Predictors of disrupted social participation in myotonic dystrophy type 1

Gagnon C, Mathieu J, Jean S, Laberge L, Perron M, Veillette S, Richer L, Noreau L. Predictors of disrupted social participation in myotonic dystrophy type 1.

Objective

To identify personal and environmental predictors of the most disrupted participation domains in people with myotonic dystrophy type 1 (DM1).

Design

Cross-sectional study.

Setting

Outpatient neuromuscular clinic.

Participants

Adults (n=200; 121 women), age 18 years or older (mean age, 47y), with a confirmed diagnosis of DM1 were selected from the registry of a neuromuscular clinic (N=416). Fifty-two participants had the mild phenotype and 148 the adult phenotype.

Interventions

Not applicable.

Main Outcome Measures

Social participation in mobility, housing, employment, and recreation was assessed with the Life Habits Measure. Disrupted participation was based on whether help was needed in performing most life habits because of incapacities or environmental barriers. Environmental factors were assessed by using the Measure of the Quality of the Environment. Personal factors were assessed with standardized instruments including the Berg Balance Scale, the Krupp Fatigue Severity Scale, and manual muscle testing.

Results

A large proportion of participants (45%-61%) reported disrupted participation in all 4 domains. Lower-extremity strength (odd ratios [OR], 15.0-5.5; P<.050) and higher fatigue (OR, 6.0-2.6; P<.05) were present in participants with disrupted participation. With regard to environmental factors, family support (OR, 3.6-2.5; P<.05) and public services (OR, 2.8-2.2; P<.05) were perceived as barriers for participants with disrupted participation in most domains.

Conclusions

This study identified personal and environmental factors that may influence the trajectory toward disrupted participation in individuals with DM1. Fatigue, strength, family support, and public services were found to be independent predictors of disrupted participation.     

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.     

Evaluation of an innovative methodology to recruit research participants with spinal cord injury through durable medical equipment suppliers

Krahn G, McCarthy M, Westwood D, Powers L. Evaluation of an innovative methodology to recruit research participants with spinal cord injury through durable medical equipment suppliers.

Objective

To evaluate the effectiveness, strengths, and limitations of an innovative research method to recruit persons with spinal cord injury (SCI).

Design

A pilot study for feasibility.

Setting

Community-based durable medical equipment suppliers (DMESs) in the states of Oregon, Washington, and New York.

Participants

Three DMESs participated and successfully distributed surveys to 591 customers with International Classification of Disease, 9th Revision, codes reflecting SCI. Of these, 316 people completed surveys, with 270 identifying SCI among their disabling conditions.

Interventions

Not applicable.

Main Outcome Measures

The effort required to solicit recruitment assistance from DMESs, survey response rate, verification of SCI by self-report, and comparability of sample demographics to those of other SCI research samples from both the United States and other countries.

Results

A moderate level of effort was required to solicit recruitment assistance from DMESs. The survey had a 53% response rate, and 85% of respondents verified that they had an SCI by self-report. Sample demographics were generally similar to those of comparable research samples but with more single and unemployed persons responding and with longer duration of SCI.

Conclusions

This method of recruitment has the potential to address limitations of other recruitment methods but presents its own challenges with implementation. Potential sampling bias is discussed.     

Normalizing lower-extremity strength data for children without disability using allometric scaling

Wren TA, Engsberg JR. Normalizing lower-extremity strength data for children without disability using allometric scaling.

Objectives

To evaluate existing approaches for normalizing lower-extremity strength data and to develop normalization equations using allometric scaling in children without disabilities.

Design

Cross-sectional study evaluating traditional mass normalization and allometry as methods of adjusting lower-extremity muscle torques for the influence of body mass.

Setting

Motion analysis laboratory.

Participants

Thirty-nine children without disability (age range, 4−17y).

Interventions

Not applicable.

Main Outcome Measures

Maximum torque generated during hip abduction and adduction, knee extension and flexion, and ankle dorsiflexion and plantarflexion.

Results

Linear regressions of torque/mass^1.0 versus body mass and age produced slopes that differed significantly from zero (P<.001) for all muscle groups except the ankle plantarflexors versus body mass (P=.28). Regressions for torque/body mass index also produced slopes that differed significantly from zero (P<.001). Regressions of torque/(mass × height) produced slopes that differed from zero in some cases but not others. Allometric scaling exponents (exponent b) differed significantly from the theoretical value of 1.0 for all muscle groups except the ankle plantarflexors (1.32; 95% confidence interval, 0.98−1.67). Linear regressions performed using torque/mass^b produced slopes that did not differ significantly from zero for all muscle groups (P≥.10). Regressions performed using torque/mass^1.6 for the hip and knee and torque/mass^1.4 for the ankle also produced slopes that did not differ significantly from zero.

Conclusions

Traditional mass normalization does not effectively adjust for the influence of body mass. Allometric scaling performed using torque/mass^1.6 for the hip and knee or torque/mass^1.4 for the ankle provides more appropriate normalization.     

Physical Activity Measurement Using MTI (Actigraph) Among Children With Cerebral Palsy

Capio CM, Sit CH, Abernethy B. Physical activity measurement using MTI (Actigraph) among children with cerebral palsy.

Objective

To investigate the validity of MTI accelerometer as a physical activity (PA) measurement instrument for children with cerebral palsy (CP).

Design

Participants were classified within Gross Motor Function Classification System I to III and took part in 2 activity sessions: (1) a structured activity protocol with increasing intensities and (2) a free play session. Concurrent measurements of activity counts, heart rate, and observed physical activity were performed.

Setting

Data were collected on normal school days in special schools within the participants' 30-minute break period.

Participants

Convenience sample of children with CP (N=31; 17 girls, 14 boys) age between 6 and 14 years (mean ± SD, 9.71±2.52y).

Interventions

Not applicable.

Main Outcome Measures

MTI measured activity counts, a monitoring device measured heart rate, and the System for Observing Fitness Instruction Time (SOFIT) was used for direct PA observation.

Results

There were strong relationships between MTI and SOFIT (r=.75; R²=.56; P<.001) and heart rate monitor (HRM) and SOFIT (r=.65; R²=.43; P<.001) data in structured activities, but the difference between these 2 correlation coefficients was not significant (P=.46). In free play activities, the association between MTI and SOFIT data (r=.67; R²=.45; P<.001) was significantly stronger (P=.01) than that between heart rate and SOFIT data (r=.14; R²=.02; P<.001) . Bland-Altman plots showed better agreement between observed SOFIT and MTI-predicted SOFIT data than observed SOFIT and HRM-predicted SOFIT data from the linear regression analysis.

Conclusions

The findings suggest that the MTI appears to be a valid instrument for measuring raw activity volume among children with CP and is suitable for use in studies attempting to characterize the PA of this population.     

Impact of Surface Type, Wheelchair Weight, and Axle Position on Wheelchair Propulsion by Novice Older Adults

Cowan RE, Nash MS, Collinger JL, Koontz AM, Boninger ML. Impact of surface type, wheelchair weight, and axle position on wheelchair propulsion by novice older adults.

Objective

To examine the impact of surface type, wheelchair weight, and rear axle position on older adult propulsion biomechanics.

Design

Crossover trial.

Setting

Biomechanics laboratory.

Participants

Convenience sample of 53 ambulatory older adults with minimal wheelchair experience (65-87y); men, n=20; women, n=33.

Intervention

Participants propelled 4 different wheelchair configurations over 4 surfaces: tile, low carpet, high carpet, and an 8% grade ramp (surface, chair order randomized). Chair configurations included (1) unweighted chair with an anterior axle position, (2) 9.05kg weighted chair with an anterior axle position, (3) unweighted chair with a posterior axle position (Δ0.08m), and (4) 9.05kg weighted chair with a posterior axle position (Δ0.08m). Weight was added to a titanium folding chair, simulating the weight difference between very light and depot wheelchairs. Instrumented wheels measured propulsion kinetics.

Main Outcome Measures

Average self-selected velocity, push frequency, stroke length, peak resultant and tangential force.

Results

Velocity decreased as surface rolling resistance or chair weight increased. Peak resultant and tangential forces increased as chair weight increased, as surface resistance increased, and with a posterior axle position. The effect of a posterior axle position was greater on high carpet and the ramp. The effect of weight was constant, but was more easily observed on high carpet and ramp. The effects of axle position and weight were independent of one another.

Conclusion

Increased surface resistance decreases self-selected velocity and increases peak forces. Increased weight decreases self-selected velocity and increases forces. Anterior axle positions decrease forces, more so on high carpet. The effects of weight and axle position are independent. The greatest reductions in peak forces occur in lighter chairs with anterior axle positions.     

Balance-Based Torso-Weighting May Enhance Balance in Persons With Multiple Sclerosis: Preliminary Evidence

Widener GL, Allen DD, Gibson-Horn C. Balance-based torso-weighting may enhance balance in persons with multiple sclerosis: preliminary evidence.

Objective

To determine whether weight placed on the trunk in response to directional balance loss would enhance function and stability in people with multiple sclerosis (MS).

Design

Quasi-experimental study in which subjects served as their own controls.

Setting

Research laboratory.

Participants

Subjects (N=16) age 20 to 65 years with MS recruited through the Northern California Chapter of the National Multiple Sclerosis Society.

Interventions

Balance-based torso-weighting where up to 1.5% body weight was placed in a garment on the trunk. Subjects were tested at baseline and then in randomly ordered balance-based torso-weighting and nonweighted garment conditions.

Main Outcome Measures

Sharpened Romberg, eyes open (SREO) and Sharpened Romberg, eyes closed, computerized dynamic platform posturography (CDPP), Timed Up & Go (TUG), and 25-foot timed walk.

Results

Significant improvement (P<.014) was found with SREO in the balance-based torso-weighting compared with nonweighted conditions. CDPP eyes open and TUG showed improvements (P<.03) from baseline to balance-based torso-weighting and nonweighted conditions.

Conclusions

Improved performance in a group of adults with MS was seen when light weights were placed on the torso to counteract balance loss. Placement of weights may have the potential to produce immediate improvements in balance in this population.     

Dual Energy X-Ray Absorptiometry of the Distal Femur May Be More Reliable than the Proximal Tibia in Spinal Cord Injury

Morse LR, Lazzari AA, Battaglino R, Stolzmann KL, Matthess KR, Gagnon DR, Davis SA, Garshick E. Dual energy x-ray absorptiometry of the distal femur may be more reliable than the proximal tibia in spinal cord injury.

Objective

To evaluate the precision of dual energy x-ray absorptiometry scanning at 2 skeletal sites at the knee (proximal femur and distal tibia) in people with SCI.

Design

Cross-sectional.

Setting

Veterans Affairs Medical Center.

Participants

Subjects (N=20) with chronic SCI.

Interventions

Not applicable.

Main Outcome Measures

Precision as determined by root mean square coefficient of variation (RMS-CV) and root mean square standard deviation (RMS-SD).

Results

At the distal femur the root RMS-CV was 3.01% and the RMS-SD was 0.025g/cm². At the proximal tibia the RMS-CV was 5.91% and the RMS-SD was 0.030g/cm².

Conclusions

Precision at the distal femur is greater than at the proximal tibia and we recommend it as the preferred site for the longitudinal assessment of bone mineral density at the knee in chronic SCI.     

The impact of social support on mental health service users’ sense of coherence: A longitudinal panel survey

Background

Social support is a crucial coping resource in the development of a strong sense of coherence. However, little is known about which components of social support are most important for the positive development of sense of coherence.

Objectives

The aim of this study is to investigate the ability of the six social provisions in Weiss's theory of social support to predict the positive development of sense of coherence among people with mental health problems.

Design

The study has a prospective design including a baseline assessment and one-year follow-up.

Settings

The community mental health care system in a large city in Norway.

Participants

The sample comprised 107 people with mental health problems. The inclusion criteria were: 18-80 years of age, living at home, mental health problems considered relatively stable, able to engage in dialogue, reliant on the mental health services and/or an activity centre, good orientation, mastery of the Norwegian language and no alcohol and/or drug problems. A total of 92 completed both measures.

Methods

Sense of coherence was measured by the Sense of Coherence questionnaire, mental symptoms by the revised Symptom Checklist-90-R and social support by The Social Provision Scale (all Norwegian versions).

Results

The results show that while social support predicted change in sense of coherence (standardized beta coefficient for social support was 0.32, P = 0.016), mental symptoms did not (standardized beta coefficient −0.07, P = 0.621). The social provision of opportunity for nurturance contributed most to the prediction (standardized beta coefficient 0.24, P = 0.019).

Conclusions

The results indicate that improving social support with special emphasis on opportunity for nurturance might provide important opportunities for increasing sense of coherence among people with mental health problems.     

Changes and determinants of life satisfaction after spinal cord injury: a cohort study in the Netherlands

van Koppenhagen CF, Post MW, van der Woude LH, de Witte LP, van Asbeck FW, de Groot S, van den Heuvel W, Lindeman E. Changes and determinants of life satisfaction after spinal cord injury: a cohort study in The Netherlands.

Objective

To determine the impact of spinal cord injury (SCI) on life satisfaction of persons with SCI 1 year after discharge of inpatient rehabilitation.

Design

A cohort study. Life satisfaction before SCI was retrospectively measured at the start of active rehabilitation. One year after discharge from inpatient rehabilitation, current life satisfaction was measured.

Setting

Eight rehabilitation centers in The Netherlands.

Participants

Persons (N=147) aged 18 to 65 and wheelchair-dependent at least for long distances.

Interventions

Not applicable.

Main Outcome Measure

The Life Satisfaction Questionnaire.

Results

Mean satisfaction with life ± SD as a whole was 5.3±0 before SCI and 4.3±1.3 one year after inpatient rehabilitation. Sexual life, self-care, and vocational situation showed the largest impact of SCI (P<.05), whereas the social relationships domains appeared to be the least affected. Decrease of life satisfaction after SCI was larger when using the retrospective ratings than when using general population scores. Significant determinants of life satisfaction after SCI were high lesion level (β=.31, P<.05), pain (β=.19, P<.05), and secondary impairments (β=.22, P<.05).

Conclusions

Life satisfaction decreased in persons with SCI. Level of lesion and suffering secondary impairments or pain were associated with low life satisfaction 1 year after discharge from inpatient rehabilitation.     

Differential features of burden between spouse and adult-child caregivers of patients with Alzheimer's disease: An exploratory comparative design

Background

Research into burden among spouse and adult-child caregivers of patients with Alzheimer's disease has generated contradictory results as regards the group which suffers the greatest burden and the factors underlying any differences.

Objectives

The aim of the present study was to identify and compare the factors associated with caregiver burden among spouse and adult-child caregivers.

Design

Cross-sectional analytic study.

Settings

All clinical subjects had been referred on an out-patient basis to the Memory and Dementia Assessment Unit of the Santa Caterina Hospital in Girona (Spain).

Participants

Data were collected from 251 patients and their caregivers, 112 with spouse and 139 with adult-child caregivers.

Methods

The association between caregiver burden and the socio-demographic and clinical variables of both patients and caregivers was analysed, the results being compared for spouse vs. adult-child caregivers. Burden was analysed using a multivariate linear regression including all the variables for the two groups of caregivers.

Results

The results show greater burden among adult-child caregivers (p < .05), who experience more feelings of guilt (p < .001). In both groups the behavioural and psychological symptoms of patients were correlated with burden (p < .001). Living with the patient has a notable influence on burden among adult children (p < .001). Husbands, wives, daughters and sons, in this order, showed increasing levels of burden (p < .05) and progressively worse mental health (p < .01). However, the correlations between burden and mental health were strongest in daughters (p < .001).

Conclusion

The differences in burden between spouse and adult-child caregivers were not associated with age, physical health or clinical factors of the patients. Overall burden was greater among adult-child caregivers, especially those who lived with the patient and who had other family duties. Feelings of guilt were associated with not living with the patient, and there was a strong correlation between burden and mental health. These results support the hypothesis that spouses regard caregiving as part of their marital duties, whereas for adult children such tasks imply an important change in their lifestyle.     

The Validity and Reliability of the Motor Point Detection System: A Preliminary Investigation of Motor Points of the Triceps Surae Muscles

Lee NG, You JH, Park HD, Myoung HS, Lee SE, Hwang JH, Kim HS, Kim SS, Lee KJ. The validity and reliability of the motor point detection system: a preliminary investigation of motor points of the triceps surae muscles.

Objective

To investigate the validity and reliability of the motor point detection system in cadavers and healthy young adults.

Design

Correlation statistics.

Setting

University research laboratory.

Participants

Sixty-two lower limbs of 31 healthy young adults (mean age, 22.3±1.8) and 10 size-matched lower limbs from cadavers were used.

Interventions

Not applicable.

Main Outcome Measures

The validity of the motor point detection system's motor point measure was determined by comparing the motor point locations of the lower-leg muscles obtained from the motor point detection system with the established anatomic motor point locations from our previous cadaveric dissection study. The anatomic motor points were determined by tracing the terminal motor nerve branches on soleus, medial, and lateral gastrocnemius muscles through the dissection of adult cadavers. The test-retest reliability was determined by repeatedly measuring the locations of motor points in healthy young adults on 2 separate occasions, approximately 24 hours apart. The intraclass correlation coefficient (ICC) was computed to determine correlation, and an independent t test was used to determine the difference between the demographic and clinical variables at the significance level (P<.05).

Results

Correlation analysis revealed relatively high validity between the motor point detection system and cadaver-dissected motor point location measurements (ICC_2,1=.71-.92, P<.05). The test-retest reliability showed excellent correlation between the repeated measures (range, ICC_1,2=.90-.95 at P<.05).

Conclusions

Our results showed that the motor point detection system was accurate and consistent in the measurement of motor point locations of the lower-leg muscles. This system can be considered as an alternative device to localize motor points in clinical settings. Our motor point detection system warrants further investigation in pathologic population.     

Menopause Characteristics and Subjective Symptoms in Women With and Without Spinal Cord Injury

Kalpakjian CZ, Quint EH, Bushnik T, Rodriguez GM, Terrill MS. Menopause characteristics and subjective symptoms in women with and without spinal cord injury.

Objective

To examine menopause transition characteristics and symptom bother in women with spinal cord injury (SCI).

Design

Prospective cohort (4 data collection periods across 4 years).

Setting

Community.

Participants

Women (n=62) with SCI (injury levels C6-T12, nonambulatory, >36mo postinjury; 86.1% retention) and women without SCI (n=66; 92.9% retention) with intact ovaries, not using hormone therapy, and between the ages of 45 and 60 years volunteered. A total of 505 observations were collected and analyzed.

Interventions

None.

Main Outcome Measures

Age at final menstrual period (FMP), transitions through menopause status classifications, and menopause symptom bother (vasomotor, somatic, psychologic symptoms).

Results

The number of women transitioning through a menopause status classification over the course of the study did not significantly vary by group (P=.263), nor did age at FMP (P=.643). Women with SCI experienced greater bother of somatic symptoms (a subscale, P<.001), bladder infections (P<.001), and diminished sexual arousal (P=.012). Women without SCI had significantly greater bother of vasomotor symptoms (P=.020). There were no significant group by menopause status interactions; main effects for menopause status were significant only for vasomotor symptoms and vaginal dryness.

Conclusions

Results suggested that women with SCI experience greater symptom bother in certain areas, but that patterns of symptom bother across menopause, transition through menopause, and age at FMP are similar to those of their peers. Larger studies are needed to examine menopause outcomes with respect to level of injury and completeness of injury. These findings provide a framework that women with SCI and their health care providers can use to address the menopause transition and highlight the importance of multidisciplinary involvement to maximize health and well being during this transition.     

Muscle stretching technique increases vital capacity and range of motion in patients with chronic obstructive pulmonary disease

Putt MT, Watson M, Seale H, Paratz JD. Muscle stretching technique increases vital capacity and range of motion in patients with chronic obstructive pulmonary disease.

Objectives

To determine if a specific hold and relax stretching technique was capable of (1) reversing the effect of tight chest wall muscles by increasing chest expansion, vital capacity, and shoulder range of motion and (2) decreasing perceived dyspnea and respiratory rate in persons with chronic obstructive pulmonary disease (COPD).

Design

Double-blind crossover trial.

Setting

A physiotherapy department at a major metropolitan hospital.

Participants

Fourteen stable patients with COPD who had recently completed a pulmonary rehabilitation program were enrolled, with 10 patients completing the study.

Intervention

A hold and relax stretching technique of the pectoralis major and a sham technique each for 2 days.

Main Outcome Measures

The primary outcome measure was vital capacity (VC), with secondary outcome measures being perceived dyspnea, axillary (ACE) and xiphisternal chest expansion (XCE), right and left shoulder horizontal extension, and respiratory rate.

Results

The hold and relax technique to the pectoralis major compared with the sham technique produced significant effects on VC (P<.01), and right (P<.01) and left (P<.05) upper-limb range of motion. There was no significant effect on ACE, XCE, perceived dyspnea, or respiratory rate. There was no order effect for either technique.

Conclusions

The hold and relax technique produces short-term benefits in patients with COPD and should be investigated further.     

Effectiveness of community-based rehabilitation after traumatic brain injury for 489 program completers compared with those precipitously discharged

Altman IM, Swick S, Parrot D, Malec JF. Effectiveness of community-based rehabilitation after traumatic brain injury for 489 program completers compared with those precipitously discharged.

Objective

To evaluate outcomes of home- and community-based postacute brain injury rehabilitation (PABIR).

Design

Retrospective analysis of program evaluation data for treatment completers and noncompleters.

Setting

Home- and community-based PABIR conducted in 7 geographically distinct U.S. cities.

Participants

Patients (N=489) with traumatic brain injury who completed the prescribed course of rehabilitation (completed-course-of-treatment [CCT] group) compared with 114 who were discharged precipitously before program completion (precipitous-discharge [PD] group).

Intervention

PABIR delivered in home and community settings by certified professional staff on an individualized basis.

Main Outcome Measures

Mayo-Portland Adaptability Inventory (MPAI-4) completed by means of professional consensus on admission and at discharge; MPAI-4 Participation Index at 3- and 12-month follow-up through telephone contact.

Results

Analysis of covariance (CCT vs PD group as between-subjects variable, admission MPAI-4 score as covariate) showed significant differences between groups at discharge on the full MPAI-4 (F=82.25; P<.001), Ability Index (F=50.24; P<.001), Adjustment Index (F=81.20; P<.001), and Participation Index (F=59.48; P<.001). A large portion of the sample was lost to follow-up; however, available data showed that group differences remained statistically significant at follow-up.

Conclusions

Results provided evidence of the effectiveness of home- and community-based PABIR and that treatment effects were maintained at follow-up.     

Intrarater test-retest reliability of hip range of motion and hip muscle strength measurements in persons with hip osteoarthritis

Pua YH, Wrigley TW, Cowan SM, Bennell KL. Intrarater test-retest reliability of hip range of motion and hip muscle strength measurements in persons with hip osteoarthritis.

Objective

To examine the relative and absolute intrarater test-retest reliability of muscle strength and range of motion (ROM) measurements of the hip performed in people with hip osteoarthritis.

Design

Repeated measures.

Setting

Human movement laboratory of a university.

Participants

Participants (N=22; 10 men, 12 women; age range, 50-84y) with hip osteoarthritis.

Interventions

On 2 separate occasions, at least 1 week apart, isometric torque measurements were obtained from the hip rotators, flexors, abductors, and extensors. Passive ROMs in hip rotation, flexion, abduction, and extension were also determined.

Main Outcome Measures

Relative reliability was estimated using the intraclass correlation coefficient, model 2,2 (ICC_2,2). Absolute reliability was estimated using the coefficient of variation (CV) and the standard error (SE) of measurement.

Results

For measurements of muscle strength, ICC_2,2 ranged from .84 to .97, and the CV ranged from 8% to 15.7%. Hip extensors and internal and external rotators showed high ICC_2,2 (>.96) and low CV (<9.8%); hip abductors showed the lowest ICC_2,2 (.84) and the highest CV (15.7%). For ROM measurements, ICC_2,2 ranged from .86 to .97 and SE ranged from 3.1° to 4.7°. Hip flexion ROM showed the highest ICC_2,2 (.97) and an SE of 3.5°; hip extension ROM showed the lowest ICC_2,2 (.86) and the highest SE (4.7°).

Conclusions

Strength and ROM testing of the hip in people with hip osteoarthritis can be performed with good to excellent reliability.     

A randomised controlled trial of two programmes of shoulder exercise following axillary node dissection for invasive breast cancer

Objective

To compare the incidence of treatment-related complications, including lymphoedema, after two programmes of shoulder mobilisation in women with invasive breast cancer when surgical treatment included axillary lymph node dissection.

Design

Randomised controlled trial.

Setting

Two secondary care National Health Service trusts.

Participants

One hundred and sixteen women (mean age 57 years, standard deviation 13.1 years) recruited from November 2003 to March 2006 (58 intervention group, 58 control group). Seven patients (6%) did not complete the study.

Intervention

Arm exercises and shoulder movement restricted to below shoulder level for the first 7 days after surgery. Controls commenced an exercise programme that incorporated exercises above shoulder level within 48 hours.

Outcome measures

All outcomes were recorded at baseline (pre-operatively) and at 1 year. The primary outcome was incidence of lymphoedema, defined by a limb volume difference of 200 ml or more compared with the contralateral arm. This outcome was measured using volume displacement. Secondary outcome measures included volume differences between the two limbs measured by actual volume displacement difference, wound drainage volumes, range of shoulder movement (manual goniometer), grip strength (hand-held dynamometer) and health-related quality of life (Shoulder Disability Questionnaire, Functional Assessment of Cancer Therapy - Breast).

Results

All statistical tests were two-sided. Data were analysed using intention-to-treat principles. The incidence of lymphoedema (200 ml or more) increased significantly in women who had undertaken a programme of early full shoulder mobilisation. Twenty-two women (19%) developed lymphoedema (200 ml or more) in their first postoperative year. There were significantly more women with lymphoedema in the early full shoulder mobilisation group (n = 16) compared with the delayed full shoulder mobilisation group (n = 6). The relative risk of developing lymphoedema after early mobilisation was 2.7 (95% confidence interval 1.1 to 6.3; P = 0.031). Limb volume differences were significantly higher in the early mobilisation group. This was apparent in differences in limb volume displacement (P = 0.004) and percentage difference between the two limbs (P = 0.007). There were no statistically significant differences in shoulder movement, grip strength or self-evaluated outcomes between the two groups at 1 year.

Conclusion

A programme of exercise that delays full shoulder mobilisation for 1 week is recommended after axillary node dissection for invasive breast cancer.