Problem-solving training for family caregivers of persons with traumatic brain injuries: a randomized controlled trial

Rivera PA, Elliott TR, Berry JW, Grant JS. Problem-solving training for family caregivers of persons with traumatic brain injuries: a randomized controlled trial.

Objective

To test the hypothesis that a problem-solving training program would lower depression, health complaints, and burden, and increase well-being reported by community-residing family caregivers of persons with traumatic brain injuries (TBIs).

Design

Randomized controlled trial.

Setting

General community.

Participants

Of the 180 people who expressed interest in the study, 113 did not meet eligibility criteria. A consenting sample of family caregivers were randomized into a problem-solving training group (4 men, 29 women; average age, 51.3y) or an education-only control group (34 women; average age, 50.8y). Care recipients included 26 men and 7 women in the intervention group (average age, 36.5y) and 24 men and 10 women in the control group (average age, 37.2y).

Intervention

Problem-solving training based on the D'Zurilla and Nezu social problem-solving model was provided to caregivers in the intervention group in 4 in-home sessions and 8 telephone follow-up calls over the course of their year-long participation. Control group participants received written educational materials and telephone calls at set intervals throughout their 12 months of participation.

Main Outcome Measures

Caregiver depression, health complaints, well-being, and social problem-solving abilities.

Results

Hierarchical linear models revealed caregivers receiving problem-solving training reported significant decreases in depression, health complaints, and in dysfunctional problem-solving styles over time. No effects were observed on caregiver well-being, burden, or constructive problem-solving styles.

Conclusions

Problem-solving training provided in the home appears to be effective in alleviating distress and in decreasing dysfunctional problem-solving styles among family caregivers of persons with TBI. Methodologic limitations and the implications for interventions and future research are discussed.     

Reproducibility of the ABILOCO Questionnaire and Comparison Between Self-Reported and Observed Locomotion Ability in Adult Patients With Stroke

Caty GD, Theunissen E, Lejeune TM. Reproducibility of the ABILOCO questionnaire and comparison between self-reported and observed locomotion ability in adult patients with stroke.

Objectives

To test the reproducibility of the ABILOCO questionnaire. To validate the patient self-reporting method and the third-party assessment of the stroke patients' locomotion ability by a treating physical therapist.

Design

Prospective study.

Setting

University hospital.

Participants

Adult stroke patients (N=28; 59±13y). The time since stroke ranged from 3 to 253 weeks.

Interventions

Not applicable.

Main Outcome Measure

The ABILOCO questionnaire.

Results

The results of patient self-assessment and the results of the third-party assessments by the physiotherapists at a 2-week interval were highly correlated (intraclass correlation coefficient [ICC]=.77 and ICC=.89, respectively). The results of the patient self-assessment and the third-party assessment by the physical therapist were both well correlated to assessment by an independent medical examiner who observed the patient during the 13 ABILOCO activities (ICC=.69 and ICC=.87, respectively).

Conclusions

The use of ABILOCO as a self-reporting questionnaire is a valid and reproducible method for assessing locomotion ability in patients with stroke in daily clinical practice and research.     

Power Doppler Presentation of Shoulders With Biceps Disorder

Chang K-V, Wu S-H, Lin S-H, Shieh J-Y, Wang T-G, Chen W-S. Power Doppler presentation of shoulders with biceps disorder.

Objectives

To investigate the patterns of power Doppler signals on the long head of the biceps tendon at asymptomatic controls and shoulders with clinically diagnosed biceps disorder.

Design

Cross-sectional study.

Setting

Hospital rehabilitation department.

Participants

Asymptomatic adults (n=27) were included in the control group, and patients with unilateral biceps disorder (n=17) were recruited for the patient group. Basic gray color ultrasound screening was performed for rotator cuff tendons antecedently.

Interventions

Not applicable.

Main Outcome Measures

Three scan views were taken on the anterior shoulder by power Doppler sonography, including the transverse plane of the long head of the biceps tendon, and the longitudinal planes along the lateral and medial edge of the bicipital groove. We compared the patterns and the power Doppler signal area within and between both groups.

Results

In shoulders of healthy controls and the asymptomatic side of patients, the power Doppler signal area of the longitudinal planes along the lateral edge of the bicipital groove was significantly larger than that along the medial edge of the bicipital groove. However, there was no significant difference in the painful side of patients. Moreover, the painful shoulders had a higher prevalence of power Doppler signal medial to the biceps tendon in the transverse plane, which paralleled bicipital peritendinous effusion and rotator cuff abnormalities.

Conclusions

The power Doppler signal was more frequently observed medial to the biceps tendon in shoulders with clinically diagnosed biceps disorder. Whether shoulders with this specific power Doppler signal pattern benefit more from anti-inflammatory therapy needs further exploration.     

ABILOCO: a Rasch-built 13-item questionnaire to assess locomotion ability in stroke patients

Caty GD, Arnould C, Stoquart GG, Thonnard J-L, Lejeune TM. ABILOCO: a Rasch-built 13-item questionnaire to assess locomotion ability in stroke patients.

Objective

To develop a questionnaire (ABILOCO), based on the Rasch measurement model, that can assess locomotion ability in adult stroke patients (International Classification of Functioning, Disability and Health activity domain).

Design

Prospective study and questionnaire development.

Setting

A faculty hospital.

Participants

Adult stroke patients (N=100) (age, 64±15y). The time since stroke ranged from 1 to 260 weeks.

Intervention

A preliminary questionnaire included 43 items representing a large sample of locomotion activities. This questionnaire was tested on the 100 stroke patients, and their responses were analyzed using the Rasch model (RUMM 2020 software) to select items that had an ordered rating scale and fitted a unidimensional model.

Main Outcome Measure

The ABILOCO questionnaire.

Results

The retained items resulted in a 13-item questionnaire, which includes a wide range of locomotion abilities well targeted to the sample population, leading to good reliability (R=.93). The item calibration was independent of age, sex, time since stroke, and affected side. The concurrent validity of ABILOCO was also investigated by comparing it with well-known, criterion standard scales (Functional Walking Category, Functional Ambulation Categories, item 12 of the FIM instrument evaluating walking ability) and the walking speed measured with the 10-meter walk test.

Conclusions

The ABILOCO questionnaire presents good psychometric qualities to measure locomotion ability in adult stroke patients. Its range and measurement precision make it attractive for clinical use throughout the rehabilitation process and for clinical research.     

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.     

Determinants of Skin Problems of the Stump in Lower-Limb Amputees

Meulenbelt HE, Geertzen JH, Jonkman MF, Dijkstra PU. Determinants of skin problems of the stump in lower-limb amputees.

Objective

To identify determinants of skin problems in lower-limb amputees.

Design

Survey, using a questionnaire.

Setting

Not applicable.

Participants

Lower-limb amputees (N=2039) who either obtained their prosthesis through the Orthopedische Instrument Makerij (a group of orthopedic workshops in the Netherlands) or were a member of the (Dutch) National Society of Amputees (Landelijke Vereniging van Geamputeerden) were invited to participate. In total, 872 lower-limb amputees agreed to participate.

Intervention

Amputees filled in the questionnaire to assess characteristics of the amputation and prosthesis, level of activity, stump and prosthesis hygiene, and skin problems. Stepwise backward logistic regression was performed to analyze determinants of skin problems.

Main Outcome Measure

Skin problems in the month prior to completing the questionnaire.

Results

A total of 816 questionnaires were received. Eventually 805 questionnaires were suitable for statistical analysis. Protective determinants were (in order of magnitude of association) older age, male sex, and amputation because of peripheral arterial disease and/or diabetes. Provocative determinants were (in order of magnitude of association) use of antibacterial soap, smoking, and washing the stump 4 times a week or more often. In total, 63% of the participants (95% confidence interval, 60%-67%) reported 1 or more skin problems.

Conclusions

The provocative determinants identified in this study—use of antibacterial soap, smoking, and stump washing frequency—have to be studied for their clinical relevance.     

An investigation into the immediate impact of breathlessness management on the breathless patient: randomised controlled trial

Objective

Physiotherapy breathlessness management is considered to be a major component in the treatment of breathlessness; however, evidence of the efficacy of this practice is lacking. This clinical study aimed to identify the immediate impact of breathlessness intervention on perceived breathlessness.

Design

A pragmatic randomised controlled study.

Setting

Collection of data took place over a 4-month period within an in-patient setting in a National Health Service acute teaching hospital.

Participants

Thirty-one subjects participating in the study were recruited over 3 consecutive days and were randomly allocated to the intervention or control groups.

Intervention

Physiotherapy breathlessness management including pursed lip and diaphragmatic breathing, ‘blow-as-you-go’, positioning and pacing techniques were taught to the individuals in the intervention group on an individual basis during a 45-minute training session.

Main outcome measure

The Borg scale was the primary outcome measure. Measurements were taken before, during and after a stair climbing exercise.

Results

Data were collected from 30 subjects (mean age 75.2 years) with a variety of cardiopulmonary conditions. The results suggested that the intervention group reported a reduction in breathlessness during stair climbing (P = 0.02) and after descending the stairs (P = 0.02) following a session of breathlessness management. No change was observed in the control group.

Conclusion

The findings of the current investigation suggest that individuals with dyspnoea are able to incorporate techniques taught as part of a breathlessness management package of care, and that in the short term, these techniques have a positive effect on the perception of breathlessness. Future studies should look at the long-term benefit of these procedures.     

A distinct pattern of myofascial findings in patients after whiplash injury

Ettlin T, Schuster C, Stoffel R, Brüderlin A, Kischka U. A distinct pattern of myofascial findings in patients after whiplash injury.

Objective

To identify objective clinical examinations for the diagnosis of whiplash syndrome, whereby we focused on trigger points.

Design

A cross-sectional study with 1 measurement point.

Setting

A quiet treatment room in a rehabilitation center.

Participants

Patients (n=124) and healthy subjects (n=24) participated in this study. Among the patient group were patients with whiplash-associated disorders (n=47), fibromyalgia (n=21), nontraumatic chronic cervical syndrome (n=17), and endogenous depression (n=15).

Interventions

Not applicable.

Main Outcome Measure

Each patient and control subject had a manual examination for trigger points of the semispinalis capitis, trapezius pars descendens, levator scapulae, scalenus medius, sternocleidomastoideus, and masseter muscles bilaterally.

Results

Forty (85.1%) of the patients with whiplash had positive trigger points in the semispinalis capitis muscle. The patients with whiplash had a significantly higher prevalence of positive trigger points in the semispinalis capitis muscle than any of the control groups (P<.05). For the other examined muscles, the prevalence of trigger points in the patients with whiplash did not differ significantly from the patients with fibromyalgia or nontraumatic chronic cervical syndrome. It did differ from the patients with endogenous depression and the healthy controls.

Conclusions

Patients with whiplash showed a distinct pattern of trigger point distribution that differed significantly from other patient groups and healthy subjects. The semispinalis capitis muscle was more frequently affected by trigger points in patients with whiplash, whereas other neck and shoulder muscles and the masseter muscle did not differentiate between patients with whiplash and patients with nontraumatic chronic cervical syndrome or fibromyalgia.     

Physiotherapists’ perceptions of clients from culturally diverse backgrounds

Objectives

The aim of this study was to identify the perceptions, attitudes and beliefs of physiotherapists towards clients of non-English-speaking backgrounds.

Design

Qualitative methods of semi-structured interviews and observations were used to conduct an exploratory study.

Setting

Three hospitals in New South Wales, Australia.

Participants

Six physiotherapists from the hospitals were interviewed and other physiotherapists were observed.

Results

Some participants acted towards clients from cultural minorities based on stereotypes, whilst other participants with limited cultural knowledge incorrectly presumed that they were proficient at cross-cultural interactions. Cultural assimilation was favoured by one physiotherapist.

Conclusion

Physiotherapists need to be aware of their own cultural biases, and be willing to undergo a change within themselves to interact effectively and provide quality care to clients from non-English-speaking backgrounds.     

A comparison between self-reported and observed activity limitations in adults with neuromuscular disorders

Vandervelde L, Dispa D, Van den Bergh PY, Thonnard J-L. A comparison between self-reported and observed activity limitations in adults with neuromuscular disorders.

Objective

To investigate the agreement between the self-reported and examiner-reported difficulties of patients with neuromuscular disorders (NMDs) in performing daily activities at home.

Design

A comparison between 2 methods of administering a measurement instrument.

Setting

Neuromuscular reference center in a university hospital.

Participants

Adult patients (N=57) with diagnosed NMDs living at home.

Interventions

Not applicable.

Main Outcome Measure

The ACTIVLIM questionnaire.

Results

The intraclass correlation coefficient, model 2,1 (ICC_2,1), between the measures was very good (ICC_2,1=.87), indicating a good agreement between self-perceived and observed measures.

Conclusions

The use of ACTIVLIM as a self-reporting questionnaire is a valid method for assessing activity limitations in patients with NMD.     

The Effects of 12 Weeks of Resistance Exercise Training on Disease Severity and Autonomic Modulation at Rest and After Acute Leg Resistance Exercise in Women with Fibromyalgia

Kingsley JD, McMillan V, Figueroa A. The effects of 12 weeks of resistance exercise training on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia.

Objective

To determine the effects of 12 weeks of resistance exercise training (RET) on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia (FM) and healthy controls (HCs).

Design

Before-after trial.

Setting

Testing and training occurred in a university setting.

Participants

Women with FM (n=9; mean age ± SD, 42±5y) and HCs (n=15; mean age, 45±5y).

Intervention

Both groups underwent testing before and after 12 weeks of whole-body RET consisting of 3 sets of 8 to 12 repetitions on 5 different exercises.

Main Outcome Measures

Disease severity was assessed using the number of active tender points, myalgic score, and the Fibromyalgia Impact Questionnaire (FIQ). Heart rate and autonomic modulation using power spectral analysis of heart rate variability (HRV) were measured at rest and 20 minutes after 5 sets of leg-press exercise.

Results

There was no group-by-time interaction for any variable. Women with FM and HCs had similar increases in maximal strength (P<.05) after RET. Number of active tender points, myalgic score, and FIQ score were decreased (P<.05) after RET in women with FM. Heart rate and natural log (Ln) high frequency (LnHF) were recovered, whereas Ln low frequency (LnLF) and LnLF/LnHF ratio were increased (P<.05) 20 minutes after acute leg resistance exercise. There were no significant effects of RET on HRV at rest or postexercise.

Conclusions

These findings indicate that cardiovagal modulation of heart rate recovers early after leg resistance exercise in women with FM and HCs. It is concluded that RET reduces the severity of FM, but it has no impact on autonomic modulation of heart rate.     

Updating the Minimal Important Difference for Six-Minute Walk Distance in Patients With Chronic Obstructive Pulmonary Disease

Holland AE, Hill CJ, Rasekaba T, Lee A, Naughton MT, McDonald CF. Updating the minimal important difference for six-minute walk distance in patients with chronic obstructive pulmonary disease.

Objective

To establish the minimal important difference (MID) for the six-minute walk distance (6MWD) in persons with chronic obstructive pulmonary disease (COPD).

Design

Analysis of data from an observational study using distribution- and anchor-based methods to determine the MID in 6MWD.

Setting

Outpatient pulmonary rehabilitation program at 2 teaching hospitals.

Participants

Seventy-five patients with COPD (44 men) in a stable clinical state with mean age 70 years (SD 9y), forced expiratory volume in one second 52% (SD 21%) predicted and baseline walking distance 359 meters (SD 104m).

Interventions

Not applicable.

Main Outcome Measures

Participants completed the six-minute walk test before and after a 7-week pulmonary rehabilitation program. Participants and clinicians completed a global rating of change score while blinded to the change in 6MWD.

Results

The mean change in 6MWD in participants who reported themselves to be unchanged was 17.7 meters, compared with 60.2 meters in those who reported small change and 78.4 meters in those who reported substantial change (P=.004). Anchor-based methods identified an MID of 25 meters (95% confidence interval 20-61m). There was excellent agreement with distribution-based methods (25.5-26.5m, κ=.95). A change in 6MWD of 14% compared with baseline also represented a clinically important effect; this threshold was less sensitive than for absolute change (sensitivity .70 vs .85).

Conclusions

The MID for 6MWD in COPD is 25 meters. Absolute change in 6MWD is a more sensitive indicator than percentage change from baseline. These data support the use of 6MWD as a patient-important outcome in research and clinical practice.     

Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain

Cleland JA, Childs JD, Whitman JM. Psychometric properties of the Neck Disability Index and numeric pain rating scale in patients with mechanical neck pain.

Objective

To examine the psychometric properties including test-retest reliability, construct validity, and minimum levels of detectable and clinically important change for the Neck Disability Index (NDI) and the numeric rating scale (NRS) for pain in a cohort of patients with neck pain.

Design

Single-group repeated-measures design.

Setting

Outpatient physical therapy (PT) clinics.

Participants

Patients (N=137) presenting to PT with a primary report of neck pain.

Interventions

Not applicable.

Main Outcome Measures

All patients completed the NDI and the NRS at the baseline examination and at a follow-up. At the time of the follow-up, all patients also completed the global rating of change, which was used to dichotomize patients as improved or stable. Baseline and follow-up scores were used to determine the test-retest reliability, construct validity, and minimal levels of detectable and clinically important change for both the NDI and NRS.

Results

Test-retest reliability was calculated using an intraclass correlation coefficient (ICC) (NDI ICC=.50; 95% confidence interval [CI], .25-.67; NRS ICC=.76; 95% CI, .51-.87). The area under the curve was .83 (95% CI, .75-.90) for the NDI score and .85 (95% CI, .78-.93) for the NRS score for determining between stable and improved patients. Thresholds for the minimum clinically important difference (MCID) for the NDI were 19-percentage points and 1.3 for the NRS.

Conclusions

Both the NDI and NRS exhibit fair to moderate test-retest reliability in patients with mechanical neck pain. Both instruments also showed adequate responsiveness in this patient population. However, the MCID required to be certain that the change in scores has surpassed a level that could be contributed to measurement error for the NDI was twice that which has previously been reported. Therefore the ongoing analyses of the properties of the NDI in a patient population with neck pain are warranted.     

Validating the six-minute walk test as a measure of recovery after elective colon resection surgery

Moriello C, Mayo NE, Feldman L, Carli F. Validating the six-minute walk test as a measure of recovery after elective colon resection surgery.

Objective

To provide evidence for construct and longitudinal validity of the six-minute walk test (6MWT) as a measure of postsurgical recovery.

Design

Data from a randomized clinical trial.

Setting

A major teaching hospital in a Canadian urban city.

Participants

Patients (N=63) undergoing elective colon resection.

Interventions

Not applicable.

Main Outcome Measures

Functional walking capacity was measured using the 6MWT at before surgery and at 3 and 6 weeks after surgery.

Results

At 3 weeks, 26 (41%) patients recovered to baseline or greater on the 6MWT distance, and 37 (59%) were at baseline or better by 6 weeks postdischarge. At all time points, the 6MWT distance correlated with age, the American Society of Anesthesiologists (ASA) score of surgical risk, albumin, the physical function subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the physical component summary score of the SF-36. Baseline 6MWT distance correlated with postoperative 6MWT recovery, and baseline SF-36 and ASA were associated with postoperative recovery. Patients with intraoperative complications had a clinically relevant lower 6MWT than those without complications at all time points.

Conclusions

This study provides evidence for construct validity and sensitivity to change for the 6MWT as a measure of surgical recovery.     

McNeill Dysphagia Therapy Program: A Case-Control Study

Carnaby-Mann GD, Crary MA. McNeill Dysphagia Therapy Program: a case-control study.

Objective

To compare the effectiveness of the McNeill Dysphagia Therapy Program, a systematic exercise-based rehabilitation framework for swallowing remediation, with traditional swallowing therapy techniques paired with surface electromyography (sEMG) biofeedback.

Design

Matched case-control study.

Setting

University medical center.

Participants

Dysphagic patients referred to an outpatient swallowing therapy service.

Interventions

Cases were individually matched to 2 separate controls for age, sex, and primary medical diagnosis (N=24). Cases were patients with dysphagia who entered the McNeill Dysphagia Therapy Program from September 2006 to October 2008. Controls entered a traditional swallowing therapy program augmented with sEMG biofeedback (traditional therapy with biofeedback group) from February 1994 to June 1999.

Main Outcome Measures

The primary outcome was the proportion of patients who improved clinical swallowing ability and functional oral intake. The secondary outcomes were the presence (or not) of tube feeding, physiologic change on instrumental swallowing studies, and occurrence of aspiration on posttreatment assessment.

Results

Case patients were more likely to demonstrate dysphagia recovery at posttreatment re-evaluation (adjusted odds ratio for dysphagia recovery=13.0 [95% CI, 1.27-63.89]; Mantel-Haenszel χ²=6.7; P=.009; relative risk reduction=.69). Dysphagia was reduced by 69% in the McNeill Dysphagia Therapy Program treatment group compared with the traditional therapy with biofeedback group.

Conclusions

Both approaches facilitated improved swallowing function. The McNeill Dysphagia Therapy Program resulted in superior outcomes compared with traditional dysphagia therapy supplemented with sEMG biofeedback.     

Self-referral, access and physiotherapy: patients’ knowledge and attitudes—results of a national trial

Objectives

To identify service users’ views and attitudes to access, physiotherapy and patient-autonomous health-seeking behaviours.

Study design

Mixed qualitative and quantitative questionnaire.

Setting

Twenty-six locations representing a range of socio-economic and geographical settings throughout Scotland.

Participants

Three thousand and ten patients over 16 years of age.

Methods

Postal questionnaires containing a mix of open and closed questions, attitude statements and free text for comments were sent to all consenting patients 4 weeks after discharge from physiotherapy. Responses were analysed by referral group: self-referred patients; patients referred by their general practitioner (GP); and patients referred at the suggestion of their GP.

Results

A response rate of 72% (2177/3010) was achieved. Males, females and all age groups were represented. Strong support for the effectiveness of physiotherapy was reported by all groups (>90%). Despite more than 80% of respondents claiming that they were able to confidently predict when they needed physiotherapy, less than 23% reported being knowledgeable or very knowledgeable about physiotherapy, with no significant association between level of knowledge and referral group (P = 0.129). Self-referred patients were more satisfied (P < 0.001), more supportive of being able to self-refer (83% vs 69% of GP-referred patients and 71% of patients referred at the suggestion of their GP), and more supportive of physiotherapists making decisions about their fitness for work or activities (59% vs 53% of GP-referred patients and 53% of patients referred at the suggestion of their GP).

Conclusions

Physiotherapy was regarded positively by all referral groups, particularly by self-referred patients, despite there being a distinct lack of knowledge about the profession. There is a clear need to raise awareness and knowledge of physiotherapy if autonomous health-seeking behaviours are to be encouraged and self-referral schemes progressed appropriately.