A Systematic Review of the Effectiveness of Eccentric Strength Training in the Prevention of Hamstring Muscle Strains in Otherwise Healthy Individuals

Background

Hamstring strains are the most common soft-tissue injury observed in recreational and athletic activities, yet no consensus exists regarding appropriate primary and secondary strategies to prevent these strains. Eccentric exercise has been reported to reduce the incidence of ham-string strains but its role has not been clearly defined.

Objective

The objective of this systematic review was to determine the effectiveness of eccentric exercise in preventing hamstring strains.

Data Sources

Online databases, including MED-LINE, PubMed, CINAHL, PEDro, SPORTDiscus, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Web of Science were searched for relevant articles. Each database was searched from the earliest date to July 2007.

Study Selection

Selection criteria included diagnosis of hamstring strain, otherwise healthy individuals, and at least one group receiving an eccentric exercise intervention. Seven articles {three randomized controlled trials (RCTs) and four cohort studies} met the inclusion criteria.

Data Extraction

Data were extracted using a customized form. Methodological rigor of included studies was assessed using the PEDro scale and Oxford Centre for Evidence-based Medicine Levels of Evidence.

Data Synthesis

Studies were grouped by eccentric exercise intervention protocol: hamstring lowers, isokinetic strengthening, and other strengthening. A best-evidence synthesis of pooled data was qualitatively summarized.

Conclusions

Findings suggest that eccentric training is effective in primary and secondary prevention of hamstring strains. Study heterogeneity and poor methodological rigor limit the ability to provide clinical recommendations. Further RCTs are needed to support the use of eccentric training protocols in the prevention of hamstring strains.     

The effect of the SAFE or SORRY? programme on patient safety knowledge of nurses in hospitals and nursing homes: A cluster randomised trial

Background

Patients in hospitals and nursing homes are at risk for the development of often preventable adverse events. Guidelines for the prevention of many types of adverse events are available, however compliance with these guidelines appears to be lacking. As a result many patients do not receive appropriate care. We developed a patient safety program that allows organisations to implement multiple guidelines simultaneously and therefore facilitates guideline use to improve patient safety. This program was developed for three frequently occurring nursing care related adverse events: pressure ulcers, urinary tract infections and falls. For the implementation of this program we developed educational activities for nurses as a main implementation strategy.

Objectives

The aim of this study is to describe the effect of interactive and tailored education on the knowledge levels of nurses.

Design

A cluster randomised trial was conducted between September 2006 and July 2008.

Settings

Ten hospital wards and ten nursing home wards participated in this study. Prior to baseline, randomisation of the wards to an intervention or control group was stratified for centre and type of ward.

Participants

All nurses from participating wards.

Methods

A knowledge test measured nurses’ knowledge on the prevention of pressure ulcers, urinary tract infections and falls, during baseline en follow-up. The results were analysed for hospitals and nursing homes separately.

Results

After correction for baseline, the mean difference between the intervention and the control group on hospital nurses’ knowledge on the prevention of the three adverse events was 0.19 points on a zero to ten scale (95% CI: −0.03 to 0.42), in favour of the intervention group. There was a statistically significant effect on knowledge of pressure ulcers, with an improved mean mark of 0.45 points (95% CI: 0.10-0.81). For the other two topics there was no statistically significant effect. Nursing home nurses’ knowledge did neither improve (0 points, CI: −0.35 to 0.35) overall, nor for the separate subjects.

Conclusion

The educational intervention improved hospital nurses’ knowledge on the prevention of pressure ulcers only. More research on long term improvement of knowledge is needed.

Trial registration

ClinicalTrials.gov ID [NCT00365430].     

Combination therapy with pegylated interferon plus ribavirin in the treatment of hepatitis C virus-related thrombocytopenia

Background:

Isolated thrombocytopenia is a common manifestation of hepatitis C virus (HCV) infection. There is no established treatment modality for this condition. The efficacy of standard interferon (IFN) monotherapy has been reported in some studies. The major disadvantage of this treatment is the high rate of recurrence due to viral breakthrough during the first 12 weeks of treatment. Pegylated IFNs are now the standard regimen for chronic hepatic disease due to HCV infection. However, due to a lack of evidence, pegylated IFNs are not widely used for HCV-related isolated thrombocytopenia.

Objective:

The aim of this report was to present the case of a male patientwith severe symptomatic thrombocytopenia due to HCV infection.

Methods:

Thrombocytopenia was treated with pegylated IFN plus ribavirin.

Results:

Although standard IFN monotherapy failed to achieve virologic and hematologic improvement, therapy with pegylated IFN alfa-2a plus ribavirin was associated with both virologic and hematologic improvement without any significant adverse effects.

Conclusions:

Pegylated IFN plus ribavirin was effective in this patient for thetreatment of HCV-related thrombocytopenia. However, further research is needed to define the response rate in different patient populations.     

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.     

Land-Based Versus Pool-Based Exercise for People Awaiting Joint Replacement Surgery of the Hip or Knee: Results of a Randomized Controlled Trial

Gill SD, McBurney H, Schulz DL. Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial.

Objective

To compare the preoperative effects of multidimensional land-based and pool-based exercise programs for people awaiting joint replacement surgery of the hip or knee.

Design

Randomized, single-blind, before-after trial.

Setting

Physiotherapy gymnasium and hydrotherapy pool.

Participants

Patients awaiting elective hip or knee joint replacement surgery.

Interventions

Land-based (n=40) or pool-based exercise program (n=42). Each 6-week program included an education session, twice-weekly exercise classes, and an occupational therapy home assessment.

Main Outcome Measures

Participants were assessed immediately before and after the 6-week intervention, then 8 weeks later. Primary outcomes were pain and self-reported function (Western Ontario and McMaster Universities Osteoarthritis Index) and patient global assessment. Secondary outcomes were performance-based measures (timed walk and chair stand) and psychosocial status (Medical Outcomes Study 36-Item Short-Form Health Survey mental component score). Pain was also measured before and after each exercise class on a 7-point verbal rating scale.

Results

Although both interventions were effective in reducing pain and improving function, there were no postintervention differences between the groups for the primary and secondary outcomes. However, the pool-based group had less pain immediately after the exercise classes.

Conclusions

While our multidimensional exercise-based interventions appeared to be effective in reducing disability in those awaiting joint replacement surgery of the hip or knee, there were no large differences in the postintervention effects of the interventions. However, pool-based exercise appeared to have a more favorable effect on pain immediately after the exercise classes.     

Exercise therapy for office workers with nonspecific neck pain: a systematic review

Objective

The purpose of this study was to evaluate the effectiveness of various types of exercise for prevention and cure of nonspecific neck pain in office workers.

Methods

Publications between 1980 and April 2010 were systematically searched in various databases (PubMed, CINAHL Plus with full text, The Cochrane Library, Science Direct, PEDro, ProQuest, PsycNet, and Scopus). The following key words were used: neck pain, cervical pain, exercise, strengthening, stretching, endurance, office workers, visual display unit, visual display terminal, and computer users. A hand search of relevant journals was also carried out. Relevant randomized controlled trials were retrieved and assessed for methodological quality by 2 independent reviewers. The strength of the evidence was based on methodological quality and consistency of the results.

Results

Nine randomized controlled trials were included in this review, of which 6 were rated as high-quality studies. No exercise type was identified as being effective in the prevention of nonspecific neck pain in office workers. Strong evidence was found for the effectiveness of muscle strengthening and endurance exercises in treating neck pain. Moderate evidence supported the use of muscle endurance exercise in reducing disability attributed to neck pain.

Conclusion

Literature investigating the efficacy of exercise in office workers with nonspecific neck pain was heterogeneous. Within the limitations, for treatment of neck pain, either muscle strengthening or endurance exercise is recommended, whereas for reduction of pain-related disability, muscle endurance exercise is suggested. Further research is needed before any firm conclusions regarding the most effective exercise programs for office workers can be reached.     

Chiropractic manipulative therapy and low-level laser therapy in the management of cervical facet dysfunction: a randomized controlled study

Purpose

The aim of this study was to determine the short-term effect of chiropractic joint manipulation therapy (CMT) and low-level laser therapy (LLLT) on pain and range of motion in the management of cervical facet dysfunction.

Methods

Sixty ambulatory women between the ages of 18 and 40 years with cervical facet joint pain of more than 30-day duration and normal neurologic examination were randomized to receive 1 of 3 treatment options: (1) CMT of the cervical spine, (2) LLLT applied to the cervical facet joints, or (3) a combination of CMT and LLLT. Each participant received 6 treatments in 3 weeks. The main outcome measures were as follows: the Numerical Pain Rating Scale, Neck Disability Index, Cervical Range of Motion Instrument, and Baseline Digital Inclinometer. Measurements were taken during weeks 1 (baseline), 2, 3, and 4.

Results

No differences existed between the 3 groups at baseline. A significant difference was seen between groups 1 (CMT) and 2 (LLLT) for cervical flexion, between groups 1 (CMT) and 3 (CMT + LLLT) for cervical flexion and rotation, and between groups 2 (LLLT) and 3 (CMT + LLLT) for pain disability in everyday life, lateral flexion, and rotation.

Conclusion

All 3 groups showed improvement in the primary and secondary outcomes. A combination of CMT and LLLT was more effective than either of the 2 on their own. Both therapies are indicated as potentially beneficial treatments for cervical facet dysfunction. Further studies are needed to explore optimal treatment procedures for CMT and LLLT and the possible mechanism of interaction between therapies.     

Predictors for identifying patients with mechanical neck pain who are likely to achieve short-term success with manipulative interventions directed at the cervical and thoracic spine

Objective

The purpose of this study was to identify the prognostic factors for individuals with mechanical neck pain likely to experience improvements in both pain and disability after the application of an intervention including cervical and thoracic spine thrust manipulations.

Methods

Patients presenting with mechanical neck pain participated in a prospective single-arm trial. Participants underwent a standardized examination and then received a series of thrust manipulations directed toward the cervical, cervicothoracic, and thoracic spine. Participants were classified as having achieved a successful outcome at the second and third sessions based on their perceived recovery. Potential prognostic variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for the prediction of treatment success.

Results

Data from 81 subjects were included in the analysis, of which 50 experienced a successful outcome (61.7%). Five variables including pain intensity greater than 4.5 points; cervical extension less than 46°; presence of hypomobility at T1; a negative upper limb tension test and female sex were identified. If 4 of 5 variables were present (likelihood ratio, +1.9), the likelihood of success increased from 61.7% to 75.4%.

Conclusions

This study identified several prognostic clinical factors that can potentially identify, a priori, patients with neck pain who are likely to experience a rapid response to the application of an intervention including both cervical and thoracic spine manipulations. However, no combination of the variables was able to dramatically increase the posttest probability.     

A randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease

Steele BG, Belza B, Cain KC, Coppersmith J, Lakshminarayan S, Howard J, Haselkorn JK. A randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease.

Objectives

To evaluate the effectiveness of an exercise adherence intervention to maintain daily activity, adherence to exercise, and exercise capacity over 1 year after completion of an outpatient pulmonary rehabilitation program.

Design

A 2-group, experimental design was used with randomization into intervention and usual care groups.

Setting

Outpatient pulmonary rehabilitation program in a university-affiliated medical center.

Participants

One hundred six subjects (98 men; 98 with chronic obstructive pulmonary disease) with a mean age of 67 years and chronic lung disease.

Intervention

Twelve-week adherence intervention (weekly phone calls and home visit) including counseling on establishing, monitoring, and problem-solving in maintaining a home exercise program.

Main Outcome Measures

Primary outcomes included daily activity (accelerometer), exercise adherence (exercise diary), and exercise capacity (six-minute walk test). All measures were performed at baseline, after the pulmonary rehabilitation program (8wk), after the adherence intervention (20wk), and at 1 year.

Results

A rank-based analysis of covariance showed less decline at 20 weeks in exercise adherence (intervention mean, +3min; control mean, −13min; P=.015) and exercise capacity (intervention mean, −10.7m; control mean, −35.4m; P=.023). There were no differences in daily activity at 20 weeks or any differences in any primary variable at 1 year.

Conclusions

The intervention enhanced exercise adherence and exercise capacity in the short term but produced no long-term benefit. These findings are in part attributed to the disappointing measurement characteristics of the accelerometer used to measure daily activity. The intervention was acceptable to participants. Further study is needed to fashion interventions that have more persistent benefit.     

Age-related differences in Tai Chi gait kinematics and leg muscle electromyography: a pilot study

Wu G. Age-related differences in Tai Chi gait kinematics and leg muscle electromyography: a pilot study.

Objective

To compare the biomechanic features of Tai Chi gait by elders with those by young adults, and with those of normative gait.

Design

Cross-sectional study.

Setting

Laboratory-based testing.

Participants

Young (n=6; 3 women) and old (n=6; 5 women) Tai Chi practitioners.

Intervention

All subjects had practiced Tai Chi for at least 4 months.

Main Outcome Measures

Spatial, temporal, and leg muscle electromyography during Tai Chi gait and normative gait.

Results

The primary age-related differences in Tai Chi gait were during single stance, with elders having significantly shorter single-stance time (−50%), less lateral displacement (-30%), knee flexion (-42%), hip flexion (-39%), activation time in the tibialis anterior (-13%), soleus (-39%), and tensor fascia lata (TFL) (-21%), activation magnitude in the tibialis anterior (-39%), and coactivation time of the tibialis anterior and soleus (-47%). Compared with normative gait, elders during Tai Chi gait had significantly larger knee (139%) and hip (66%) flexions, longer duration (90%-170%) and higher magnitude (200%-400%) of the tibialis anterior, rectus femoris, and TFL muscle activities, and longer duration of coactivation of most leg muscle pairs (130%-380%).

Conclusions

The elders practice Tai Chi gait in higher posture than younger subjects. The Tai Chi gait poses significantly higher challenges to elder’s balance and muscular system than does their normative gait.     

Effect of 2 lumbar spine postures on transversus abdominis muscle thickness during a voluntary contraction in people with and without low back pain

Objective

The present study investigated the effect of 2 different lumbar spine postures, neutral and flexed lumbar postures, on transversus abdominis (TrA) muscle function during a voluntary contraction (hollowing and draw-in maneuver) in people with and without low back pain (LBP).

Methods

Thirty participants with LBP and 30 healthy participants were recruited for this cross-sectional study. Transversus abdominis muscle function was measured as a change in thickness with ultrasound imaging. Participants performed voluntary TrA contraction in a supine lying position with the lumbar spine in neutral and flexed postures. Data were analyzed using a 2-way (groups, postures) analysis of variance.

Results

Lumbar posture influenced TrA function during a voluntary contraction in people with and without LBP. There was a significant main effect of posture (F_1,58 = 16.140, P < .001). Neutral lumbar posture improved participants' ability to recruit TrA in both group (mean difference, 7.5%; 95% confidence interval, 3.8%-11.3%). No significant differences were found between healthy subjects and those with LBP.

Conclusions

The results of the present study showed that, in subjects performing a voluntary TrA contraction, the neutral lumbar posture improves the ability to increase change in TrA thickness. This study found no significant difference in TrA thickness change between healthy subjects and those with nonspecific LBP.     

Interventions for preventing hamstring injuries: a systematic review

Objectives

To assess, by systematic review, the effects of interventions used for preventing hamstring injuries in physically active individuals.

Selection criteria

Randomised or quasi-randomised trials of interventions for preventing hamstring injuries were included, as were trials testing interventions for the prevention of lower limb injuries, provided that hamstring injuries were reported. Risk ratios (RRs) and 95% confidence intervals (95% CIs) were calculated for dichotomous variables and are reported for individual and pooled data.

Main results

Seven randomised controlled trials involving 1919 participants were included. Some trials were compromised by poor methodology, including lack of blinding and incomplete outcome data. Four trials, including 287 participants, examined interventions directly targeted at preventing hamstring injuries. Three of these trials, which tested hamstring strengthening protocols, had contradictory findings, with one small trial showing benefit, although the control rate of mainly minor hamstring injury was unusually high. The other two trials found no benefit, with a greater incidence of hamstring injury in the intervention group. One unpublished and underpowered trial provided some evidence that manual therapy may prevent lower limb muscle strain (RR 0.13, 95% CI 0.02 to 0.97), although the finding for hamstring injury did not reach statistical significance (RR 0.21, 95% CI 0.03 to 1.66).

Conclusions

There is insufficient evidence from randomised controlled trials to draw conclusions on the effectiveness of interventions used to prevent hamstring injuries in people participating in football or other high-risk activities. The findings for manual therapy need confirmation.     

Hamstring length in patellofemoral pain syndrome

Objectives

To investigate whether there was a difference in hamstring length between patients with patellofemoral pain syndrome and healthy asymptomatic controls aged 18 to 35 years.

Design

A cross-sectional observational study measuring hamstring length in patients and asymptomatic controls.

Setting

Hospital physiotherapy department.

Participants

Two groups were tested; one group diagnosed with patellofemoral pain syndrome (mean age 27 years, n = 11, six males, five females) and one group of asymptomatic controls (mean age 25 years, n = 25, 13 males, 12 females).

Main outcome measures

Hamstring length was evaluated using the passive knee extension method to measure popliteal angle.

Results

The mean (standard deviation) values for hamstring length were 145.6 (8.7)° for patients with patellofemoral pain syndrome and 153.7 (10.1)° for the asymptomatic controls. The mean (95% confidence interval) difference between the groups was 8.0 (0.8 to 15.1)°, and analysis with a t-test revealed that this was statistically significant (P < 0.05).

Conclusions

This study found that patients with patellofemoral pain had shorter hamstring muscles than asymptomatic controls. It is not clear whether this is a cause or effect of the condition. Further research is suggested to study how hamstring length changes with rehabilitation, and the relationship with pain.     

Integrated physical therapy intervention for a person with pectus excavatum and bilateral shoulder pain: a single-case study

Canavan PK, Cahalin L. Integrated physical therapy intervention for a person with pectus excavatum and bilateral shoulder pain: a single-case study.

Objective

To examine the effects of an individualized physical therapy (PT) program for a subject with pectus excavatum and bilateral shoulder pain.

Design

Single-case study of a man diagnosed with moderate-to-severe pectus excavatum and constant bilateral shoulder pain. Exercise tolerance was measured through the Bruce protocol and home exercise log, pulmonary function, ventilatory muscle strength, echocardiography, chest wall and abdominal excursion, self-perception of pectus excavatum, and a variety of anthropometric and volumetric tests before and after PT.

Setting

University laboratory.

Participant

A 22-year-old man.

Intervention

A 3-month PT program including breathing exercises and therapeutic exercises.

Main Outcome Measures

Exercise tolerance, ventilatory muscle strength, chest wall and abdominal excursion, self-perception of the pectus excavatum, and other anthropometric and volumetric tests.

Results

The most striking anthropometric and volumetric test change was the pectus severity index (in H₂O), which decreased from 50 to 20mL H₂O (60% change). The subject reported no shoulder pain at rest and with recreational activity after 8 weeks of intervention.

Conclusion

An individualized PT program provided minimal-to-moderate improvements on many characteristics of pectus excavatum. Bilateral shoulder pain was eliminated. An individualized PT program integrating cardiopulmonary and musculoskeletal interventions that is provided to other patients with pectus excavatum may provide similar results. However, PT provided to younger patients with the pectus excavatum may be of even greater benefit because of a less mature skeleton. Further investigation of the effects of PT intervention provided to younger and older persons with the pectus excavatum is needed.     

Validity of the 6-minute walk test for assessing heart rate recovery after an exercise-based cardiac rehabilitation programme

Objectives

To compare heart rate responses in the 6-minute walk test and the treadmill exercise test before and after an exercise-based cardiac rehabilitation programme.

Design

Prospective cohort study.

Setting

Hospital-based cardiac rehabilitation programme in Hong Kong.

Participants

Thirty patients (mean age 62.1 ± 8.5 years, 20 males) with stable ischaemic heart disease.

Interventions

Eight-week exercise-based cardiac rehabilitation programme involving upper and lower limb aerobic and resistance training.

Main outcome measures

Six-minute walk test and treadmill exercise test before and after the exercise programme.

Results

Comparing parameters before and after the exercise programme, the peak heart rate in the 6-minute walk test increased (median of 105 beats per minute (bpm), interquartile range 96.8-116.5 versus 110 bpm, interquartile range 100.5-124.5, P = 0.006), while heart rate recovery improved in each 30-second interval of a 2-minute recovery period. The distance covered during the 6-minute walk increased from a mean of 486.3 m (±standard deviation 113.9 m) to 552.5 m (±standard deviation 111.9 m) (P < 0.001). Rating of perceived exertion during the 6-minute walk test decreased from a median of 14 (interquartile range 13-15) to 13 (interquartile range 13-13) (P = 0.001). Heart rate recovery following treadmill exercise testing improved during the 30-second periods from 60 to 90 seconds and from 90 to 120 seconds of recovery. Metabolic equivalents increased during treadmill testing from a median of 7.0 (interquartile range 5.8-8.6) to 8.6 (interquartile range 7-8.6) (P < 0.001).

Conclusions

Both treadmill exercise and 6-minute walk tests demonstrated improvements in heart rate recovery and increases in achieved workload following exercise training. This suggests that the 6-minute walk test is a valid tool to assess heart rate recovery following such a programme.     

Does the pulse frequency of transcutaneous electrical nerve stimulation (TENS) influence hypoalgesia?: A systematic review of studies using experimental pain and healthy human participants

Objectives

To determine the hypoalgesic effect of pulse frequency of transcutaneous electrical nerve stimulation (TENS) when all other TENS parameters are held constant.

Data sources

Systematic review of studies using experimentally induced pain on healthy participants where there was a head-to-head comparison of different pulse frequencies. AMED, CINAHL, EMBASE, Inspec, PEDro, Pre-CINAHL, PsycARTICLES, PubMed, SPORTDiscus were searched in September 2006.

Review methods

Inclusion criteria were studies that directly compared two or more pulse frequencies head-to-head and recorded outcome as change in pain threshold or pain intensity. Studies were excluded if pulse intensity, pulse pattern, or pulse duration of TENS were not standardized between groups. Two reviewers judged the trial outcome independently. Primary outcome was a report of a statistically significant difference between pulse frequencies for pain threshold or intensity at any time point through the experiment.

Results

Twenty studies were identified, of which 13 experimental studies from 12 published reports were included for review. Ten studies found no statistically significant differences in hypoalgesia between pulse frequencies. Of the three studies judged as positive outcome, one reported that 100 pulses per second (pps) was superior to 10 pps; one that 4 pps was superior to 100 pps; and one that 5 pps and 80 pps were superior to 2 pps.

Conclusion

Evidence from experimental pain studies suggests that TENS pulse frequency does not influence hypolagesia when its pulse intensity, pulse pattern, and pulse duration are kept constant. Inadequate sample sizes may have generated false negative findings in some studies.     

Pain in persons with postpolio syndrome: frequency, intensity, and impact

Stoelb BL, Carter GT, Abresch RT, Purekal S, McDonald CM, Jensen MP. Pain in persons with postpolio syndrome: frequency, intensity, and impact.

Objective

To describe the frequency, intensity, and impact of pain in persons with postpoliomyelitis syndrome (PPS).

Design

Retrospective, cross-sectional survey.

Setting

Community-based survey.

Participants

Convenience sample of people with PPS.

Interventions

Not applicable.

Main Outcome Measures

Overall intensity and duration of pain, pain sites, pain interference, pain treatments, and relief provided by pain treatments.

Results

A total of 91% (n=57) of the study participants (N=63) reported pain. The most frequently reported pain sites were the shoulders, lower back, legs, and hips. Participants reported pain intensity to be the greatest in the knees, legs, wrists, lower back, and head. Pain interfered most with sleep and with activities requiring a high level of musculoskeletal involvement. Respondents also reported pain problems that were more severe than those of the general population and than those of a sample of people with multiple sclerosis. Many treatments had been tried previously for pain, but continued use of treatments was reported by relatively few participants at the time of the survey.

Conclusions

The findings indicate that pain is a persistent and common problem in persons with PPS, highlighting the need for effective and accessible pain treatments for this population.     

Prediction of Postoperative Ambulatory Status 1 Year After Hip Fracture Surgery

Hirose J, Ide J, Yakushiji T, Abe Y, Nishida K, Maeda S, Anraku Y, Usuku K, Mizuta H. Prediction of postoperative ambulatory status 1 year after hip fracture surgery.

Objectives

To assess the validity of Estimation of Physiologic Ability and Surgical Stress (E-PASS) for predicting the postoperative risk and ambulatory status long-term follow-up after hip fracture surgery and to establish an algorithm for predicting their ambulatory status.

Design

Cohort study.

Setting

Twelve hospitals belonging to the regional network for hip fracture in Japan.

Participants

The study population was composed of 421 patients; 268 underwent surgery between April 2004 and March 2006 (group A), and 153 were treated surgically between April 2006 and March 2007 (group B). All were operated at 3 surgical hospitals and, subsequently, transferred to 9 rehabilitation centers.

Interventions

Not applicable.

Main Outcome Measures

We evaluated various factors, including their E-PASS scores to determine whether there was a correlation with the patients' mortality rate and their ability to walk at discharge and 1 year after surgery (group A). Using multiple regression analysis, we then developed algorithms to predict the ability of elderly patients to walk after hip fracture surgery. We applied the algorithms to group B patients and compared their actual and predicted ambulatory status.

Results

In group A patients, the postoperative walking ability and mortality rate were highly correlated with their E-PASS scores and dementia status. In group B, our algorithms exhibited good correlations between the predicted and actual walking ability at both time points (ρ=0.6, P<.001).

Conclusions

In candidates for hip fracture surgery, the E-PASS scores exhibited a good correlation with the patients' functional and survival prognoses, and the algorithm including E-PASS scores and dementia status can accurately estimate the ambulatory status at discharge and 1 year after surgery.