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.     

Effects of Motor Imagery on Hand Function During Immobilization After Flexor Tendon Repair

Stenekes MW, Geertzen JH, Nicolai J-P, De Jong BM, Mulder T. Effects of motor imagery on hand function during immobilization after flexor tendon repair.

Objective

To determine whether motor imagery during the immobilization period after flexor tendon injury results in a faster recovery of central mechanisms of hand function.

Design

Randomized controlled trial.

Setting

Tertiary referral hospital.

Participants

Patients (N=28) after surgical flexor tendon repair were assigned to either an intervention group or a control group.

Intervention

Kinesthetic motor imagery of finger flexion movements during the postoperative dynamic splinting period.

Main Outcome Measures

The central aspects of hand function were measured with a preparation time test of finger flexion in which subjects pressed buttons as fast as possible following a visual stimulus. Additionally, the following hand function modalities were recorded: Michigan Hand Questionnaire, visual analog scale for hand function, kinematic analysis of drawing, active total motion, and strength.

Results

After the immobilization period, the motor imagery group demonstrated significantly less increase of preparation time than the control group (P=.024). There was no significant influence of motor imagery on the other tested hand function (P>.05). All tests except kinematic analysis (P=.570) showed a significant improvement across time after the splinting period (P≤.001).

Conclusions

Motor imagery significantly improves central aspects of hand function, namely movement preparation time, while other modalities of hand function appear to be unaffected.     

Physiotherapy After Volar Plating of Wrist Fractures Is Effective Using a Home Exercise Program

Krischak GD, Krasteva A, Schneider F, Gulkin D, Gebhard F, Kramer M. Physiotherapy after volar plating of wrist fractures is effective using a home exercise program.

Objective

To determine the effect of 2 different postoperative therapy approaches after operative stabilization of the wrist fractures: treatment by a physical therapist with 12 sessions and an unassisted home exercise program.

Design

Randomized controlled cohort study.

Setting

Hospital-based care, primary center of orthopedic surgery.

Participants

Volunteers (N=48) with fractures of the distal radius after internal fixation with locking plates. There were 46 patients available for follow-up after exclusion of 2 participants due to physiotherapy sessions in excess of the study protocol.

Interventions

Not applicable.

Main Outcome Measures

Evaluation of grip strength using a Jamar dynamometer, range of motion (ROM), and Patient Related Wrist Evaluation (PRWE).

Results

After a 6-week period of postoperative treatment, the patients (n=23) performing an independent home exercise program using a training diary showed a significantly greater improvement of the functionality of the wrist. Grip strength reached 54% (P=.003), and ROM in extension and flexion 79% (P<.001) of the uninjured side. Ulnar and radial abduction was also higher in this group. In contrast, patients who were treated by a physical therapist achieved grip strength equal to 32%, and ROM in extension and flexion of 52% of the uninjured side. Patients who were performing the home training after operation recorded an improved wrist function with a nearly 50% lower value (P<.001) in the PRWE score.

Conclusions

In the postoperative rehabilitation of wrist fractures, instructions in a home exercise program are an effective alternative to prescribed physical therapy treatment.     

The effect of a lightweight massage system in a car seat on comfort and electromyogram

Objective

The objective of this study was to determine the effect of a lightweight low-intensity massage system (LWMAS) in a car seat on the electromyogram (EMG) of the neck and shoulder muscles and on the comfort experience during driving.

Methods

Two experiments were performed during driving with and without the active LWMAS in the seat. Subjective measurements were taken, in which the comfort experience was recorded for 20 participants driving a prescribed path around Munich for 120 minutes. Then objective (surface EMG above the rhomboideus and trapezius muscles) measurements and subjective measurements of the comfort experience were recorded over 7 laps on a test track for 24 participants.

Results

The comfort was higher, and the EMG was significantly lower in the trapezius area while driving with the LWMAS.

Conclusion

Despite the fact that the LWMAS system is lightweight, has low intensity, and might have had a smaller effect, similar effects to previous studies with heavier systems were found, indicating that this massage system increases comfort and reduces muscle activity during driving as well.     

Effect of Intrathecal Baclofen Bolus Injection on Lower Extremity Joint Range of Motion During Gait in Patients With Acquired Brain Injury

Horn TS, Yablon SA, Chow JW, Lee JE, Stokic DS. Effect of intrathecal baclofen bolus injection on lower extremity joint range of motion during gait in patients with acquired brain injury.

Objectives

To evaluate lower extremity joint range of motion (ROM) during gait before and after intrathecal baclofen (ITB) bolus administration, and to explore the relation between changes in ROM and concurrent changes in gait speed and muscle hypertonia.

Design

Case series.

Setting

Tertiary care rehabilitation center.

Participants

Adults (N=28) with muscle hypertonia due to stroke, trauma, or anoxia.

Interventions

50-μg ITB bolus injection via lumbar puncture (75 and 100μg in 2 cases).

Main Outcome Measures

Ashworth score, self-selected gait speed, and sagittal plane ROMs in hip, knee, and ankle joints before and 2, 4, and 6 hours after ITB bolus.

Results

A significant decrease in the mean Ashworth score on the more involved side (2.0 to 1.3) and an increase in gait speed (41 to 47cm/s) were noted at different intervals after ITB bolus injection. Ankle ROM significantly increased on the more involved (13° to 15°, P<.01) and less involved (22° to 24°, P<.05) sides. ROM significantly improved, significantly worsened, or showed no significant change in 42%, 34%, and 24% of individual joints, respectively. The peak change in ROM did not coincide with the peak decrease in Ashworth score. Peak changes in ROM and speed coincided more often (P<.001) in participants who increased gait speed after ITB bolus compared with those who decreased speed. The absolute change in ROM after ITB bolus injection correlated better with the concurrent changes in speed (r=.41, P<.001) than with the baseline speed (r=.18, P<.05).

Conclusions

ITB bolus injection produces variable changes in joint ROM during gait, with significant improvements in the ankles only. Timing and magnitude of peak changes in ROM are associated with concurrent changes in speed but not muscle hypertonia.     

Functional Overloading of Dystrophic Mice Enhances Muscle-Derived Stem Cell Contribution to Muscle Contractile Capacity

Ambrosio F, Ferrari RJ, Fitzgerald GK, Carvell G, Boninger ML, Huard J. Functional overloading of dystrophic mice enhances muscle-derived stem cell contribution to muscle contractile capacity. Arch Phys Med Rehabil

Objectives

To evaluate the effect of functional overloading on the transplantation of muscle derived stem cells (MDSCs) into dystrophic muscle and the ability of transplanted cells to increase dystrophic muscle's ability to resist overloading-induced weakness.

Design

Cross-sectional.

Setting

Laboratory.

Animals

Male mice (N=10) with a dystrophin gene mutation.

Interventions

MDSCs were intramuscularly transplanted into the extensor digitorum longus muscle (EDL). Functional overloading of the EDL was performed by surgical ablation of the EDL's synergist.

Main Outcome Measures

The total number of dystrophin-positive fibers/cross-section (as a measure of stem cell engraftment), the average number of CD31+ cells (as a measure of capillarity), and in vitro EDL contractile strength. Independent t tests were used to investigate the effect of overloading on engraftment, capillarity, and strength. Paired t tests were used to investigate the effect of MDSC engraftment on strength and capillarity.

Results

MDSC transplantation protects dystrophic muscles against overloading-induced weakness (specific twitch force: control 4.5N/cm²±2.3; MDSC treated 7.9N/cm²±1.4) (P=.02). This improved force production following overloading is concomitant with an increased regeneration by transplanted MDSCs (MDSC: 26.6±20.2 dystrophin-positive fibers/cross-section; overloading + MDSC: 170.6±130.9 dystrophin-positive fibers/cross-section [P=.03]). Overloading-induced increases in skeletal muscle capillarity is significantly correlated with increased MDSC engraftment (R²=.80, P=.01).

Conclusions

These findings suggest that the functional contribution of transplanted MDSCs may rely on activity-dependent mechanisms, possibly mediated by skeletal muscle vascularity. Rehabilitation modalities may play an important role in the development of stem cell transplantation strategies for the treatment of muscular dystrophy.     

Effects of concurrent strength and endurance training on physical fitness and symptoms in postmenopausal women with fibromyalgia: a randomized controlled trial

Valkeinen H, Alén M, Häkkinen A, Hannonen P, Kukkonen-Harjula K, Häkkinen K. Effects of concurrent strength and endurance training on physical fitness and symptoms in postmenopausal women with fibromyalgia: a randomized controlled trial.

Objective

To examine the effectiveness of concurrent strength and endurance training on muscle strength, aerobic and functional performance, and symptoms in postmenopausal women with fibromyalgia (FM).

Design

Randomized controlled trial.

Setting

Local gym and university research laboratory.

Participants

Twenty-six women with FM.

Intervention

Progressive and supervised 21-week concurrent strength and endurance training.

Main Outcome Measures

Muscle strength of leg extensors, upper extremities, and trunk; peak oxygen uptake (Vo₂peak), maximal workload (Wmax), and work time; 10-m walking and 10-step stair-climbing time and self-reported functional capacity (Health Assessment Questionnaire); and symptoms of FM.

Results

After concurrent strength and endurance training, the groups differed significantly in Wmax (P=.001), work time (P=.001), concentric leg extension force (P=.043), walking (P=.001) and stair-climbing (P<.001) time, and fatigue (P=.038). The training led to an increase of 10% (P=.004) in Wmax and 13% (P=.004) in work time on the bicycle but no change in Vo₂peak.

Conclusions

Concurrent strength and endurance training in low to moderate volume improves the muscle strength of leg extensors, Wmax, work time, and functional performance as well as perceived symptoms, fatigue in particular. Concurrent strength and endurance training is beneficial to postmenopausal women with FM without adversities, but more extensive studies are needed to confirm the results.     

Efficacy of a short multidisciplinary falls prevention program for elderly persons with osteoporosis and a fall history: a randomized controlled trial

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.     

Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy

Monga U, Garber SL, Thornby J, Vallbona C, Kerrigan AJ, Monga TN, Zimmermann KP. Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy.

Objective

To show fatigue prevention and quality of life (QOL) improvement from cardiovascular exercise during radiotherapy.

Design

Prospective enrollment (n=21), randomized to exercise (n=11) and control groups (n=10), with pre- and post-radiotherapy between- and within-group comparisons.

Setting

Academic medical center.

Participants

Localized prostate cancer patients undergoing radiotherapy.

Interventions

The interventional group received radiotherapy plus aerobic exercise 3 times a week for 8 weeks whereas the control group received radiotherapy without exercise.

Main Outcome Measures

Pre- and post-radiotherapy differences in cardiac fitness, fatigue, depression, functional status, physical, social, and functional well-being, leg strength, and flexibility were examined within and between 2 groups.

Results

No significant differences existed between 2 groups at pre-radiotherapy assessment. At post-radiotherapy assessment, the exercise group showed significant within group improvements in: cardiac fitness (P<.001), fatigue (P=.02), Functional Assessment of Cancer Therapy-Prostate (FACT-P) (P=.04), physical well-being (P=.002), social well-being (P=.02), flexibility (P=.006), and leg strength (P=.000). Within the control group, there was a significant increase in fatigue score (P=.004) and a decline in social well-being (P<.05) at post-radiotherapy assessment. Between-group differences at post-radiotherapy assessment were significant in cardiac fitness (P=.006), strength (P=.000), flexibility (P<.01), fatigue (P<.001), FACT-P (P=.006), physical well-being (P<.001), social well-being (P=.002), and functional well-being (P=.04).

Conclusions

An 8-week cardiovascular exercise program in patients with localized prostate cancer undergoing radiotherapy improved cardiovascular fitness, flexibility, muscle strength, and overall QOL and prevented fatigue.     

Reliability of the assessment of lumbar range of motion and maximal isometric strength in patients with chronic low back pain

Roussel NA, Truijen S, De Kerf I, Lambeets D, Nijs J, Stassijns G. Reliability of the assessment of lumbar range of motion and maximal isometric strength in patients with chronic low back pain.

Objective

To examine the interobserver reliability of the assessment of lumbar range of motion (ROM) and maximal isometric strength in patients with chronic low back pain (CLBP) using commercially available equipment.

Design

A prospective repeated-measures design.

Setting

Ambulatory care in a university hospital.

Participants

Twelve patients (5 men, 7 women; age range, 20−52y) with CLBP, with a mean visual analog scale score of 31.5±25.8mm, volunteered for the study. The duration of their symptoms was 63±115 months and the mean Oswestry Disability Index score was 31%.

Interventions

Not applicable.

Main Outcome Measures

Movements of the lumbar spine were assessed with commercially available equipment. Both the range of motion (ROM) and the maximal isometric strength for flexion, extension, lateroflexion, and rotation of the lumbar spine were evaluated twice to analyze the interobserver reliability. The same test procedure was performed on 2 separate days by 2 investigators who were blinded to the outcome of the assessment of their colleague. The order of investigator was balanced, so that each investigator tested the same number of patients as first investigator.

Results

The intraclass correlation coefficient varied between .91 and .98 for the measurements of the lumbar ROM and was between .93 and .97 for all the strength measurements. Post hoc power analysis confirmed previous power analysis, that is, despite the small sample size, an excellent power was found for the observed interobserver reliability coefficients (power range, 0.93−1.00). No learning effect was found when comparing the results of the second measurement with the first measurement (P>.05).

Conclusions

The interobserver reliability is excellent for the measurement of the ROM of the lumbar spine and for the maximal isometric strength using specific devices in patients with CLBP.     

Pain-Related Fear Contributes to Self-Reported Disability in Patients With Foot and Ankle Pathology

Lentz TA, Sutton Z, Greenberg S, Bishop MD. Pain-related fear contributes to self-reported disability in patients with foot and ankle pathology.

Objective

To determine the unique influence of pain-related fear of movement on foot and ankle disability, after accounting for pain, demographic, and physical impairment variables.

Design

Cross-sectional study using retrospective chart review.

Setting

Outpatient rehabilitation clinic.

Participants

Referred sample of subjects with foot- and ankle-related disability (N=85, 40 men; mean age, 33y; range, 16-77y).

Interventions

Not applicable.

Main Outcome Measures

Lower Extremity Functional Scale (LEFS), Shortened Tampa Scale of Kinesiophobia (TSK-11).

Results

Hierarchical regression analysis determined the proportions of explained variance in disability (LEFS). Demographic variables were entered into the model first, followed by pain intensity and range-of-motion (ROM) deficit, and finally, TSK-11. Demographics collectively contributed 9% (P=.015) of the variance in disability scores. Pain intensity and overall ROM deficit contributed an additional 11% (P<.001) of the variance, and TSK-11 scores contributed an additional 14% (P<.001). In the overall model, age (β=−.29, P=.004), chronicity of symptoms (β=.23, P=.024), ROM deficit (β=−.28, P=.003), and TSK-11 (β=−.41, P<.001) explained 34% of the variance in the LEFS score (P<.001).

Conclusions

Age, chronicity of symptoms, ROM deficit, and TSK-11 scores all significantly contributed to baseline foot and ankle self-reported disability. Pain-related fear of movement was the strongest single contributor to disability in this group of patients.     

Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial

Bürge E, Kupper D, Finckh A, Ryerson S, Schnider A, Leemann B. Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial.

Objective

To quantify the preventive effect of a neutral functional realignment orthosis on pain, mobility, and edema of the hand in subacute hemiparetic poststroke patients with severe motor deficits.

Design

Randomized trial.

Setting

Rehabilitation center.

Participants

Poststroke patients (N=30) with subacute hemiparesis and severe deficits of the upper limb were enrolled. Fifteen patients were randomized to a standard rehabilitation program without orthosis and 15 patients received an experimental orthosis in addition to their standard rehabilitation program.

Intervention

The orthosis group wore the neutral functional realignment orthosis for at least 6 hours daily.

Main Outcome Measures

Hand pain at rest (visual analog scale), wrist range of motion (Fugl-Meyer Assessment subscale), and edema of hand and wrist (circumferences). Outcome measures were assessed at time of randomization and after 13 weeks between groups.

Results

At baseline, 2 patients in each group complained about a painful hand. After 13 weeks, 8 subjects in the control group and 1 subject in the orthosis group complained of hand pain (P=.004). Mobility and edema evolved similarly in both groups.

Conclusions

Neutral functional realignment orthoses have a preventive effect on poststroke hand pain, but not on mobility and edema in the subacute phase of recovery.     

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.     

Disability in patients with degenerative lumbar spinal stenosis

Lin S-I, Lin R-M, Huang L-W. Disability in patients with degenerative lumbar spinal stenosis.

Objective

To determine factors associated with disability in patients with degenerative lumbar spinal stenosis.

Design

One-group cross-sectional study.

Setting

University hospital.

Participants

One hundred eight patients with degenerative lumbar spinal stenosis.

Interventions

Not applicable.

Main Outcome Measures

Oswestry Disability Index and 4 categories of factors, including patient demographics (age, sex, number of comorbidities, medications), symptom-related factors (intensity, location, onset duration, neurogenic claudication), body structure and function as described in the International Classification of Functioning, Disability and Health model (muscle strength, vibration sense, spine flexibility), and stenotic condition (type and number of spinal segments involved).

Results

Patients with symptoms in both back and leg reported greater disability than those with symptoms only in the leg or back (P=.008). Greater disability correlated significantly with greater symptom intensity (r=.385, P<.001) and higher vibration threshold (r=.236, P=.014). While controlling the variance in patient demographics in the regression analysis, vibration sense and symptom location each added 10% of the variance in disability, and symptom intensity and strength each added 5%, with a total of 44% variance explained (P=.044).

Conclusions

Symptom intensity and location, vibration sense, and muscle strength were identified as significant factors and, together with patient demographics, accounted for 44% of the variance explained in disability. Further investigations are needed to determine if causal relationships exist between these factors and disability.     

Effect of Pulmonary Rehabilitation on Balance in Persons With Chronic Obstructive Pulmonary Disease

Beauchamp MK, O'Hoski S, Goldstein RS, Brooks D. Effect of pulmonary rehabilitation on balance in persons with chronic obstructive pulmonary disease.

Objectives

To describe within-subject effects of pulmonary rehabilitation (PR) on balance in persons with chronic obstructive pulmonary disease (COPD) and to determine whether any observed changes in balance were associated with change in exercise tolerance or health-related quality of life.

Design

Single-arm longitudinal study.

Setting

Inpatient PR center.

Participants

Subjects with COPD (N=29; mean ± SD age, 69.8±10.3y; forced expiratory volume in 1 second, 46.3%±22.3% predicted; 59% men [n=17]).

Interventions

A standardized 6-week multidisciplinary PR program (exercise training, breathing exercises, education, and psychologic support).

Main Outcome Measures

Balance was assessed using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and the Activities-Specific Balance Confidence (ABC) scale. Exercise tolerance was determined from the 6-minute walk test (6MWT), and health-related quality of life from the Chronic Respiratory Questionnaire (CRQ).

Results

Subjects showed small improvements in BBS (2.8±2.8 points; P<.001) and TUG (−1.5±2.4s; P=.003) scores, but not in ABC scores (4.8±15.4 points; P>.05). There was a weak relationship between change in BBS and change in CRQ scores (r=.40; P=.045) and no relationship with change in 6MWT.

Conclusions

PR contributed to minor improvements in balance and had no effect on balance confidence in subjects with COPD. Further work is warranted to determine the optimal intervention for improving balance in this population.     

Comparison of Trunk Proprioception Between Patients With Low Back Pain and Healthy Controls

Lee AS, Cholewicki J, Reeves NP, Zazulak BT, Mysliwiec LW. Comparison of trunk proprioception between patients with low back pain and healthy controls.

Objective

To determine whether proprioceptive impairments exist in patients with low back pain (LBP). We hypothesized that patients with LBP would exhibit larger trunk proprioception errors than healthy controls.

Design

Case-control study.

Setting

University laboratory.

Participants

24 patients with nonspecific LBP and 24 age-matched healthy controls.

Interventions

Not applicable.

Main Outcome Measures

We measured trunk proprioception in all 3 anatomical planes using motion perception threshold, active repositioning, and passive repositioning tests.

Results

LBP patients had significantly greater motion perception threshold than controls (P<.001) (1.3±0.9° vs 0.8±0.6°). Furthermore, all subjects had the largest motion perception threshold in the transverse plane (P<.001) (1.2±0.7° vs 1.0±0.8° for all other planes averaged). There was no significant difference between LBP and healthy control groups in the repositioning tasks. Errors in the active repositioning test were significantly smaller than in the passive repositioning test (P=.032) (1.9±1.2° vs 2.3±1.4°).

Conclusions

These findings suggest that impairments in proprioception may be detected in patients with LBP when assessed with a motion perception threshold measure.     

Effect of Hamstring Flexibility on Hip and Lumbar Spine Joint Excursions During Forward-Reaching Tasks in Participants With and Without Low Back Pain

Johnson EN, Thomas JS. Effect of hamstring flexibility on hip and lumbar spine joint excursions during forward-reaching tasks in participants with and without low back pain.

Objective

To examine the correlation between hamstring flexibility and hip and lumbar spine joint excursions during standardized reaching and forward-bending tasks.

Design

Retrospective analysis of data obtained during 2 previous prospective studies that examined kinematics and kinetics during forward-reaching tasks in participants with and without low back pain (LBP).

Setting

The 2 previous studies were conducted in the Motor Control Lab at Ohio University and the Orthopaedic Ergonomics Laboratory at The Ohio State University.

Participants

Data from a total of 122 subjects from 2 previous studies: study 1: 86 subjects recovered from an episode of acute LBP (recovered) and study 2 (A.I. McCallum, unpublished data): 18 chronic LBP subjects and 18 healthy-matched controls (healthy).

Interventions

Not applicable.

Main Outcome Measure

Correlation values between hamstring flexibility as measured by straight leg raise (SLR) and amount of hip and lumbar spine joint excursions used during standardized reaching and forward-bending tasks.

Results

No significant correlation was found between hamstring flexibility and hip and lumbar joint excursions during forward-bending tasks in the LBP or recovered groups. The SLR had a significant negative correlation with lumbar spine excursions during reaching tasks to a low target in the healthy group (right SLR: P=.011, left SLR: P=.004).

Conclusions

Hamstring flexibility is not strongly related to the amount of lumbar flexion used to perform forward-reaching tasks in participants who have chronic LBP or who have recovered from LBP. More research needs to be conducted to examine the influence of hamstring flexibility on observed movement patterns to further evaluate the efficacy of flexibility training in the rehabilitation of patients with LBP.     

Factor Structure and Predictive Validity of Somatic and Nonsomatic Symptoms From the Patient Health Questionnaire-9: A Longitudinal Study After Spinal Cord Injury

Krause JS, Reed KS, McArdle JJ. Factor structure and predictive validity of somatic and nonsomatic symptoms from the Patient Health Questionnaire-9: a longitudinal study after spinal cord injury.

Objective

To investigate the factor structure and predictive validity of somatic and nonsomatic depressive symptoms over the first 2.5 years after spinal cord injury (SCI) using the Patient Health Questionnaire-9 (PHQ-9).

Design

Somatic and nonsomatic symptoms were assessed at baseline during inpatient hospitalization (average of 50 days after onset) and during 2 follow-ups (average of 498 and 874 days after onset).

Setting

Data were collected at a specialty hospital in the Southeastern United States and analyzed at a medical university. We performed time-lag regression between inpatient baseline and follow-up somatic and nonsomatic latent factors of the PHQ-9.

Participants

Adults with traumatic SCI (N=584) entered the study during inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measure

PHQ-9, a 9-item measure of depressive symptoms.

Results

The inpatient baseline nonsomatic latent factor was significantly predictive of the nonsomatic (r=.40; P=.000) and somatic latent factors at the second follow-up (r=.29; P=.006), whereas the somatic factor at inpatient baseline did not significantly predict either factor. In contrast, when regressing latent factors between the 2 follow-ups, the nonsomatic factor predicted only the nonsomatic factor (r=.66; P=.002), and the somatic factor predicted only future somatic symptoms (r=.66; P=.000). In addition, the factor structure was not stable over time. Item analysis verified the instability of somatic items between inpatient baseline and follow-up and also indicated that self-harm at inpatient baseline was highly predictive of future self-harm.

Conclusions

Nonsomatic symptoms are better predictors of future depressive symptoms when first assessed during inpatient rehabilitation, whereas somatic symptoms become stable predictors only after inpatient rehabilitation. Self-harm (suicidal ideation) is the most stable symptom over time. Clinicians should routinely assess for suicidal ideation and use nonsomatic symptoms when performing assessments during inpatient rehabilitation.     

Weight Lifting in Patients With Lower-Extremity Lymphedema Secondary to Cancer: A Pilot and Feasibility Study

Katz E, Dugan NL, Cohn JC, Chu C, Smith RG, Schmitz KH. Weight lifting in patients with lower-extremity lymphedema secondary to cancer: a pilot and feasibility study.

Objective

To assess the feasibility of recruiting and retaining cancer survivors with lower-limb lymphedema into an exercise intervention study. To develop preliminary estimates regarding the safety and efficacy of this intervention. We hypothesized that progressive weight training would not exacerbate leg swelling and that the intervention would improve functional mobility and quality of life.

Design

Before-after pilot study with a duration of 5 months.

Setting

University of Pennsylvania.

Participants

Cancer survivors with a known diagnosis of lower-limb lymphedema (N=10) were directly referred by University of Pennsylvania clinicians. All 10 participants completed the study.

Intervention

Twice weekly slowly progressive weight lifting, supervised for 2 months, unsupervised for 3 months.

Main Outcome Measures

The primary outcome was interlimb volume differences as measured by optoelectronic perometry. Additional outcome measures included safety (adverse events), muscle strength, objective physical function, and quality of life.

Results

Interlimb volume differences were 44.4% and 45.3% at baseline and 5 months, respectively (pre-post comparison, P=.70). There were 2 unexpected incident cases of cellulitis within the first 2 months. Both resolved with oral antibiotics and complete decongestive therapy by 5 months. Bench and leg press strength increased by 47% and 27% over 5 months (P=.001 and P=.07, respectively). Distance walked in 6 minutes increased by 7% in 5 months (P=.01). No improvement was noted in self-reported quality of life.

Conclusions

Recruitment of patients with lower-limb-lymphedema into an exercise program is feasible. Despite some indications that the intervention may be safe (eg, a lack of clinically significant interlimb volume increases over 5mo), the unexpected finding of 2 cellulitic infections among the 10 participants suggests additional study is required before concluding that patients with lower-extremity lymphedema can safely perform weight lifting.