Effects of neuromuscular electrical stimulation on torque and performance in recreational distance runners: A randomized controlled trial

IntroductionNeuromuscular electrical stimulation (NMES) is used by athletes to improve muscle performance. However, evidence on the use of NMES in long distance runners is scarce. As such, this study aimed to evaluate the effects of NMES on the muscle torque and sports performance of long-distance recreational runners.MethodsThis was a blinded randomized controlled trial. Data from 30 volunteers were analyzed. Participants were randomly allocated to an experimental (n = 15) or control group (n = 15). The experimental group was submitted to running training (RT) and a strengthening protocol with NMES (1 kHz, modulated in 2 ms bursts, 50 Hz modulated burst frequency and 10% duty cycle, 15 min totaling 18 contractions per sessions) for 6 weeks, with 3 sessions per week, while controls were submitted to RT alone. The following variables were analyzed: peak isometric (ISO), concentric (CON), and eccentric (ECC) torque of the quadriceps muscle in voluntary contractions, ventilatory anaerobic thresholds (VATs), maximal oxygen uptake (VO2max), and oxygen cost of transport (OCT).ResultsThe NMES group obtained higher values of ISO, 21.04% (p = 0.001), CON, 21.97% (p = 0.001) and ECC, 18.74% (p = 0.001) peak torque and VAT1, 9.56% (p = 0.001), as well as a statistically significant improvement in oxygen cost of transport at VAT1 when compared to controls (p = 0.001).ConclusionNMES was effective in improving peak isometric, concentric and eccentric quadriceps muscle torque, in addition to being an interesting resource for enhancing sports performance in long-distance recreational runners and future clinical trials should be performed to compare the use of NMES to different forms of training over longer training periods.     

Efficacy of the Pilates versus general exercises versus educational workshops on neuromuscular parameters: A randomized controlled trial

IntroductionMuscle strength, flexibility and changes in muscle recruitment patterns are usually associated to low back pain (LBP). Physical exercises can reverse the adverse changes associated to LBP.ObjectivesCompare Pilates, general exercises and educational workshop on muscle flexibility, strength and recruitment of the trunk extensor muscles in women with LBP.MethodsForty-six women were randomly divided into Pilates group (PG, n = 16), general exercise group (GEG, n = 15), and educational group (EG, n = 15). This study sought to determine flexibility, muscle strength, and muscle recruitment of right (RIL), left (LIL) iliocostalis lumbar; right (RMU) and left (LMU) lumbar multifidus muscles. Both PG and GEG performed 16 exercise sessions, while EG attended 4 workshops. Statistical analysis used data sample from Shapiro-Wilk test, Pearson's correlation, multivariate analysis, mixed variance analysis, and Cohen's index.ResultsFlexibility showed no differences (p > 0.05). Muscle strength increased in the intragroup analysis for PG (p = 0.003) and GEG (p = 0.002); however, the intergroup analysis presented no difference. Intergroup showed statistically significant differences for the recruitment of RMU in PG (p < 0.001). Intragroup analysis presented differences after interventions in PG for RIL (p = 0.001); in GEG for LIL (p = 0.005); and in EG for RIL (p = 0.007), LIL (p = 0.002) and RMU (p < 0.001).ConclusionsNone of the groups showed flexibility improvements. PG and GEG increased muscle strength through intragroup analysis. Intergroup analysis showed an increase in recruitment of the RMU muscle in PG and all groups demonstrated significant improvements in the intragroup analysis.     

Efficacy of ketamine for initial control of acute agitation in the emergency department: A randomized study

BackgroundClinicians often encounter agitated patients, and current treatment options include benzodiazepines and antipsychotics. Ketamine rapidly induces dissociation, maintains cardiovascular stability, spontaneous respirations, and airway reflexes. There are no prospective, randomized studies comparing ketamine to other agents in the initial management of acute agitation in the Emergency Department (ED).ObjectiveDetermine the efficacy and safety of ketamine compared to parenteral haloperidol plus lorazepam for initial control of acute agitation.MethodsThis study was a prospective, single-institution, randomized, open-label, real world, standard of care pilot study. Adult patients with combative agitation were randomized to ketamine (4 mg/kg IM or 1 mg/kg IV) or haloperidol/lorazepam (haloperidol 5–10 mg IM or IV + lorazepam 1–2 mg IM or IV). The primary outcome was sedation within 5 min, and secondary outcomes included sedation within 15 min, time to sedation, and safety.ResultsNinety three patients were enrolled from January 15, 2018 to October 10, 2018. Significantly more patients who received ketamine compared to haloperidol/lorazepam were sedated within 5 min (22% vs 0%, p = 0.001) and 15 min (66% vs 7%, p < 0.001). The median time to sedation in patients who received ketamine compared to haloperidol/lorazepam was 15 vs 36 min respectively (p < 0.001). Patients who received ketamine experienced a significant, but transient tachycardia (p = 0.01) and hypertension (p = 0.01).ConclusionIn patients with combative agitation, ketamine was significantly more effective than haloperidol/lorazepam for initial control of acute agitation, and was not associated with any significant adverse effects.     

Evaluating the relationship between quadriceps muscle quality captured using ultrasound with clinical severity in women with knee osteoarthritis

BackgroundInfiltration of muscle with non-lean tissue, such as fat, reduces muscle quality. Ultrasound captures muscle quality through measurement of echogenicity. Given the potential implications of quadriceps muscle quality on physical function, particularly in knee osteoarthritis, the purpose of this study was to investigate the relationship between echogenicity, muscle thickness and subcutaneous fat thickness with the clinical severity of osteoarthritis.MethodsThirty-one women with clinical knee osteoarthritis participated. Rectus femoris and vastus lateralis echogenicity, muscle thickness and subcutaneous fat thickness were measured from ultrasound images of the most symptomatic knee. Clinical severity of osteoarthritis was characterized with pain, self-reported function, six-minute walk test, and knee extensor strength. Correlation coefficients were calculated between muscle and fat architecture outcomes (muscle quality, muscle and fat thicknesses) and osteoarthritis clinical severity outcomes.FindingsData from 25 women were of sufficient quality for analysis. Echogenicity (muscle quality) related to the six-minute walk test for both rectus femoris (r = −0.52, p = 0.02) and vastus lateralis (r = −0.74, p = 0.004), with poorer muscle quality related to lower mobility. Subcutaneous fat thickness was related to the six-minute walk test (rectus femoris, r = −0.61, p = 0.0012; vastus lateralis, r = −0.73, p = 0.003) and strength (rectus femoris, r = −0.46, p = 0.02; vastus lateralis, r = −0.59, p = 0.03). Muscle thickness was not related to any severity outcomes.InterpretationMuscle quality, rather than thickness, is associated with mobility performance in women with knee osteoarthritis. Thus, interventions for osteoarthritis that specifically target muscle quality, rather than size, should be explored.     

A comparison of the effects of different stretching methods on flexibility,muscle activity,and pain threshold in ballet dancers; a preliminary randomized controlled trial

BackgroundThe purpose of this study is to compare the effects of stretching methods on flexibility, muscle activation, and pressure pain threshold in ballet dancers, and to suggest an effective stretching method.MethodsThirty-three ballet dancers were randomized to the static stretching group (n = 11), muscle energy technique stretching group (n = 11), and vibration-assisted stretching group (n = 11). The angle of hip joint extension in arabesque, activation of the rectus femoris in devéloppé, and pressure pain threshold on the rectus femoris in the sitting position were measured to compare the effects of the different stretching methods. Paired t-test was used to compare the pre and post-intervention findings within each group and one-way analysis of variance to compare the difference in the amount of changes among the groups.ResultsThe hip joint extension angles increased in all stretching methods (p < 0.05); however, vibration-assisted stretching and muscle energy technique stretching were more effective than static stretching (p < 0.05). The activation of the rectus femoris decreased in all groups (p < 0.05); however the muscle energy technique stretching group and vibration-assisted stretching group showed a significant decrease in muscle activation compared with the static stretching group (p < 0.05). The pressure pain threshold significantly improved only in the static stretching group (p < 0.05); and vibration-assisted stretching group (p < 0.05).ConclusionsCompared with static stretching and muscle energy technique stretching, vibration-assisted stretching is a beneficial method for improving flexibility, muscle activation, and pressure pain threshold in ballet dancers.     

A comparison between whole-body vibration and conventional training on pain and performance in athletes with patellofemoral pain

IntroductionPatellofemoral pain (PFP) is the most common cause of anterior knee pain in athletes, which affects their performance especially during single leg activities. The aim of this study was to compare the effects of whole-body vibration training (WBVT) and conventional training (CT) on pain and performance in athletes with PFP.Methods30 athletes with unilateral PFP were randomly assigned to the WBVT (6 women, 9 men) or CT (7 women, 8 men) group. All participants received training for 4 weeks in 12 sessions. The outcomes of pain and performance were measured at three points in time: baseline, immediately after training and 2 weeks after training. Pain was assessed with the Numeric Pain Rating Scale (NPRS). Performance was measured with the leg-press test and the Kujala Patellofemoral Score (KPS).ResultsIn both groups, pain intensity decreased significantly (p < 0.001) and the KPS and number of leg presses increased significantly (p < 0.001) with time. There was no significant difference between groups for changes in the pain score (p = 0.896), KPS (p = 0.463) or leg press (p = 0.796) results.ConclusionWhole-body vibration training had the same effect as exercise therapy on pain reduction and on improvements in performance in athletes with PFP.     

The effect of foam rollers of varying densities on range of motion recovery

ObjectiveThis study aimed to compare the effect of different density foam rollers on range of motion recovery.MethodTen active men completed two, 3-day trials in random order. During the experimental trials, all participants performed 2 min of foam rolling (FR) using a medium-density (medium trial) or hard-density (hard trial) foam roller on the right posterior thigh after completing the 90-min Loughborough Intermittent Shuttle Test (LIST). The hip joint range of motion (ROM), muscle hardness, and muscle soreness were assessed before and after the LIST and at 0 min, 20 min, 60 min, 24 h, and 48 h after FR intervention. Serum creatine kinase (CK) concentrations were assessed before the LIST and at 60 min, 24 h, and 48 h after FR intervention. The contralateral leg in each trial was used as a control.ResultsThe ROM at 0 min, 20 min, 60 min, 24 h, and 48 h after FR intervention were higher in the right leg (the massage leg) than in the left leg (the contralateral leg) (p < 0.05). In the right leg, the ROM at 0 min after FR intervention was higher than after the LIST (p < 0.05). There were no significant differences between the medium and hard trials for ROM. Muscle hardness, muscle soreness, and serum CK concentration were not affected by FR.ConclusionFR has a positive effect on ROM recovery. Moreover, the two roller densities provided similar ROM recovery.     

Reliability of Processing 3-D Freehand Ultrasound Data to Define Muscle Volume and Echo-intensity in Pediatric Lower Limb Muscles with Typical Development or with Spasticity

This investigation assessed the processer reliability of estimating muscle volume and echo-intensity of the rectus femoris, tibialis anterior and semitendinosus. The muscles of 10 typically developing children (8.15 [1.40] y) and 15 children with spastic cerebral palsy (7.67 [3.80] y; Gross Motor Function Classification System I = 5, II = 5, III = 5) were scanned with 3-D freehand ultrasonography. For the intra-processer analysis, the intra-class correlations coefficients (ICCs) for muscle volume ranged from 0.943–0.997, with relative standard errors of measurement (SEM%) ranging from 1.24%–8.97%. For the inter-processer analysis, these values were 0.853 to 0.988 and 3.47% to 14.02%, respectively. Echo-intensity had ICCs >0.947 and relative SEMs <4% for both analyses. Muscle volume and echo-intensity can be reliably extracted for the rectus femoris, semitendinosus and tibialis anterior in typically developing children and children with cerebral palsy. The need for a single processer to analyze all data is dependent on the size of the expected changes or differences.     

Effects of an elastic resistance band exercise program on kinetics and muscle activities during walking in young adults with genu valgus: A double-blinded randomized controlled trial

BackgroundThis double-blinded randomized-controlled-trial aimed to identify the effects of an elastic band resistance training on walking kinetics and muscle activities in young adults with genu valgus.MethodsForty-two male young adults aged 22.5(2.7) years with genu valgus were randomly allocated to two experimental groups. The intervention group (n = 21) conducted a 14-weeks elastic band resistance training. The control group was passive during the intervention period and received the same treatment after the post-tests. Pre and post training, ground reaction forces and lower limb muscle activities were recorded during walking.FindingsResults revealed significant group-by-time interactions for peak medial ground reaction force and time-to-peak for posterior ground reaction force in favor of the intervention group (p < 0.012; d = 0.83–3.76). Resistance training with elastic bands resulted in significantly larger peak medial ground reaction force (p < 0.001; d = 1.45) and longer time-to-peak for posterior ground reaction force (p < 0.001; d = 1.85). Finding showed significant group-by-time interactions for peak positive free moment amplitudes in favor of the intervention group (p < 0.001; d = 1.18–2.02). Resistance training resulted in a lower peak positive free moment amplitude (p = 0.001; d = 1.46). With regards to muscle activities, the analysis revealed significant group-by-time interactions for rectus femoris and gluteus medius activities during the push-off phase in favor of the intervention group (p < 0.038; d = 0.68–0.89). Resistance training induced higher rectus femoris (p = 0.038; d = 0.84) and gluteus medius (p = 0.007; d = 0.54) activities.InterpretationThis study proved the effectiveness of resistance training using elastic bands on kinetics and muscle activities during walking in male adults with genu valgus disorder. Given that this training regime is low cost, effective, and easy-to-administer, we suggest that it should be implemented as a rehabilitative or preventive means for young adults with genu valgus.     

Muscle Ultrasound Changes Correlate With Functional Impairment in Spinal Muscular Atrophy

ObjectiveWe investigated ultrasound patterns of muscle involvement in different types of spinal muscular atrophy (SMA) and their correlation with functional status to determine the pattern of muscle compromise in patients with SMA and the potential role of ultrasound to evaluate disease progression.MethodsWe examined muscles (biceps brachii, rectus femoris, diaphragm, intercostals and thoracic multifidus) of 41 patients with SMA (types 1 to 4) and 46 healthy age- and sex-matched control individuals using B-mode ultrasound for gray-scale analysis (GSA), area (biceps brachii and rectus femoris) and diaphragm thickening ratio. Functional scales were applied to patients only. We analyzed ultrasound abnormalities in specific clinical subtypes and correlated findings with functional status.ResultsCompared with controls, patients had reduced muscle area and increased mean GSA for all muscles (p < 0.001), with an established correlation between the increase in GSA and the severity of SMA for biceps brachii, rectus femoris and intercostals (p = 0.03, 0.01 and 0.004 respectively) when using the Hammersmith Functional Motor Scale Expanded. Diaphragm thickening ratio was normal in the majority of patients, and intercostal muscles had higher GSA than diaphragm in relation to the controls.ConclusionUltrasound is useful for quantifying muscular changes in SMA and correlates with functional status. Diaphragm thickening ratio can be normal even with severe compromise of respiratory muscles in quantitative analysis, and intercostal muscles were more affected than diaphragm.     

Analgesic efficacy of the serratus anterior plane block in rib fractures pain: A randomized controlled trial

BackgroundSerratus anterior plane block (SAPB) was evaluated that in patients with the complaint of rib fracture pain in terms of total analgesic consumption and pain scores.MethodSixty patients with rib fracture and NRS (Numeric Rating Scala) pain scores equal or greater than four were included in randomized controlled study. Patients were randomized to perform SAPB or control group. Primary outcome was total tramadol consumption in 24 h. Secondary outcomes were NRS scores (after Patient Controlled Analgesia (PCA) application 30 min, first, second, 4 th, 6 th, 12 th, 24 th hour), peripheral oxygen saturation (first and 24 th hour after PCA application), chronic pain. and complications.ResultsThe total tramadol consumption significantly lower in group S (p = 0.02). NRS scores after 30 min, 1 h, 2 h, 4 h, 6 h, 12 h, and 24 h were significantly lower in group S than in group C (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.002, p = 0.026). The total number of patients who reported of chronic pain at rest and during effort was significantly lower in group SAPB than in group C (p = 0.006). Nine patients in group C were reported of pain, four of whom had pain at rest and five had pain during effort. One patient in group S was reported of pain during effort.ConclusionThis study demonstrated that SAPB, as part of multimodal analgesia in pain management due to rib fractures, is safe and effective in reducing acute pain.     

Muscle activities of the rectus abdominis and rectus femoris and their ratio during leg raises performed by healthy adults

[Purpose] The purpose of this study was to analyze muscle activation during hip flexion in the supine position to examine the activation characteristics of the rectus abdominis and rectus femoris. [Subjects] The subjects of this study were 20 healthy adults (10 males and 10 females). [Methods] Muscle activities of the rectus abdominis and rectus femoris while raising the leg from 0°–60° were measured in 15-degree divisions and their ratio was calculated. [Results] Statistically significant differences were found in the muscle activities of the rectus femoris and rectus abdominis were found among each division of during hip flexion in the supine position. The rectus abdominis and rectus femoris ratios increased as the angle of hip flexion increased. [Conclusion] During hip flexion from 0°–45° in the supine position, femur motion caused hip flexion. At angles greater than or equal to 45° hip flexion was accompanied by pelvic motion.Key words: Hip flexion, Leg raise, Muscle activities     

Comparative analysis of core muscle activation according to the use of props and the different knee angle during the modified Pilates Hundred

BackgroundThere are not so many Pilates studies related to muscle activation. Since the effectiveness and efficiency of the Pilates Hundred to muscle activation has recently emerged, it is necessary to investigate the effects of the Pilates Hundred on core muscles.ObjectivesThe purpose of this study was to determine what difference occurs in the muscle activity, during the Pilates Hundred, to suggest the optimal props for muscle function improvement and then to provide data for the efficient exercise program.MethodsTwenty-eight men in their twenties who were able to fully conduct Pilates Hundred. According to the difference between the small tool application (no prop: NP, soft ball mini: SB, Pilates ring: PR) and the knee joint angle (90° and 180°), muscle activations of rectus abdominis (RA), external oblique (EO), rectus femoris (RF), lateral muscle (vastus lateralis: VL), medial muscle (vastus medialis: VM), biceps femoris (BF), and semitendinosus (ST) were measured by the using surface electromyography (EMG) while different exercise conditions.ResultsDuring Pilates Hundred, the use of tools was found to be more effective in activating the core muscle (NP < SB < PR). During Pilates Hundred, 180° of knee angle had more influence on core muscle activation than 90°, and knee angle and props use showed an interaction for activating core muscles.ConclusionThe Pilates Hundred with PR and 180° knee angle intervention can increase core muscle activation, and this leads to effective Pilates exercise program for those who need to enhance core muscle volume and function and to rehabilitate core muscles.     

Reliability and discriminative validity of real-time ultrasound elastography in the assessment of tissue stiffness after calf muscle injury

ObjectiveTo investigate the reliability and discriminative validity of real-time ultrasound elastography (RTE) measures of soft-tissue elasticity after calf muscle tear.DesignCross-sectional, intra/inter-examiner reliability and comparative validity study.SettingDepartment of Physical Therapy.ParticipantsTwenty-one recreational athletes were included and examined 6 weeks after sustaining a grade I-II calf musculature tear.Main outcome measuresSoft-tissue elasticity was measured by two experienced assessors using RTE assessments in both the longitudinal and transverse planes of the athletes’ injured and uninjured calf muscles. Elasticity was estimated by using the strain ratio (SR), which was calculated by dividing the strain (displacement) value taken at the medial gastrocnemius-soleus myotendinous junction (reference) by the strain value taken at the centre of the injury (index) as visualized on B-mode sonogram. Intra- and inter-observer reliability was estimated calculating intra-class correlation coefficients (ICCs) and standard error of measurement (SEM). Differences in elasticity between injured and healthy legs were assessed using t-tests or Wilcoxon tests for repeated measures.ResultsAll RTE assessments in both planes showed ICC values ranging from 0.77 to 0.95 and SEM values ranging from 0.72 to 0.99. Additionally, RTE enabled both assessors to determine differences in elastic properties between injured and control legs (p < 0.001).ConclusionRTE measures of calf muscles demonstrated good reliability and were able to differentiate injured from non-injured muscle tissue. RTE may provide a fast and objective measure in sports medicine to improve the detection of risk factors for muscle injury related to alterations of the mechanical behaviour of soft tissues during healing process.     

Assessment of neuromuscular electrical stimulation effect on contralateral quadriceps muscle

BackgroundIn the field of rehabilitation, the acute application of neuromuscular electrical stimulation (NMES) causes not only peripheral muscle contraction but also involve the central nervous system by the transient increase in spinal motor neuron and cortical activity. Therefore it has been used in several fields of rehabilitation. Previous studies used surface electromyography to assess this effect. But we conducted our study to assess the effect of NMES on contralateral quadriceps muscle in normal individuals using another method needle electromyography.MethodsA study carried out on 20 normal males, who were subjected to (i) NMES Training Program for 60 min for the right quadriceps muscle. (ii) Assessment of EMG activity for rectus femoris muscle (RF) on the contralateral side. An assessment was done for minimal volition and maximal volition or interference pattern analysis, this assessment was done twice: before the start of NMES and during the session.ResultsEMG of voluntary activity (Minimal volition) and Maximum voluntary activity analysis for RF muscles showed increased duration (in millisecond), amplitude (in millivolt) (P < 0.01), increased activity in turn per second, amplitude/turn (M) (uV) compared to the result before NMES application.ConclusionOur study provides a new evident date that the acute NMES application to the contralateral quadriceps muscles, leads to significant facilitation of the maximal voluntary power in the ipsilateral muscles through activation of efferent neural control. This facilitating effect of motor neurons in the contralateral muscles is likely due to the complex combination interaction between spinal and supraspinal control.Trial registrationTrial registration: PACTR202010887172053.     

Quantifying muscle fatigue during walking in people with multiple sclerosis

BackgroundThis study aimed to examine muscle fatigue in lower leg muscles in of people with multiple sclerosis and healthy controls, and whether muscle fatigue coincided with potential changes in gait.MethodsIn this case-control study, people with multiple sclerosis (n = 8; 3male; mean age (SD) = 49.7 (9.6) yr) and age-matched healthy controls (n = 10; 4male; mean age (SD) = 47.4 (8.7) yr) walked on a treadmill for 12-min at self-paced speed. Muscle fatigue was indirectly quantified by a decrease in median frequency and increase in root mean square of surface electromyographic recordings of lower leg muscles. Walking speed, ankle push-off power and net ankle work were calculated from marker positions and force plate data using inverse dynamic calculations.ResultsPeople with multiple sclerosis showed larger decreases in median frequency of soleus (most affected leg: p = 0.003; least affected leg: p = 0.009) and larger increases in root mean square of soleus (most and least affected leg: p = 0.037), gastrocnemius medialis (most affected leg: p = 0.003; least affected leg: p = 0.005) and lateralis (most and least affected leg: p < 0.001) compared to controls. Walking speed (p = 0.001), ankle push-off power (most affected leg: p = 0.018; least affected leg: p = 0.001) and net work around the ankle (most affected leg: p = 0.046; least affected leg: p = 0.001) were lower in people with multiple sclerosis compared to controls, but increased in both groups.InterpretationThe results yield preliminary evidence that soleus muscles of people with multiple sclerosis fatigue during prolonged walking. Changes in electromyography of gastrocnemius muscles could however be related to muscle fatigue, changes in gait or a combination.     

Interrelationships among workload,illness severity,and function on return to work following acute respiratory distress syndrome

BackgroundInability to return to work (RTW) is common after acute respiratory distress syndrome (ARDS).ObjectivesThe aim of this study is to examine interrelationships among pre-ARDS workload, illness severity, and post-ARDS cognitive, psychological, interpersonal, and physical function with RTW at 6 and 12 months after ARDS.MethodsWe conducted a secondary analysis using the US multicentre ARDS Network Long-Term Outcomes Study. The US Occupational Information Network was used to determine pre-ARDS workload. The Mini-Mental State Examination and SF-36 were used to measure four domains of post-ARDS function. Analyses used structural equation modeling and mediation analyses.ResultsAmong 329 previously employed ARDS survivors, 6- and 12-month RTW rates were 52% and 56%, respectively. Illness severity (standardised coefficients range: ?0.51 to ?0.54, p < 0.001) had a negative effect on RTW at 6 months, whereas function at 6 months (psychological [0.42, p < 0.001], interpersonal [0.40, p < 0.001], and physical [0.43, p < 0.001]) had a positive effect. Working at 6 months (0.79 to 0.72, P < 0.001) had a positive effect on RTW at 12 months, whereas illness severity (?0.32 to ?0.33, p = 0.001) and post-ARDS function (psychological [6 months: 0.44, p < 0.001; 12 months: 0.33, p = 0.002], interpersonal [0.44, p < 0.001; 0.22, p = 0.03], and physical abilities [0.47, p < 0.001; 0.33, p = 0.007]) only had an indirect effect on RTW at 12 months mediated through work at 6 months.ConclusionsRTW at 12 months was associated with patients' illness severity; post-ARDS cognitive, psychological, interpersonal, and physical function; and working at 6 months. Among these factors, working at 6 months and function may be modifiable mediators of 12-month post-ARDS RTW. Improving ARDS survivors' RTW may include optimisation of workload after RTW, along with interventions across the healthcare spectrum to improve patients’ physical, psychological, and interpersonal function.     

Hip abduction with ankle dorsiflexion (HAAD) score and trunk seating control within 72 h after stroke predicts long-term disability: A cohort study

BackgroundThe aim of this study was to determine whether muscle strength of the lower limb and trunk during the acute phase after stroke are predictors of motor function and disability 90 days after hospital discharge.MethodsThis prospective study used a nonconcurrent design to evaluate stroke patients at two time points: a) first 72 h: hip abduction and ankle dorsiflexion (HAAD) score, trunk sitting control, clinical evaluation, demographic profile, and stroke severity using the National Institutes of Health Stroke Scale (NIHSS); b) 90 days after hospital discharge: modified Rankin scale (mRS). The participants were divided into two groups: good outcome (mRS 0–2) and worse outcome (mRS>2), and the differences between them were assessed statistically. Clinical and demographic variables were included in the multiple logistic regression analysis. The ROC curve was used to illustrate the clinical sensitivity and specificity of the HAAD score cutoff for the outcomes.ResultsThirty-seven patients were included: 16 with mRS≤2 and 21 with mRS>2. Patients in the worse outcome group were older (p = 0.02) and presented with higher NIHSS scores (p = 0.002), lower HAAD scores (p < 0.001), higher pain sensation (p = 0.04), greater altered perception (p = 0.008), and no trunk control in the sitting position (p = 0.004). A lower HAAD score (OR = 0.09; 95%CI: 0.14–0.53; p < 0.001) and the absence of trunk control in the sitting position (OR = 0.55; 95%CI:0.54–0.95; p < 0.001) were associated with unsatisfactory outcomes.ConclusionA HAAD score <6 and the absence of trunk control while sitting during the first 72 h are predictors of worse long-term disability in stroke patients.     

Reliability of Muscle Quantity and Quality Measured With Extended-Field-of-View Ultrasound at Nine Body Sites

ObjectiveMeasuring muscle quantity and quality is very important because the loss of muscle quantity and quality is associated with several adverse effects specifically in older people. Ultrasound is a method widely used to measure muscle quantity and quality. One problem with ultrasound is its limited field of view, which makes it impossible to measure the muscle quantity and quality of certain muscles. In this study, we aimed to evaluate the intra- and inter-rater reliability of extended-field-of-view (EFOV) ultrasound for the measurement of muscle quantity and quality in nine muscles of the limbs and trunk.MethodsTwo examiners took two ultrasound EFOV images with a linear probe from each of the muscle sites. The intraclass correlation coefficient (ICC) was used, and the standard error of measurement and coefficient of variation were calculated.ResultsIntra-rater reliability was good to excellent (ICC = 0.2–1.00) for all muscle measurements. The inter-rater reliability for most of the muscle measurements was good to excellent (ICC = 0.82–0.98). Inter-rater reliability was moderate (0.58–0.72) for some muscle quantity measurements of the tibialis anterior, gastrocnemius, rectus femoris, biceps femoris and triceps brachii muscles.ConclusionMuscle quantity and quality can be measured reliably using EFOV US.