Prediction of peak oxygen consumption from the ratings of perceived exertion during a graded exercise test and ramp exercise test in able-bodied participants and paraplegic persons

Al-Rahamneh HQ, Eston RG. Prediction of peak oxygen consumption from the ratings of perceived exertion during a graded exercise test and ramp exercise test in able-bodied participants and paraplegic persons.

Objective

To assess the accuracy of predicting peak oxygen consumption (Vo₂peak) from a graded exercise test (GXT) and a ramp exercise test during arm exercise in able-bodied persons and persons with paraplegia using ratings of perceived exertion (RPEs).

Design

Each participant performed a GXT (started at 30W and increased by 15W every 2min) and a ramp exercise test (started at 0W and increased by 15W·min⁻¹).

Setting

Universities' laboratories.

Participants

Able-bodied men (n=13; mean ± SD, 27.2±4.3y) and men with paraplegia (n=12; 31.1±5.7y). Six of the persons with paraplegia had flaccid paralysis as a result of poliomyelitis infection. The other 6 persons had complete spinal cord injuries with neurologic levels at and below T6.

Intervention

Not applicable.

Main Outcome Measures

Prediction of Vo₂peak by extrapolating submaximal oxygen consumption (V?o₂) and RPE values to RPE 20 on the Borg 6 to 20 RPE scale.

Results

This study showed a very strong linear relationship between RPE and V?o₂ during the GXT and the ramp test for able-bodied persons (R²≥.95 and R²≥.96, respectively) and persons with paraplegia (R²≥.96 and R²≥.95, respectively). There was no significant difference between measured and predicted Vo₂peak from RPEs before and including RPE 13, 15, and 17 during the GXT for persons with paraplegia (P>.05). For the able-bodied participants, there was no significant difference between measured and predicted Vo₂peak from RPEs before and including RPE 15 and 17 during the ramp exercise test (P>.05).

Conclusion

The GXT provided acceptable predictions of Vo₂peak for persons with paraplegia, and the ramp test provided acceptable predictions of Vo₂peak for able-bodied persons.     

A comparison of the physiologic effects of acute whole-body vibration exercise in young and older people

Cochrane DJ, Sartor F, Winwood K, Stannard SR, Narici MV, Rittweger J. A comparison of the physiologic effects of acute whole-body vibration exercise in young and older people.

Objective

To examine the acute physiologic effects of acute whole-body vibration (WBV) exercise in young and older people.

Design

Every participant performed 9 conditions in a static squat position, consisting of no vibration and WBV at 30Hz and 3 loads corresponding to (1) no load (0% body mass), (2) load of 20% body mass, and (3) load of 40% body mass. A Jendrassik voluntary contraction was also performed with no vibration and WBV at 30Hz with no load and 20% body mass.

Setting

Laboratory facilities at a university in the United Kingdom.

Participants

Healthy young people (n=12; 6 men, 6 women; mean age, 21.5y) and 12 healthy older people (6 men, 6 women; mean age, 69.2y) from the local community.

Interventions

Not applicable.

Main Outcome Measures

The Physical Activity Questionnaire, anthropometric measures, counter-movement jump, and isometric maximal voluntary contraction with the Jendrassik maneuver were assessed in both groups. Oxygen uptake (V?o₂), blood pressure, heart rate, and rating of perceived exertion (RPE) were recorded during WBV and load conditions as the outcome of the study.

Results

Both vibration and load were associated with an increase (P<.001) in V?o₂ for older and young groups. WBV elicited the equivalent of a .35 metabolic equivalent (MET) increase in V?o₂, with additional loads of 20% and 40% body mass increasing V?o₂ by 0.8 and 1.2 METs, respectively. Additionally, there was an interaction effect of vibration and group in which the WBV-related V?o₂ increase was less in the old compared with the young. Both vibration and load caused an increase in heart rate, blood pressure, and RPE (all P<.001); however, there were no significant group differences between young and older groups. The Jendrassik maneuver elicited an increase in V?o₂ by 27.6% for the old and 33% for the young group (P<.001); however, there was no significant difference between groups.

Conclusions

V?o₂ significantly increased in both the older and young people with vibration and additional load and when the Jendrassik maneuver was superimposed with vibration and load. However, the elicited increase in V?o₂ (1.2mL·kg⁻¹·min⁻¹) from WBV may be an insufficient stimulus to improve cardiovascular fitness.     

Energy Expenditure in Adults With Cerebral Palsy Playing Wii Sports

Hurkmans HL, van den Berg-Emons RJ, Stam HJ. Energy expenditure in adults with cerebral palsy playing Wii Sports.

Objective

To determine energy expenditure of adults with bilateral spastic cerebral palsy while playing Wii Sports tennis and boxing.

Design

Cross-sectional study.

Setting

University medical center.

Participants

Five men and 3 women with bilateral spastic cerebral palsy and ambulatory ability (Gross Motor Function Classification System level I or II) participated. The mean participant age ± SD was 36±7 years. Exclusion criteria were comorbidities that affected daily physical activity and fitness, contraindications to exercise, or inability to understand study instructions owing to cognitive disorders or language barriers.

Intervention

Participants played Wii Sports tennis and boxing, each for 15 minutes in random order.

Main Outcome Measure

By using a portable gas analyzer, we assessed energy expenditure by oxygen uptake (V?o₂) while sitting and during Wii Sports game play. Energy expenditure is expressed in metabolic equivalents (METs), which were calculated as V?o₂ during Wii Sports play divided by V?o₂ during sitting.

Results

Mean ± SD energy expenditure during Wii Sports game play was 4.5±1.1METs for tennis and 5.0±1.1METs for boxing (P=.024). All participants attained energy expenditures greater than 3METs, and 2 participants attained energy expenditures greater than 6METs while playing Wii Sports tennis or boxing.

Conclusions

Both Wii Sports tennis and boxing seem to provide at least moderate-intensity exercise in adults with bilateral spastic cerebral palsy (GMFCS level I or II). These games, therefore, may be useful as treatment to promote more active and healthful lifestyles in these patients. Further research is needed to determine the energy expenditures of other physically disabled patient groups while playing active video games, and to determine the effectiveness of these games in improving health and daily activity levels.     

Association of Dynamic Joint Power With Functional Limitations in Older Adults With Symptomatic Knee Osteoarthritis

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.     

The Impact of Adaptive Seating Devices on the Lives of Young Children With Cerebral Palsy and Their Families

Ryan SE, Campbell KA, Rigby PJ, Fishbein-Germon B, Hubley D, Chan B. The impact of adaptive seating devices on the lives of young children with cerebral palsy and their families.

Objective

To determine the parent-perceived effect of adaptive seating devices on the lives of young children with cerebral palsy (CP) (aged 2-7y) and their families.

Design

Baseline-intervention-baseline study.

Setting

Homes of participating families.

Participants

Thirty parents and their children with Gross Motor Function Classification System level III or IV CP.

Interventions

Two special-purpose seating devices: 1 for sitting support on the floor or on a chair and the other for postural control on a toilet.

Main Outcome Measures

Family Impact of Assistive Technology Scale (FIATS) and Impact on Family Scale (IFS).

Results

Thirty parents (29 mothers, 1 father) and their children with CP participated. Repeated-measures analysis of variance detected significant mean differences among the FIATS scores (F_1.4,40.6=19.25, P<.001). Post hoc testing confirmed significant mean differences in overall FIATS scores between baseline and intervention and intervention and postintervention phases. The test of within-subject effects did not detect a significant change among IFS mean scores.

Conclusions

The introduction of adaptive seating devices for young children who need support to sit had a meaningful, positive impact on child and family life. Removal of the study devices showed a concomitant negative impact on key aspects of child and family life. Environmental resources, such as seating and other assistive technology devices, may have an important role to play in the lives of young children with physical disabilities and their families.     

Is the Fear Avoidance Model Associated With the Reduced Level of Aerobic Fitness in Patients With Chronic Low Back Pain?

Smeets RJ, van Geel KD, Verbunt JA. Is the fear avoidance model associated with the reduced level of aerobic fitness in patients with chronic low back pain?

Objectives

To compare aerobic fitness of patients with chronic low back pain (CLBP) against healthy controls and to assess whether variables of the fear avoidance model are associated with loss of aerobic fitness.

Design

A case-comparison study.

Setting

Rehabilitation centers.

Participants

Patients with CLBP (n=223), and normative data from healthy subjects (n=18,082).

Interventions

Not applicable.

Main Outcome Measures

Maximal oxygen uptake (V?o₂max) was estimated on the basis of a modified submaximal Åstrand bicycle test performed by patients with CLBP (observed level of aerobic fitness) and compared with the normative data of healthy controls matched for age, sex, and level of sport activity (expected level of aerobic fitness). Pain (visual analog scale); disability (Roland Disability Questionnaire); pain-related fear (Tampa Scale for Kinesiophobia); depression (Beck Depression Inventory); catastrophizing (Pain Catastrophizing Scale); and the level of activity during sport, work/household, and leisure time (Baecke Physical Activity Questionnaire) were assessed. Multiple linear regression analysis was performed with the difference of the observed and expected level of aerobic fitness as dependent variable and putative influential factors including those of the fear avoidance model as independent variables.

Results

V?o₂max could be calculated in 175 (78%) of the patients. Both men and women with CLBP had significant lower V?o₂max than expected (10.3mL/kg lean body mass (LBM)×min⁻¹ and 6.5mL/kg LBM×min⁻¹, respectively; P<.001). The levels of activity during leisure time and work/household were significantly associated with this reduced level of aerobic fitness. However, the variables of the fear avoidance model were not.

Conclusions

Most patients with CLBP-associated disability have a lower level of aerobic fitness, but this is not associated with fear avoidance.     

Can the Six-Minute Walk Test Predict Peak Oxygen Uptake in Men With Heart Transplant?

Doutreleau S, Di Marco P, Talha S, Charloux A, Piquard F, Geny B. Can the six-minute walk test predict peak oxygen uptake in men with heart transplant?

Objective

To determine whether the six-minute walk test (6MWT) might predict peak oxygen consumption (Vo₂peak) after heart transplantation.

Design

Case-control prospective study.

Setting

Public hospital.

Participants

Patients with heart transplant (n=22) and age-matched sedentary male subjects (n=13).

Interventions

Not applicable.

Main Outcome Measures

Exercise performance using a maximal exercise test, distance walked using the 6MWT, heart rate, and Vo₂peak.

Results

Compared with controls, exercise performance was decreased in patients with heart transplant with less distance ambulated (516±13m vs 592±13m; P<.001) and a decrease in mean Vo₂peak (23.3±1.3 vs 29.6±1mL·min⁻¹·kg⁻¹; P<.001). Patients with heart transplant showed an increased resting heart rate, a response delayed both at the onset of exercise and during recovery. However, the patient's heart rate at the end of the 6MWT was similar to that obtained at the ventilatory threshold. The formula did not predict measured V?o₂, with a weak correlation observed between the six-minute walk distance and both Vo₂peak (r=.53; P<.01) and ventilatory threshold (r=.53; P<.01) after heart transplantation. Interestingly, when body weight was considered, correlations coefficient increased to .74 and .77, respectively (P<.001).

Conclusions

In heart transplant recipients, the 6MWT is a safe, practical, and submaximal functional test. The distance-weight product can be used as an alternative method for assessing the functional capacity after heart transplantation but cannot totally replace maximal V?o₂ determination.     

Predicting Exercise Capacity Through Submaximal Fitness Tests in Persons With Multiple Sclerosis

Kuspinar A, Andersen RE, Teng SY, Asano M, Mayo NE. Predicting exercise capacity through submaximal fitness tests in persons with multiple sclerosis.

Objective

To estimate, for persons with multiple sclerosis (MS), the extent to which peak oxygen consumption (Vo₂peak) can be predicted by the results on submaximal tests.

Design

Cross-sectional study.

Setting

Three MS clinics in the Greater Montreal region, Canada.

Participants

A center-stratified random sample of 135 women and 48 men was drawn (N=183). A subgroup of 59 subjects with MS, who were able to perform the step test, was selected from this sample to complete the maximal exercise test.

Interventions

Not applicable.

Main Outcome Measure

Vo₂peak.

Results

In this sample (mean age ± SD, 39 ± 9y; median Expanded Disability Status Scale=1.5), the mean Vo₂peak ± SD was 27.6 ± 7.3mL·kg⁻¹·min⁻¹. This value is considerably low when compared with healthy persons, ranking below the 25th percentile for both men and women. In a multivariate regression analysis, the step test and grip strength were identified as the only significant predictors of Vo₂peak. When combined with body weight, grip strength and the step test explained 74% of the variance in Vo₂peak.

Conclusions

Patients with MS with a mild degree of disability exhibit marked reductions in exercise capacity. Also, in persons with MS, submaximal tests are good predictors of exercise capacity. These measures may be used in clinical settings to help assess and monitor maximum oxygen consumption and in research to evaluate the effect of exercise-related interventions. Furthermore, they will allow people with MS to self-monitor their exercise capacity and be more actively engaged in taking charge of their fitness level.     

Power-assisted wheels ease energy costs and perceptual responses to wheelchair propulsion in persons with shoulder pain and spinal cord injury

Nash MS, Koppens D, van Haaren M, Sherman AL, Lippiatt JP, Lewis JE. Power-assisted wheels ease energy costs and perceptual responses to wheelchair propulsion in persons with shoulder pain and spinal cord injury.

Objective

Test effects of pushrim-activated power-assisted wheelchairs (PAPAWs) on the energetics and perceptual responses to steady-state and intensity-graded wheelchair propulsion in persons with paraplegia and tetraplegia having chronic shoulder pain.

Design

Test, retest with a control condition.

Setting

Academic medical center.

Participants

Subjects (N=18) aged 19 to 70 years with chronic, motor-complete paraplegia and tetraplegia having confirmed shoulder pain.

Interventions

Study participants underwent testing on 4 randomized nonconsecutive days during either 6 minutes of steady-state or 12 minutes of intensity-graded wheelchair propulsion on stationary rollers. Participants used their own manual wheelchair and either their customary wheels or power-assist wheels attached with an axle bracket.

Main Outcome Measures

Oxygen consumption (V?o₂, L/min), distance (m), energy cost (L/m), and ratings of perceived exertion (RPE; Borg Categorical 6-20 Scale) were measured during propulsion.

Results

Significant main effects of testing were observed for V?o₂, heart rate, and RPE in both subject groups. Distances propelled were significantly increased in both groups across both tests and in each of their 2-minute exercise stages.

Conclusions

Use of PAPAWs by persons with paraplegia and tetraplegia having shoulder pain significantly lowers energy cost responses and perceived exertion compared with manual wheelchair propulsion while significantly increasing the distanced propelled.     

Isometric Muscle Function of Knee Extensors and the Relation With Functional Performance in Patients With Stroke

Gerrits KH, Beltman MJ, Koppe PA, Konijnenbelt H, Elich PD, de Haan A, Janssen TW. Isometric muscle function of knee extensors and the relation with functional performance in patients with stroke.

Objective

(1) To examine the isometric strength, speed, and fatigue resistance of the knee extensors of the paretic limb and nonparetic limb in patients with stroke and compare these with able-bodied subjects. (2) To relate the contractile properties with different indices of functional performance.

Design

Case-control study.

Setting

Rehabilitation center research laboratory.

Participants

Eighteen stroke patients and 10 able-bodied controls.

Interventions

Not applicable.

Main Outcome Measures

Maximal voluntary torque (MVT), maximal rate of torque development, time to maximal rate of torque development, half relaxation time (½RT), and fatigue index. Scores on the Functional Ambulation Category scale, Berg Balance Scale, and Rivermead Mobility Index as well as distance walked during the six-minute walk test were obtained.

Results

MVT of the paretic leg was lower than of the nonparetic leg (P<.05), and both limbs had lower MVT than controls (P<.05). Both the paretic and the nonparetic leg showed longer ½RT compared with controls (P<.05). The fatigue index was reduced in the paretic leg (P<.05) but not in the nonparetic leg compared with controls. MVT and fatigue index of the paretic leg were related to indices of functional performance (r=0.49-0.64; P<.05).

Conclusions

Apart from bilateral weakness, knee extensors in patients with stroke showed a lower rate of torque development and relaxation (both paretic and nonparetic leg) and lower fatigue resistance (paretic leg only) than controls, which in part may be a consequence of changes within the muscles. Strength and fatigue resistance relate to functional performance, indicating that these muscle properties should be addressed during rehabilitation. However, future research is needed to elucidate the efficacy of exercise programs.     

The role of order of practice in learning to handle an upper-limb prosthesis

Bouwsema H, van der Sluis CK, Bongers RM. The role of order of practice in learning to handle an upper-limb prosthesis.

Objective

To determine which order of presentation of practice tasks had the highest effect on using an upper-limb prosthetic simulator.

Design

A cohort analytic study.

Setting

University laboratory.

Participants

Healthy, able-bodied participants (N=72) randomly assigned to 1 of 8 groups, each composed of 9 men and 9 women.

Interventions

Participants (n=36) used a myoelectric simulator, and participants (n=36) used a body-powered simulator. On day 1, participants performed 3 tasks in the acquisition phase. On day 2, participants performed a retention test and a transfer test. For each simulator, there were 4 groups of participants: group 1 practiced random and was tested random, group 2 practiced random and was tested blocked, group 3 practiced blocked and was tested random, and group 4 practiced blocked and was tested blocked.

Main Outcome Measures

Initiation time, the time from the starting signal until the beginning of the movement, and movement time, the time from the beginning until the end of the movement.

Results

Movement times got faster during acquisition (P<.001). The blocked group had faster movement times (P=.009), and learning in this group extended over the complete acquisition phase (P<.001). However, this advantage disappeared in the retention and transfer tests. Compared with a myoelectric simulator, movements with the body-powered simulator were faster in acquisition (P=.004) and transfer test (P=.034).

Conclusions

Performance in daily life with a prosthesis is indifferent to the structure in which the training is set up. However, practicing in a blocked fashion leads to faster performance; in novice trainees, it might be suggested to practice part of the training tasks in blocks.     

One-leg cycling versus arm cranking: which is most appropriate for physical conditioning after knee surgery?

Olivier N, Legrand R, Rogez J, Berthoin S, Prieur F, Weissland T. One-leg cycling versus arm cranking: which is most appropriate for physical conditioning after knee surgery?

Objective

To compare the cardiorespiratory responses, blood lactate concentration and perceived exertion between 1-leg cycling and arm cranking.

Design

Comparison of exercise modalities.

Setting

Hospital.

Participants

Fourteen men who had undergone knee surgery were evaluated during rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

Each patient performed 2 maximal graded tests: 1-leg cycling and arm cranking exercise, with a 7-day interval. Respiratory gas exchange, heart rate, blood lactate concentration, and the ratings of perceived exertion (RPE) were measured.

Results

Peak power output, peak minute ventilation, peak oxygen uptake (Vo₂peak), and peak heart rate did not differ significantly between 1-leg cycling and arm cranking. The first and second ventilatory thresholds occurred at above 40% and 72% of Vo₂peak, respectively, in both tests. The maximal lactate concentrations and the RPE values were significantly higher during arm cranking (+10%, +12%, respectively, P<.05) compared with corresponding 1-leg cycling values.

Conclusions

The maximal cardiorespiratory values were not different between arm cranking and 1-leg cycling. However, the RPE and blood lactate concentration were lower when the exercise was performed with the lower limb. Thus 1-leg cycling may be more easily tolerated than arm cranking by patients participating in aerobic conditioning after knee surgery.     

Longitudinal Changes in Physical Capacity Over 20 Years in Athletes With Spinal Cord Injury

Shiba S, Okawa H, Uenishi H, Koike Y, Yamauchi K, Asayama K, Nakamura T, Tajima F. Longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury.

Objective

To investigate the longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury (SCI).

Design

Longitudinal study (20-y follow-up).

Setting

Laboratory setting.

Participants

Persons with SCI (N=7).

Interventions

Not applicable.

Main Outcome Measures

Maximum oxygen consumption V?o₂max) measured in 1986-1988 and in 2006.

Results

Subjects with SCI maintained stable V?o₂max in 2006. Six of the 7 continued various wheelchair sports activities, while 1 person quit sports activities 1 year after the baseline study. The latter person showed reduced V?o₂max by 53%, while 2 persons who continued strenuous wheelchair sports activities showed increased V?o₂max by 43% and 45% after 20 years.

Conclusion

The results indicated that physical capacity reflected the level of sports activity in subjects with SCI who maintained sports activities.     

Predictors of Success for Physiotherapy Treatment in Women With Persistent Postpartum Stress Urinary Incontinence

Dumoulin C, Bourbonnais D, Morin M, Gravel D, Lemieux M-C. Predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence.

Objective

To identify predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence (SUI).

Design

Secondary analysis of data from a single-blind randomized controlled trial comparing 2 physiotherapy intervention programs for persistent SUI in postpartum women.

Setting

Obstetric clinic of a mother and children's university hospital.

Participants

Women, ages 23 to 39 (N=57), were randomized to 1 of 2 pelvic floor muscle (PFM) training programs, 1 with and 1 without abdominal muscle training.

Intervention

Over 8 weeks, participants in each group followed a specific home exercise program once a day, 5 days a week. In addition, participants attended individual weekly physiotherapy sessions throughout the 8-week program.

Main Outcome Measures

Treatment success was defined as a pad weight gain of less than 2g on a 20-minute pad test with standardized bladder volume after 8 weeks' treatment. The relationship between potential predictive PFM function variables as measured by a PFM dynamometer and success of physiotherapy was studied using forward stepwise multivariate logistic regression analyses.

Results

Forty-two women (74%) were classified as treatment successes, and 15 (26%) were not. Treatment success was associated with lower pretreatment PFM passive force and greater PFM endurance pretreatment, but the latter association was barely statistically significant. This model explained between 23% (Cox and Snell R²) and 34% (Nagelkerke R²) of the outcome variability.

Conclusions

The results contribute new information on predictors of success for physiotherapy treatment in women with persistent postpartum SUI.     

Validity of the Fingertip-To-Floor Test and Straight Leg Raising Test in Patients With Acute and Subacute Low Back Pain: A Comparison by Sex and Radicular Pain

Ekedahl KH, Jönsson B, Frobell RB. Validity of the fingertip-to-floor test and straight leg raising test in patients with acute and subacute low back pain: a comparison by sex and radicular pain.

Objective

To use self-reported disability (Roland-Morris Disability Questionnaire [RMDQ]) to assess the criterion validity of straight leg raising (SLR) test and flexion range of motion (ROM) (fingertip-to-floor test) before and after stratification by sex and presence/absence of radicular pain.

Design

Cross-sectional study.

Setting

Outpatient physical therapy clinic.

Participants

Subjects with acute/subacute low back pain with (n=40) and without (n=35) radicular pain.

Interventions

Not applicable.

Main Outcome Measures

We examined the relationship between RMDQ (reference variable) and SLR test and fingertip-to-floor test. The sample was stratified by presence/absence of radicular pain (categorized by the dichotomous slump test).

Results

In the entire sample, fair correlations were found between both physical impairment tests (ie, SLR test and flexion ROM) and self-reported disability (.27<r>.44). After stratification by sex, the correlation between RMDQ and flexion ROM and between RMDQ and nonside-specific SLR test increased in women but decreased in men. In those with radicular pain, good correlations were found between RMDQ and flexion ROM (r=.68 for men and r=.70 for women), and moderate correlation was found between the RMDQ and SLR tests of the affected side in women (r=.60), but only fair correlation was found between the RMDQ and SLR tests of the affected side in men (r=.28).

Conclusions

After stratification by sex and presence/absence of radicular pain, the present study supports a good validity of the fingertip-to-floor test for both men and women with radicular pain. The SLR test, however, was of less value as an indicator of self-reported disability after stratification, especially for men.     

Reduction in Hyoid Bone Forward Movement in Irradiated Nasopharyngeal Carcinoma Patients With Dysphagia

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.     

Effects of Wheelchair Mass on the Physiologic Responses, Perception of Exertion, and Performance During Various Simulated Daily Tasks

Sagawa Y Jr, Watelain E, Lepoutre F-X, Thevenon A. Effects of wheelchair mass on the physiologic responses, perception of exertion, and performance during various simulated daily tasks.

Objective

To verify whether additional manual wheelchair mass above a critical level would produce, during many daily tasks, an increase in physiologic parameters, an increase in the perceived exertion, and a decrease in performance.

Design

A repeated-measurement design.

Setting

Six standardized tests thought to mimic daily activities.

Participants

Volunteers (N=21), 8 men with spinal cord injuries (SCIs; mean age, 34±12y; range, 19-56y) and 13 able-bodied persons (11 men and 2 women; mean, 24±5y; range, 18-37y).

Interventions

Random additional masses (“0”, 1, 2, 5kg) were placed under the seat of a multisport manual wheelchair (mass approximately 10kg) out of the subject's field of vision.

Main Outcome Measures

Energy expenditure (EE; total o₂ consumed), heart rate (total number of beats), perceived exertion (visual analog scale), and performance (seconds to execute a sprint test) were measured.

Results

For all tests, there was no significant effect of mass found for either group for the EE, heart rate, and performance. In addition, for all tests, no significant effect of mass was found for the SCI group for the visual analog perceived exertion. However, for the able-bodied group, the added mass had a significant effect for the visual analog perceived exertion (F=6.11; P=.02) in the Stop-and-Go test. A post hoc Tukey test showed a significant difference between the 0kg and 5kg mass conditions (P<.01; d=.8), between 1kg and 5kg (P=.02; d=.6), and between 2kg and 5kg (P=.01; d=.6).

Conclusions

Based on these findings, it can be concluded that, under the conditions of this study, additional mass (up to 5kg) loaded on a multisport manual wheelchair does not seem have any effect on EE, heart rate, or performance and has a minor effect on the visual analog perceived exertion evaluated in many activities of daily living.     

Pain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education: A Double-Blind Randomized Controlled Trial

Meeus M, Nijs J, Van Oosterwijck J, Van Alsenoy V, Truijen S. Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial.

Objective

To examine whether pain physiology education was capable of changing pain cognitions and pain thresholds in patients with chronic fatigue syndrome (CFS) and chronic widespread pain.

Design

Double-blind randomized controlled trial.

Setting

Specialized chronic fatigue clinic in university hospital.

Participants

A random sample of patients (N=48) with CFS patients (8 men, 40 women) experiencing chronic pain, randomly allocated to the control group (n=24) or experimental group (n=24). Two women in the experimental group did not complete the study because of practical issues (lack of time and restricted mobility).

Interventions

One individual pain physiology education session (experimental) or 1 pacing and self-management education session (control).

Main Outcome Measures

Algometry, the Neurophysiology of Pain Test, and questionnaires evaluating pain cognitions—the Pain Coping Inventory, the Pain Catastrophizing Scale, and the Tampa Scale for Kinesiophobia-version CFS—were completed immediately before and immediately after the intervention.

Results

After the intervention, the experimental group demonstrated a significantly better understanding of the neurophysiology of pain (P<.001) and a reduction of the Pain Catastrophizing Scale subscale “ruminating” (P=.009) compared with controls. For these variables, moderate to large Cohen d effect sizes were revealed (.79-2.53).

Conclusions

A 30-minute educational session on pain physiology imparts a better understanding of pain and brings about less rumination in the short term. Pain physiology education can be an important therapeutic modality in the approach of patients with CFS and chronic pain, given the clinical relevance of inappropriate pain cognitions.     

Exploratory Study on Oxygen Consumption On-kinetics During Treadmill Walking in Women With Systemic Lupus Erythematosus

Keyser RE, Rus V, Mikdashi JA, Handwerger BS. Exploratory study on oxygen consumption on-kinetics during treadmill walking in women with systemic lupus erythematosus.

Objective

To determine whether oxygen consumption (V˙o₂) on-kinetics differed between groups of women with systemic lupus erythematosus (SLE) and sedentary but otherwise healthy controls.

Design

Exploratory case-control study.

Setting

Medical school exercise physiology laboratory.

Participants

Convenience samples of women with SLE (n=12) and sedentary but otherwise healthy controls (n=10).

Intervention

None.

Main Outcome Measures

V˙o₂ on-kinetics indices including time to steady state, rate constant, mean response time (MRT), transition constant, and oxygen deficit measured during bouts of treadmill walking at intensities of 3 and 5 metabolic equivalents (METs).

Results

Time to steady state and oxygen deficit were increased and rate constant was decreased in the women with SLE compared with controls. At the 5-MET energy demand, the transition constant was lower and MRT was longer in the women with SLE than in controls. For a similar relative energy expenditure that was slightly lower than the anaerobic threshold, the transition constant was higher in controls than in women with SLE.

Conclusion

V˙o₂ on-kinetics was prolonged in women with SLE. The prolongation was concomitant with an increase in oxygen deficit and may underlie performance fatigability in women with SLE.