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1.
Villafañe JH Silva GB Fernandez-Carnero J 《Journal of manipulative and physiological therapeutics》2011,34(7):449-456
Objective
The purpose of this study is to evaluate whether neurodynamic mobilization of the median nerve improves pressure pain threshold (PPT) and pinch and grip strength in patients with secondary thumb carpometacarpal osteoarthritis (TCOA).Method
Fifteen patients with secondary TCOA (13 women and 2 men) between 70 and 90 years old were received by neurodynamic therapy. All patients received median nerve mobilization of the dominant hand by sliding technique during 4 sessions over 2 weeks. The outcome measures of this case series were monitored by using PPT measured by algometry as PPT at the trapeziometacarpal (TM) joint, tubercle of the scaphoid bone, and the unciform apophysis of the hamate bone. Tip and tripod pinch strength was also measured. Grip strength was measured by a grip dynamometer. These variables were measured at pretreatment, 5 minutes posttreatment, 1 week (first follow-up [FU]) and 2 weeks after treatment (second FU).Results
Pressure pain threshold in the TM joint was 3.54 ± 0.04 kg/cm2. After treatment, it increased to 4.38 ± 0.04 kg/cm2 (P < .01) and maintained in the first FU (4.27 ± 0.04 kg/cm2, P < .02) and second FU (4.08 ± 0.04 kg/cm2, P < .02). In contrast, we found no differences in PPT in the other studied structures after treatment. Similarly, tip and tripod pinch strength remained without change after treatment. Grip strength was 10.77 ± 0.18 kg, and after treatment, it increased to 11.55 ± 0.16 kg (P < .05) and maintained in first FU (11.73 ± 0.18 kg, P < .02) and second FU (11.2 ± 0.17 kg, P < .05).Conclusions
Median nerve mobilization decreased pain in the TM joint and increased grip strength in this group of patients with TCOA. 相似文献2.
Tricia J. Hubbard Charlie Hicks-Little Mitchell Cordova 《Archives of physical medicine and rehabilitation》2010,91(1):73-77
Hubbard TJ, Hicks-Little C, Cordova M. Changes in ankle mechanical stability in those with knee osteoarthritis.
Objective
To examine ankle joint mechanical stability in patients who had mild to moderate knee osteoarthritis (OA).Design
Case control study.Setting
Biodynamics research laboratory.Participants
Subjects with knee OA (n=15; 5 men and 10 women; mean age ± SD, 60.3±10.2y; mean mass ± SD, 93.9±18.3kg; mean height ± SD, 167.23±9.5cm) were matched to healthy controls (n=15; 5 men and 10 women; mean age ± SD, 59.6±12.6y; mean mass ± SD, 83.5±19.2kg; mean height ± SD, 169.7±12.6cm).Interventions
Not applicable.Main Outcome Measures
Mechanical ankle-subtalar joint stability was assessed with an instrumented arthrometer where ankle-subtalar joint motion for anterior/posterior displacement and inversion/eversion rotation was measured. Separate 2 × 2 mixed model analyses of variance were performed.Results
Significant group × side interactions were observed for anterior and posterior displacement (P<.05) where patients with knee OA had significantly less anterior and posterior ankle displacement compared with the control group, as well as compared with their unaffected extremity. Additionally, patients with knee OA had significantly (P<.05) less inversion/eversion rotation than their respective controls.Conclusions
These data suggest that altered ankle joint mechanics may be the result of deviations in ankle joint alignment secondary to the structural changes at the knee. Compensatory changes in ankle joint mechanics must also be considered when addressing lower extremity functional deficits in patients with knee OA. 相似文献3.
Jorge H. Villafañe Joshua A. Cleland Cesar Fernandez-de-las-Peñas 《Journal of manipulative and physiological therapeutics》2013,36(4):232-237
ObjectiveThe purpose of this study was to investigate changes in pressure sensitivity and pinch grip force in the nonsymptomatic side in patients with thumb carpometacarpal (CMC) osteoarthritis (OA) after the application of a unilateral passive accessory mobilization to the symptomatic hand.MethodsSecondary analysis of data from a randomized trial with concealed allocation, blinded assessor, and intention-to-treat analysis was performed. Twenty-eight patients (72% females), with unilateral CMC OA and mean age ± SD of 82 ± 6 years, met all the inclusion criteria and agreed to participate. The experimental group received passive accessory mobilization to the CMC OA, and the control group received a nontherapeutic dose of intermittent ultrasound on the affected side for 4 sessions over 2 weeks. Outcome measures including pressure pain thresholds (PPTs) at the lateral epicondyle, thumb CMC joint, tubercle of the scaphoid bone, and the unciform apophysis of the hamate bone and tip and tripod pinch and grip strength of the contralateral/unaffected hand were assessed at baseline as well as 1 and 2 weeks after treatment by an assessor blinded to the group allocation. A repeated measures analysis of variance was used to determine changes in PPT and pinch and grip strength.ResultsNo important baseline differences were observed between groups. At the end of the follow-up period, the experimental group exhibited a significant increase in PPT at the CMC joint as compared with the control group 0.6 kg/cm2 (95% confidence interval, 0.3-1.0; F3.0 = 4.89; P = .009). Although PPT changes in the experimental group were higher than the control group at the remaining sites, differences did not reach statistically significance. Similarly, tip, tripod pinch, and grip strength remained unchanged after the intervention.ConclusionThis secondary analysis found that the application of a unilateral passive accessory mobilization targeted to the symptomatic CMC joint induced an increase of PPT levels 2 weeks after treatment; however, differences were small and likely of limited clinical value. No contralateral motor effects were observed. Future studies including larger sample sizes are needed to examine the effects of joint mobilization on motor and sensory effects. 相似文献
4.
Erik A. Wikstrom Tricia J. Hubbard PhD 《Archives of physical medicine and rehabilitation》2010,91(8):1267-1271
Wikstrom EA, Hubbard TJ. Talar positional fault in persons with chronic ankle instability.
Objective
To determine whether sagittal plane talar position differs between uninjured controls and individuals with chronic ankle instability (CAI) using lateral ankle radiographs.Design
Single-blind case control.Setting
University-based sports medicine research laboratory.Participants
University students (N=48) volunteered to participate. Twenty-four uninjured controls (12 men, 12 women; mean ± SD, 21.8±2.6y; 170±10cm; 73±16kg), and 24 adults with CAI (12 men, 12 women; 21.7±2.8y; 175±13cm; 71±13kg) participated.Intervention
A single nonweight-bearing lateral radiograph was taken of each ankle. Subjects were positioned side lying with the hip and knee in a neutral position in the transverse plane and the ankle joint in a neutral position (90° of dorsiflexion, 0° of inversion/eversion).Main Outcome Measure
The sagittal plane talar position was calculated as the distance between the most anterior margin of the inferior tibia and the most anterior margin of the talar dome in millimeters for each radiograph.Results
Talar position was significantly more anterior in the involved CAI limb (3.69±1.37mm) than the uninvolved CAI limb (2.98±1.61mm; P=.03). Additionally, an anterior talar position was significantly greater in the involved CAI limb than the matched control limb (2.65±1.24cm; P<.01). No differences were found between the uninvolved CAI limb and the matched control group limb (P=.57) or between the limbs of the uninjured control group (P=.75). Intratester reliability was found to be .90, while intertester reliability was .78.Conclusions
An anterior talar positional fault is present in the involved limb of individuals with CAI relative to their uninvolved limb and compared with the matched limb of a control group. The talar position measurement technique has excellent intratester and intertester reliability. 相似文献5.
Jill M. Wecht Dwindally Rosado-Rivera John P. Handrakis Miroslav Radulovic William A. Bauman 《Archives of physical medicine and rehabilitation》2010,91(9):1429-1435
Wecht JM, Rosado-Rivera D, Handrakis JP, Radulovic M, Bauman WA. Effects of midodrine hydrochloride on blood pressure and cerebral blood flow during orthostasis in persons with chronic tetraplegia.
Objective
To determine the mean arterial pressure (MAP) and middle cerebral artery mean blood flow velocity (MFV) responses to 5 and 10mg midodrine during head-up tilt (HUT) in persons with tetraplegia.Design
Prospective dose-response trial.Setting
James J. Peters Veterans Administration Medical Center.Participants
Persons (N=10) with chronic tetraplegia (duration of injury=23±11y).Intervention
A dose titration study was performed over 3 testing days: control (no drug), 5mg midodrine (5mg), or 10mg midodrine (10mg) during 30 minutes of baseline (predrug/no drug), 30 minutes of supine rest postdrug/no drug, 15 minutes of progressive HUT (5 minutes at 15°, 25°, 35°), and 45 minutes of 45° HUT.Main Outcome Measures
MAP and MFV response to midodrine supine and during HUT.Results
Ten milligrams of midodrine significantly increased MAP while supine and during the HUT maneuver. Of note, the mean increase in MAP during HUT with 10mg was a result of a robust effect in 2 persons, with minimal change in the remaining 8 study subjects. The reduction in cerebral MFV during HUT was attenuated with 10mg.Conclusions
These findings suggest that midodrine 10mg may be efficacious for treatment of hypotension and orthostatic hypotension in select persons with tetraplegia. Although midodrine is routinely prescribed to treat orthostatic hypotension, the results of our work suggests limited efficacy of this agent, but additional studies in a larger sample of subjects with spinal cord injury should be performed. 相似文献6.
Jorge Hugo Villafa?e Kristin Valdes Virginia OBrien Monica Seves Raquel Cantero-Téllez Pedro Berjano 《Journal of bodywork and movement therapies》2018,22(1):37-39
Objective
The purpose of this study was to elucidate expert opinion on the conservative treatment of thumb carpometacarpal (CMC) joint osteoarthritis (OA).Methods
A 21-item survey to determine the practice patterns of Italian hand therapists who treat arthritis of the CMC joint was developed and distributed through a professional online survey service to assure confidentiality and anonymity.Results
Of the respondents, 80.8% were physical therapists; the remaining 19.2% were occupational therapists. 84.6% of the specialists who make decisions regarding patient pain management education.Conclusions
There is variability in the knowledge and practice patterns of Italian hand therapists relating to conservative management of thumb CMC OA. 相似文献7.
Tyng-Guey Wang Yeun-Chung Chang Wen-Shiang Chen Pei-Hung Lin Tzu-Yu Hsiao 《Archives of physical medicine and rehabilitation》2010,91(6):926-931
Wang T-G, Chang Y-C, Chen W-S, Lin P-H, Hsiao T-Y. Reduction in hyoid bone forward movement in irradiated nasopharyngeal carcinoma patients with dysphagia.
Objective
To quantitatively assess the movement of the hyoid bone and pyriform sinus stasis in irradiated nasopharyngeal carcinoma (NPC) patients suffering from dysphagia.Design
Retrospective data analysis.Setting
A tertiary teaching hospital.Participants
NPC subjects (n=33, 25 men and 8 women) and healthy subjects (n=10, 7 men and 3 women) participated in the study.Intervention
Videofluoroscopic swallowing study (VFSS) of all subjects.Main Outcome Measures
The displacement and velocity of hyoid bone movement, the amount of pyriform sinus stasis, and the widest opening distance of the cricopharyngeal muscle during swallowing.Results
The displacement of the hyoid bone in the NPC patients was significantly less than that of the healthy subjects (1.58±0.59 vs 2.23±0.49cm, P=.0033). The displacement of the hyoid bone was divided into forward and vertical directions, and the forward displacement in the NPC patients was found to be less than that of the healthy subjects (0.85±0.50 vs 1.65±0.51cm), achieving statistic significance (P<.0001). The pyriform sinus stasis of the NPC subjects was significantly more than that of the healthy subjects (2.24±0.98 vs 0.30±0.17cm2, P<.0001). The movement velocity of the NPC subjects was less than that of the healthy subjects (2.49±1.41 vs 5.10±0.85cm/s, P=.0086). Furthermore, the NPC subjects with aspiration experienced less displacement of the hyoid bone than those without aspiration (1.23±0.45 vs 1.76±0.58cm, P=.029).Conclusion
The irradiated NPC subjects with dysphagia experienced a reduction in hyoid bone displacement, occurring in a forward direction. The displacement of the hyoid bone was less in the aspiration subjects than in those without aspiration. 相似文献8.
Background
Acupoint electrical stimulation (AES) is commonly used for pain management. However, its true or placebo effect to achieve pain relief needs to be verified.Objective
This study aimed to examine the true effect of AES to reduce postoperative pain in patients with spinal surgery receiving patient-controlled analgesia (PCA).Method
A placebo- and sham-controlled study was conducted. Participants were randomly assigned to intervention with AES at true acupoints (the AES group, n = 30), AES at sham acupoints (the sham group, n = 30), or no intervention with AES (the control group, n = 30). Outcomes were assessed according to the amount of pain experienced and analgesics used.Results
There were significant differences among the three groups in pain relief across time, and the occurrence of PCA button pushed and amount of analgesics used. The beneficial effects of AES were discernible when compared to the sham and the control.Conclusions
AES at the true acupoints effectively reduced postoperative pain and analgesic usage. AES has now been implemented into healthcare and it is recommended that nurses be provided with the opportunity to earn their AES skills. More studies evaluating the effects of AES over a longer period and on pain after different surgical procedures are suggested. 相似文献9.
Correlation of plasma and synovial fluid osteopontin with disease severity in knee osteoarthritis 总被引:1,自引:0,他引:1
Objectives
The purposes of this study were to examine osteopontin levels in both plasma and synovial fluid of patients with primary knee osteoarthritis (OA) and to investigate their relationship with severity of the disease.Design and methods
Thirty-two patients aged 53-83 years with knee OA and 15 healthy controls were enrolled in this study. Anteroposterior knee radiographs were taken to determine the disease severity of the affected knee. The radiographic grading of OA in the knee was performed by using the Kellgren-Lawrence criteria. Osteopontin levels in the plasma and synovial fluid were measured using enzyme-linked immunosorbent assay.Results
The mean plasma osteopontin concentration of the knee OA patients was significantly higher compared with that of healthy controls (168.8 ± 15.6 vs 67.2 ± 7.7 ng/mL, P < 0.0001). Osteopontin levels in synovial fluid were significantly higher with respect to paired plasma samples (272.1 ± 15.0 vs 168.8 ± 15.6 ng/mL, P < 0.001). In addition, plasma osteopontin levels showed a positive correlation with synovial fluid osteopontin levels (r = 0.373, P = 0.035). Subsequent analysis showed that plasma osteopontin levels significantly correlated with severity of disease (r = 0.592, P < 0.001). Furthermore, the synovial fluid levels of osteopontin also correlated with disease severity (r = 0.451, P = 0.01).Conclusion
The data suggest that osteopontin in plasma and synovial fluid is related to progressive joint damage in knee OA. Osteopontin may serve as a biochemical marker for determining disease severity and could be predictive of prognosis with respect to the progression of knee OA. 相似文献10.
Neil A. Segal H. John Yack Morgan Brubaker James C. Torner Robert Wallace 《Archives of physical medicine and rehabilitation》2009,90(11):1821-1828
Segal NA, Yack HJ, Brubaker M, Torner JC, Wallace R. Association of dynamic joint power with functional limitations in older adults with symptomatic knee osteoarthritis.
Objectives
To determine which lower-limb joint moments and powers characterize the level of gait performance of older adults with symptomatic knee osteoarthritis (OA).Design
Cross-sectional observational study.Setting
University motion analysis laboratory.Participants
Community-dwelling adults (N=60; 27 men, 33 women; age 50-79y) with symptomatic knee OA.Interventions
Not applicable.Main Outcome Measures
Physical function was measured using the long-distance corridor walk, the Short Physical Performance Battery, and the Late Life Function and Disability Instrument (LLFDI Function). Joint moments and power were estimated using an inverse dynamics solution after 3-dimensional computerized motion analysis.Results
Subjects aged 64.2±7.4 years were recruited. Ranges (mean ± SD) for the 400-m walk time and the LLFDI Advanced Lower-Limb Function score were 215.3 to 536.8 (304.1±62.3) seconds and 31.5 to 100 (57.0±14.9) points, respectively. In women, hip abductor moment (loading response), hip abductor power (midstance), eccentric hamstring moment (terminal stance), and power (terminal swing) accounted for 41%, 31%, 14%, and 48% of the variance in the 400-m walk time, respectively (model R2=.61, P<.003). In men, plantar flexor and hip flexor power (preswing) accounted for 19% and 24% of the variance in the 400-m walk time, respectively (model R2=.32, P=.025).Conclusions
There is evidence that men and women with higher mobility function tend to rely more on an ankle strategy rather than a hip strategy for gait. In higher functioning men, higher knee extensor and flexor strength may contribute to an ankle strategy, whereas hip abductor weakness may bias women with lower mobility function to minimize loading across the knee via use of a hip strategy. These parameters may serve as foci for rehabilitation interventions aimed at reducing mobility limitations. 相似文献11.
Tricia J. Hubbard Charlie Hicks-Little Mitchell Cordova 《Archives of physical medicine and rehabilitation》2009,90(7):1136-1726
Hubbard TJ, Hicks-Little C, Cordova M. Mechanical and sensorimotor implications with ankle osteoarthritis.
Objective
To understand the mechanical and sensorimotor adaptations that may occur with ankle osteoarthritis (OA).Design
Case-control.Setting
Biodynamics research laboratory.Participants
Subjects with ankle OA (n=8; 4 males, 4 females) were matched to healthy controls (n=8; 4 males, 4 females).Interventions
Not applicable.Main Outcome Measures
Mechanical joint stability was assessed with an instrumented ankle arthrometer. Static balance was measured using a force platform during a double-legged stance. Isometric ankle/foot complex strength in the sagittal and frontal plane was assessed with a handheld dynamometer. Last, subjective level of function was assessed using the foot and ankle disability index.Results
There were significant group × side interactions for anterior displacement, inversion rotation, eversion rotation, ankle isometric strength, and the foot and ankle disability index (P<.05). The affected ankle of the OA group demonstrated significantly more mechanical stiffness, more impairments in ankle/foot isometric strength, and less subjective level of function than the matched controls. Additionally, the ankle OA group exhibited significantly more center of pressure displacement, total velocity, and medial-lateral velocity (P<.05).Conclusions
These limitations observed in joint laxity, postural control, muscle strength, and perceived function provide evidence that patients with ankle OA display a number of characteristics that affect joint stability and overall function. These identified impairments necessitate the need for rehabilitation and exercise programs to be developed to help improve joint stability and function in patients with ankle OA. 相似文献12.
Michael I. Weintraub David N. Herrmann A. Gordon Smith Misha M. Backonja Steven P. Cole 《Archives of physical medicine and rehabilitation》2009,90(7):1102-1109
Weintraub MI, Herrmann DN, Smith AG, Backonja MM, Cole SP. Pulsed electromagnetic fields to reduce diabetic neuropathic pain and stimulate neuronal repair: a randomized controlled trial.
Objective
To determine whether repetitive and cumulative exposure to low-frequency pulsed electromagnetic fields (PEMF) targeting painful feet can reduce neuropathic pain (NP), influence sleep in symptomatic diabetic peripheral neuropathy (DPN), and influence nerve regeneration.Design
Randomized, double-blind, placebo-controlled parallel study.Setting
Sixteen academic and clinical sites in 13 states.Participants
Subjects (N=225) with DPN stage II or III were randomly assigned to use identical devices generating PEMF or sham (placebo) 2 h/d to feet for 3 months.Interventions
Nerve conduction testing was performed serially.Main Outcome Measures
Pain reduction scores using a visual analog scale (VAS), the Neuropathy Pain Scale (NPS), and the Patient's Global Impression of Change (PGIC). A subset of subjects underwent serial 3-mm punch skin biopsies from 3 standard lower limb sites for epidermal nerve fiber density (ENFD) quantification.Results
Subjects (N=225) were randomized with a dropout rate of 13.8%. There was a trend toward reductions in DPN symptoms on the PGIC, favoring the PEMF group (44% vs 31%; P=.04). There were no significant differences between PEMF and sham groups in the NP intensity on NPS or VAS. Twenty-seven subjects completed serial biopsies. Twenty-nine percent of PEMF subjects had an increase in distal leg ENFD of at least 0.5 SDs, while none did in the sham group (P=.04). Increases in distal thigh ENFD were significantly correlated with decreases in pain scores.Conclusions
PEMF at this dosimetry was noneffective in reducing NP. However neurobiological effects on ENFD, PGIC and reduced itching scores suggest future studies are indicated with higher dosimetry (3000-5000 G), longer duration of exposure, and larger biopsy cohort. 相似文献13.
Li-Wei Chou Yueh-Ling Hsieh Mu-Jung Kao Chang-Zern Hong 《Archives of physical medicine and rehabilitation》2009,90(6):905-1124
Chou L-W, Hsieh Y-L, Kao M-J, Hong C-Z. Remote influences of acupuncture on the pain intensity and the amplitude changes of endplate noise in the myofascial trigger point of the upper trapezius muscle.
Objective
To investigate the remote effect of acupuncture on the pain intensity and the endplate noise (EPN) recorded from a myofascial trigger point (MTrP) of the upper trapezius muscle.Design
Randomized controlled trial.Setting
University hospital.Participants
Patients (N=20) with active MTrPs in upper trapezius muscles and no experience in acupuncture therapy.Interventions
Patients were divided into 2 groups. Those in the control group received sham acupuncture, and those in the acupuncture group received modified acupuncture therapy with needle insertion into multiple loci to elicit local twitch responses. The acupuncture points of Wai-guan and Qu-chi were treated.Main Outcome Measures
Subjective pain intensity (numerical pain rating scale) and mean EPN amplitude in the MTrP of the upper trapezius muscle.Results
The pain intensity in the MTrP was significantly reduced after remote acupuncture (from 7.4±0.8 to 3.3±1.1; P<.001), but not after sham acupuncture (from 7.4±0.8 to 7.1±0.9; P>.05). The mean EPN amplitude was significantly lower than the pretreatment level after acupuncture treatment (from 21.3±9.5μV to 9.5±3.5μV; P<.01), but not after sham acupuncture treatment (from 19.6±7.6μV to 19.3±7.8μV; P>.05). The change in the pain intensity was significantly correlated with the change of EPN amplitude (r = 0.685).Conclusions
Both subjective changes in the pain intensity and objective changes of the EPN amplitude in the MTrP region of the upper trapezius muscle were found during and after acupuncture treatment at the remote ipsilateral acupuncture points. This study may further clarify the physiological basis of the remote effectiveness of acupuncture therapy for pain control. 相似文献14.
Niessen MH Veeger DH Koppe PA Konijnenbelt MH van Dieën J Janssen TW 《Archives of physical medicine and rehabilitation》2008,89(2):333-338
Niessen MH, Veeger DH, Koppe PA, Konijnenbelt MH, van Dieën J, Janssen TW. Proprioception of the shoulder after stroke.
Objective
To investigate position sense and kinesthesia of the shoulders of stroke patients.Design
Case-control study.Setting
A rehabilitation center.Participants
A total of 22 inpatients with stroke and 10 healthy control subjects.Interventions
Not applicable.Main Outcome Measures
Angular displacement (in degrees) for threshold to detection of passive motion (TDPM) tests and absolute error (in degrees) for passive reproduction of joint position tests.Results
For patients, the TDPM for internal and external rotation was significantly higher for both the contralateral (paretic) side (internal, 7.92°±7.19°; external, 8.46°±8.87°) and the ipsilateral (nonparetic) side (internal, 4.86°±5.03°; external, 6.09°±9.15°) compared with the control group (internal, 1.83°±1.09°; external, 1.71°±.85°). Also, for internal rotation, TDPM was significantly higher for patients on the contralateral side compared with the ipsilateral side. For passive reproduction of joint position tests, no differences were found.Conclusions
Both the contralateral and ipsilateral shoulders of stroke patients showed impaired TDPM. Passive reproduction of joint position does not seem to be affected as a result of a stroke. The control of the muscle spindles and central integration or processing problems of the afferent signals provided by muscle spindles might cause these effects. 相似文献15.
16.
Smulders E Weerdesteyn V Groen BE Duysens J Eijsbouts A Laan R van Lankveld W 《Archives of physical medicine and rehabilitation》2010,91(11):1705-1711
Smulders E, Weerdesteyn V, Groen BE, Duysens J, Eijsbouts A, Laan R, van Lankveld W. Efficacy of a short multidisciplinary falls prevention program for elderly persons with osteoporosis and a fall history: a randomized controlled trial.
Objective
To evaluate the efficacy of the Nijmegen Falls Prevention Program (NFPP) for persons with osteoporosis and a fall history in a randomized controlled trial. Persons with osteoporosis are at risk for fall-related fractures because of decreased bone strength. A decrease in the number of falls therefore is expected to be particularly beneficial for these persons.Design
Randomized controlled trial.Setting
Hospital.Participants
Persons with osteoporosis and a fall history (N=96; mean ± SD age, 71.0±4.7y; 90 women).Intervention
After baseline assessment, participants were randomly assigned to the exercise (n=50; participated in the NFPP for persons with osteoporosis [5.5wk]) or control group (n=46; usual care).Main Outcome Measures
Primary outcome measure was fall rate, measured by using monthly fall calendars for 1 year. Secondary outcomes were balance confidence (Activity-specific Balance Confidence Scale), quality of life (QOL; Quality of Life Questionnaire of the European Foundation for Osteoporosis), and activity level (LASA Physical Activity Questionnaire, pedometer), assessed posttreatment subsequent to the program and after 1 year of follow-up.Results
The fall rate in the exercise group was 39% lower than for the control group (.72 vs 1.18 falls/person-year; risk ratio, .61; 95% confidence interval, .40-.94). Balance confidence in the exercise group increased by 13.9% (P=.001). No group differences were observed in QOL and activity levels.Conclusion
The NFPP for persons with osteoporosis was effective in decreasing the number of falls and improving balance confidence. Therefore, it is a valuable new tool to improve mobility and independence of persons with osteoporosis. 相似文献17.
Kluding PM, Santos M. Effects of ankle joint mobilizations in adults poststroke: a pilot study.
Objective
To compare the effect of 2 interventions on ankle mobility, ankle kinematics, and weight-bearing symmetry during functional activities in subjects with hemiparesis after a stroke.Design
Randomized trial.Setting
Academic medical center.Participants
A convenience sample of 16 subjects with hemiparesis after stroke (mean age, 55.2y; mean time since stroke, 21.4mo).Intervention
Subjects received 8 sessions over 4 weeks of either functional task practice combined with ankle joint mobilizations, or functional task practice only.Main Outcome Measures
Changes in ankle range of motion (ROM) (not blinded), ankle kinematics during sit-to-stand (STS) and gait, and lower-extremity weight-bearing symmetry during STS and static standing.Results
The combined intervention group gained 5.7°±3.1° in passive ankle ROM compared with 0.2°±2.6° in the functional practice only group (95% confidence interval [CI], 2.5-8.6; P<.01). No significant changes in ankle kinematics or weight bearing during static standing were noted in either group. The functional practice group decreased differences in weight bearing during STS by 9.5%±6.47%, whereas the combined intervention group increased this difference by 3.37%±5.29% (95% CI, 3.26-19.46; P=.01).Conclusions
The increase in ankle motion did not improve joint kinematics and may have prevented improvement in weight-bearing symmetry. 相似文献18.
Su-Ju Tsai Tsung-Ho Ying Yu-Hui Huang Ju-Wen Cheng Liu-Ing Bih Henry L. Lew 《Archives of physical medicine and rehabilitation》2009,90(5):832-348
Tsai S-J, Ying T-H, Huang Y-H, Cheng J-W, Bih LI, Lew HL. Transperineal injection of Botulinum Toxin A for treatment of detrusor sphincter dyssynergia: localization with combined fluoroscopic and electromyographic guidance.
Objective
To determine the effectiveness of a combined method for localizing external urethral sphincter for transperineal injection of botulinum toxin A (BTX-A) in the treatment of detrusor sphincter dyssynergia (DSD) in patients with spinal cord injury (SCI).Design
A prospective, open-label trial.Setting
A rehabilitation hospital affiliated with a medical university.Participants
Eighteen SCI patients with voiding dysfunction resulting from urodynamically confirmed DSD.Interventions
100 units of BTX-A injected transperineally into the external urethral sphincter, which was localized using combined fluoroscopic and electromyographic guidance, using a Foley catheter inserted for visualization of vesicourethral anatomy.Main Outcome Measures
(1) postvoid residual volume, (2) leak point pressure, (3) maximal intravesical pressure, (4) maximal urethral pressure, (5) quality of life measures for urination, quantified by the Quality of Life Index (QLI).Results
Positive clinical outcomes were observed in all 18 patients in this study. The mean reductions in postvoid residual volume, leak point pressure, maximal intravesical pressure, and maximal urethral pressure before and after BTX-A injection were 183ml, 37cm H2O, 45cm H2O, and 92cm H2O, respectively (all P values <.05). The mean QLI significantly improved from −0.68±0.27 to 0.66±0.19 (P<.01). No significant side effects were noted after injection. The clinical therapeutic effects have shown reductions in occurrence and degree of autonomic dysreflexia, vesicoureteral reflux, hydronephrosis, and urinary tract infection. The bladder management programs also obtained improvements in our patients, either doing intermittent catheterizations less frequently, or resuming spontaneous voiding without indwelling catheters.Conclusion
With this combined method for localization of the external urethral sphincter, transperineal injection of BTX-A was safe, accurate, easy to perform, and effective for treatment of DSD in patients with SCI. 相似文献19.
Liikavainio T Lyytinen T Tyrväinen E Sipilä S Arokoski JP 《Archives of physical medicine and rehabilitation》2008,89(11):2185-2194
Liikavainio T, Lyytinen T, Tyrväinen E, Sipilä S, Arokoski JP. Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis.
Objectives
To examine the objective physical function of the lower extremities, to measure the properties of quadriceps femoris muscle (QFM), and to assess subjective disabilities in men with knee osteoarthritis (OA) and to compare the results with those obtained from age- and sex-matched control subjects.Design
Cross-sectional study.Setting
Rehabilitation clinic in a university hospital.Participants
Male volunteers (n=54) (age range, 50-69y) with knee OA and randomly selected healthy, age- and sex-matched control subjects (n=53).Interventions
Not applicable.Main Outcome Measures
Physical function evaluated with a test battery including the QFM composition measurement, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the RAND 36-Item Short-Form Health Survey, version 1.0.Results
Knee OA patients had 13% to 26% poorer (P range, .050-.001) physical function and muscle strength compared with the controls. There were also significant differences in QFM composition. WOMAC (P range, .050-.001) and muscle strength (P<.001) associated with physical function tests, but subjective pain correlated with neither physical function nor muscle strength in knee OA patients. The radiographic knee OA grade did not have any significant effect on physical function, but passive knee motion, knee extension strength, and WOMAC were related to the severity of the disease (P<.05).Conclusions
The patients with knee OA exhibited impaired physical function and muscle strength and QFM composition compared with healthy controls. The severity of radiographic knee OA clearly had adverse effects on functional ability at the later stages of the disease. The results highlight the effect of QFM strength on physical function as well as the importance of patient's subjective and objective physical function when deciding on knee OA treatment policy. 相似文献20.
Kristen A. Scopaz Sara R. Piva Stephen Wisniewski G. Kelley Fitzgerald 《Archives of physical medicine and rehabilitation》2009,90(11):1866-1873
Scopaz KA, Piva SR, Wisniewski S, Fitzgerald GK. Relationships of fear, anxiety, and depression with physical function in patients with knee osteoarthritis.