG test significantly increased with the severity of the disease. TUG can offer real-time data on the management and progression of hip OA. Future studies should explore the correlation between hip OA and the TUG test, as understanding the relationship can influence treatment and patient outcomes.

Total hip arthroplasty (THA) is a preferred treatment for primary osteoarthritis (OA) or secondary degenerative arthropathy due to developmental hip dysplasia (DDH). Gait analysis is considered a gold standard for evaluating post-arthroplasty walking patterns. This study compared post-THA spatiotemporal gait parameters (SGPs) between OA and DDH patients and explored correlations with demographic and clinical variables. Thirty patients (15 per group) were recorded during gait and their SGPs were analyzed. Functionality was evaluated with the Oxford Hip Score (OHS). The OA patients were significantly older than DDH patients (p < 0.005). Significant and moderate to strong were the correlations between SGPs, age, and four items of the OHS concerning hip pain and activities of daily life (0.31 < Pearson’s r < 0.51 all p < 0.05). Following THA, both groups exhibited similar levels of the examined gait parameters. Post-arthroplasty SGPs and OHS correlations indicate limitations in certain activities. Given the absence of pre-operative data and the correlation between age and SGPs and OHS, ANCOVA testing revealed that age adjusts OHS and SGP values, while pre-operative diagnosis has no main effect. These findings indicate that hip OA or DDH do not affect postoperative SGPs and patients’ functionality. Future studies should examine both kinematic and kinetic data to better evaluate the post-THA gait patterns of OA and DDH patients.

Total hip arthroplasty (THA) is a preferred treatment for primary osteoarthritis (OA) or secondary due to developmental hip dysplasia (DDH). Gait analysis is considered a golden standard for evaluating post-arthroplasty walking patterns. This study compared post-THA spatiotemporal gait parameters (SGPs) between OA and DDH patients and explored correlations with demographic and clinical variables. Thirty patients (15 per group) were recorded during gait, and their SGPs were analyzed. Functionality was evaluated with the Oxford Hip Score (OHS). The OA patients were significantly older than DDH (pr< 0.51, all p< 0.05). The preoperative gait alterations associated with OA or DDH were improved to similar levels in both groups after THA. Post-arthroplasty SGPs and OHS correlations indicate limitations in certain activities. These find-ings must be correlated with kinetic gait analysis data to fully evaluate gait and functionality dif-ferences among patient groups.

Background/Objectives: There is a lack of reliable biomarkers for diagnosis of infection eradication prior to second-stage reimplantation in two-stage exchange arthroplasty for periprosthetic joint infections (PJIs). The aim of this study was to assess the diagnostic accuracy of rotational thromboelastometry (ROTEM) for persistent infection in two-stage exchange arthroplasties. Methods: A pilot, retrospective analysis was performed including 70 patients who underwent a two-stage exchange arthroplasty for PJI. They were categorized as patients without (n = 64) or patients with persistent infection (n = 6) prior to reimplantation. Definition of persistent infection prior to reimplantation was based on the 2018 ICM criteria. Conventional coagulation biomarkers and ROTEM parameters were compared between groups. Results: Higher FIBTEM MCF values were associated with persistent infection (odds ratio [OR], 1.30, 95% confidence interval [CI], 1.04–1.63; p = 0.020), and FIBTEM MCF had the highest diagnostic accuracy for persistent infection prior to second-stage reimplantation (AUC, 0.907; 95% CI, 0.812–1.000). A cut-off value ≥ 18 mm for FIBTEM MCF was found to have 100.0% sensitivity and 73.4% specificity for diagnosing persistent infection prior to second-stage reimplantation. Moreover, the diagnostic accuracy of FIBTEM MCF was higher than that of fibrinogen levels (p = 0.036) and D-dimer (p = 0.006). Conclusions: Our findings indicate that ROTEM parameters have the potential to identify persistent infections before reimplantation in two-stage exchange arthroplasties for PJI. Such coagulation biomarkers could provide guidance regarding the optimal timing for reimplantation. Further studies in larger populations are warranted to validate the diagnostic accuracy of ROTEM parameters for persistent PJI.