Entraînement en endurance à partir du membre inférieur sain chez des footballeurs amateurs opérés de ligamentoplastie de genou

Objective

To examine cardiorespiratory fitness changes in subjects having undergone knee surgery and to assess the benefits of one-leg cycling aerobic training program during the rehabilitation period.

Method

Two groups of 12 patients took part in this study. The control group profited from a five weeks conventional rehabilitation in day hospital without cardiorespiratory training. The second group profited in supplement from a one-leg cycling aerobic training program with the valid leg. The subjects were trained for 21 min, by alternating 3 min at 70% and 3 min at 85% of VO_2peak. They totaled 15 sessions spread over five weeks. The initial evaluation (T1) is carried out the first day of rehabilitation and the final evaluation (T2) at a distance within 35 days. The evaluation consisted in realizing a maximal graded tests starting from the valid leg.

Results

After five weeks of conventional rehabilitation, we record a reduction of peak power output (W_peak), peak oxygen uptake (VO_2peak) and peak minute ventilation (VE_peak), respectively of 11, 12 and 13% for the control group. On the other hand, in T2, the training group has on average identical maximum values and some of them increased (W_peak: +14%; VE_peak: +15%). The first and second ventilatory thresholds appear with higher intensities of exercises.

Conclusion

After knee surgery, conventional rehabilitation does not limit cardiorespiratory deconditioning. One leg cycling appears to be an adapted method to stop the effects of hypoactivity.     

Validation transculturelle de l’Oswestry disability index en français

Aim

The aim of this study was to interpret and validate a French version of the Oswestry disability index (ODI), using a cross-cultural validation method. The validity and reliability of the questionnaire was assessed in order to ensure the psychometric characteristics.

Method

The cross-cultural validation was carried out according to Beaton's methodology. The study was conducted with 41 patients suffering from low back pain. The correlation between the ODI and the Roland-Morris disability questionnaire (RMDQ), the medical outcome survey short form-36 (MOS SF-36) and a pain visual analogical scale (VAS) was assessed.

Results

The validity of the Oswestry questionnaire was studied using the Cronbach Alpha coefficient calculation: 0.87 (n = 36). The significant correlation between the ODI and RMDQ was 0.8 (P < 0.001, n = 41) and 0.71 (P < 0.001, n = 36) for the pain VAS. The correlation between the ODI and certain subscales (physical functioning 0.7 (P < 0.001, n = 41), physical role 0.49 et bodily pain 0.73 (P < 0.001, n = 41)) of the MOS SF-36 were equally significant. The reproducibility of the ODI was calculated using the Wilcoxon matched pairs test: there was no significant difference for eight out of ten sections or for the final score.

Conclusion

This French translation of the ODI should be considered as valid and reliable. It should be used for any future clinical studies carried out using French language patients. Complimentary studies must be completed in order to assess its sensitivity to change in the event of any modifications in the patients functional capacity.     

A multiconvergent approach to the rehabilitation of patients with chronic fatigue syndrome: a comparative study

Objectives

This study investigated the efficacy of a rehabilitation technique for the treatment of chronic fatigue syndrome that was developed by a physiotherapist. Data collected retrospectively from a pilot study indicated that patients benefited from this multiconvergent approach, so further assessments were warranted.

Design

Treatment efficacy was assessed by comparing the primary and secondary outcome measures of patients attending multiconvergent therapy (MCT) with those of patients attending relaxation therapy and a group of non-intervention controls.

Setting

The active treatment took place at a clinic within the physiotherapy outpatient unit. Relaxation therapy and all assessments were conducted at the psychology unit.

Participants

Thirty-five participants, fitting the Centers for Disease Control and Prevention criteria for chronic fatigue syndrome, were recruited from two outpatient clinics and an existing patient panel.

Intervention

Patients were assigned to either MCT (n = 12) or relaxation therapy (n = 14). Nine participants who received general medical care were used as a comparison group.

Main outcome measures

The Karnofsky performance scale was used as the primary outcome measure of function. Secondary outcome measures assessing overall improvement in patient condition, fatigue and disability levels were also administered.

Results

A significant percentage of the patients attending the MCT sessions showed improvement in the primary outcome score used to measure the success of the treatment (MCT = 83%, relaxation = 21%, controls = 0; P < 0.001). A significant percentage of this group also reported improvement in their overall condition (MCT = 92%, relaxation = 64%, controls = 22%; P < 0.001), lower fatigue levels (MCT = 83%, relaxation = 57%, controls = 11%; P < 0.001) and lower levels of disability (MCT = 75%, relaxation = 43%, controls = 11%; P = 0.032) immediately post-therapy. In addition, these improvements were maintained at 6-month follow-up.

Conclusions

Outcomes from this small preliminary study were encouraging. The multiconvergent approach produced significant improvements for standardised primary and secondary outcome measures. Further research is required to examine the efficacy of this approach over time, and its effectiveness on a larger scale within the primary healthcare setting using additional therapists trained in the technique.     

Le devenir fonctionnel et la qualité de vie des ruptures de la coiffe des rotateurs non opérées

Our objective was to determine the long-term functional and quality-of-life outcomes for patients with rotator cuff tears receiving conservative treatment. We also studied correlations between the Constant and SF-36 scores.

Material and methods

This was a prospective survey carried out on patients having consulted in our Rehabilitation Department between January 1995 and December 2004 for radiologically-confirmed rotator cuff tears and having received medical treatment combined with a rehabilitation programme. The outcome measures used in our study were as follows: degree of motion, muscle strength, degree of pain on a visual analogical scale (VAS) and scores on the Constant and SF-36 scales.

Results

The study population consisted of 38 women and 21 men (mean age: 61 years; range 46–75). The mean final outcome measurements were taken after an average of seven years of follow-up (range: 4–12). The VAS score for pain at rest dropped from 68.3 ± 31 to 28.3 ± 12 (p < 10⁻³) over the follow-up period. The score for pain during effort fell from 82.5 ± 36 to 40.3 ± 15. In all cases, active joint mobility was better at the final assessment (p < 0.001). The Constant score rose from 28.8 ± 14.2 to 51.6 ± 21.8. The SF36 score showed a 16% improvement. Sixty-two percent of patients were satisfied or very satisfied with this treatment. The change over time was rated as good to very good by 42 patients (71.8%). The observed improvement in quality of life was correlated with reduced pain at rest (r = 0.62) and during effort (r = 0.59) and with the increased Constant score.

Conclusion

Our results underline the benefits (in terms of short- and long-term pain reduction, functional improvements and better quality of life) of an individualized rehabilitation programme (combined with medical treatment) in cases of rotator cuff tears.     

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.     

The vastus medialis oblique:vastus lateralis electromyographic intensity ratio does not differ by gender in young participants without knee pathology

Objectives

To investigate whether there was a gender difference in the intensity of electromyographic (EMG) activity in vastus medialis oblique (VMO) relative to vastus lateralis (VL).

Design

A cross-sectional observational study measuring EMG activity during stepping down from a step and during straight leg raise exercises.

Setting

University campus laboratory.

Participants

Two groups of healthy participants were tested, one female (mean age 23.5 years, n = 15) and one male (mean age 23.5 years, n = 15).

Main outcome measures

Surface EMG activity (sampling rate 1000 Hz) was recorded from VMO and VL of the dominant limb during five repetitions of a step down activity and five repetitions of a straight leg raise exercise. The average intensity of the rectified and smoothed EMG activity from each activity was normalised to that elicited in a maximal quadriceps setting exercise. The ratio of normalised VMO:VL EMG intensity levels was calculated.

Results

The median difference in the VMO:VL ratio between the groups was 0.11 [approximate 95% confidence interval (CI) −0.62 to 1.00] during step down and −0.07 (approximate 95% CI −0.26 to 0.20) during straight leg raise. Using Mann Whitney U-tests, these differences were not statistically significant (P = 0.648 and 0.619, respectively).

Conclusions

This study found no gender difference in the VMO:VL EMG intensity ratio in asymptomatic participants. This suggests that the difference in incidence of patellofemoral pain syndrome between genders is not influenced by quadriceps intensity ratios, when participants are asymptomatic.     

Incidence and effect of leg length discrepancy following total hip arthroplasty

Objectives

The clinical importance of a leg length discrepancy (LLD) following total hip arthroplasty (THA) remains controversial. This study was undertaken to determine the effects of LLD on clinical outcomes at up to 3 years follow-up.

Design and setting

Prospective, multicentre study.

Participants

Nine hundred and eighty-seven cases of primary THA, categorised into two main groups: the NoLLD group (LLD of less than 10 mm) and the LLD group (LLD of 10 mm or more).

Main outcome measures

The primary outcome measure was the change in Oxford Hip Score (ΔOHS) at up to 3 years follow-up. Secondary outcome measures were length of operating time and hospital stay, and revision and dislocation rates. Potential predisposing factors for LLD, including body mass index, age and type of anaesthesia employed, were examined.

Results

At 3 years, the LLD group had a significantly worse ΔOHS [22.0; 95% confidence interval (CI) 20.5 to 23.5] compared with the NoLLD group (23.8; 95% CI 23.1 to 24.5) (P = 0.034). There were no significant differences in revision (P = 0.389) or dislocation (P = 0.220) rates between the two groups. Use of an epidural was associated with a decreased incidence of developing an LLD of 10 mm (P = 0.004).

Conclusion

A postoperative LLD of 10 mm or more leads to poorer functional outcomes. Further studies are needed to assess the impact of an LLD on clinical outcomes in the longer term.     

A prospective randomised controlled trial of spinal manipulation and ultrasound in the treatment of chronic low back pain

Objectives

To assess the short- and long-term effectiveness of spinal manipulation therapy, and to identify the effect of manipulation on lumbar muscle endurance in patients with chronic low back pain (LBP).

Design

A randomised controlled trial comparing manipulation and exercise treatment with ultrasound and exercise treatment.

Setting

An outpatient physiotherapy department.

Participants

One hundred and twenty patients with chronic LBP were allocated at random into the manipulation/exercise group or the ultrasound/exercise group.

Interventions

Both groups were given a programme of exercises. In addition, one group received spinal manipulation therapy and the other group received therapeutic ultrasound.

Main outcome measures

Pain intensity, functional disability, lumbar movements and muscle endurance were measured shortly before treatment, at the end of the treatment programme and 6 months after randomisation using surface electromyography.

Results

Following treatment, the manipulation/exercise group showed a statistically significant improvement (P = 0.001) in pain intensity [mean 16.4 mm, 95% confidence interval (CI) 6.1-26.8], functional disability (mean 8%, 95% CI 2-13) and spinal mobility (flexion: mean 9.4 mm, 95% CI 5.5-13.4; extension: mean 3.4 mm, 95% CI 1.0-5.8). There was no significant difference (P = 0.068) between the two groups in the median frequency of surface electromyography (multifidus: mean 6.8 Hz, 95% CI 1.24-14.91; iliocostalis: mean 2.4 Hz, 95% CI 2.5-7.1), although a significant difference (P = 0.013) was found in the median frequency slope of surface electromyography in favour of spinal manipulation for multifidus alone (mean 0.3, 95% CI 0.1-0.5). A significant difference was also found between the two groups in favour of the manipulation/exercise group at 6-month follow-up.

Conclusions

Although improvements were recorded in both groups, patients receiving manipulation/exercise showed a greater improvement compared with those receiving ultrasound/exercise at both the end of the treatment period and at 6-month follow-up.     

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.     

Inter-rater reliability of McKenzie assessment in patients with neck pain

Objectives

To determine inter-rater agreement on diagnostic category using the Mechanical Diagnosis and Therapy (MDT) classification system for neck pain. If the diagnostic category was derangement syndrome, inter-rater agreement on the subcategory and the directional preference of treatment was also determined.

Design

Clinicians viewed videotaped MDT examinations of 20 patients with neck pain and rated the MDT diagnosis independently for each patient. If the diagnostic category was derangement syndrome, the subcategory and directional preference of treatment were also rated.

Setting

Private physical therapy outpatient clinics and a university clinical laboratory.

Participants

Fifty-four clinicians trained in MDT for neck pain from the USA and Canada, and 20 adult patients with neck pain.

Main outcome measures

Inter-rater agreement for MDT diagnosis, derangement subcategory and directional preference of treatment was determined using Kappa and percentage agreement.

Results

Overall, agreement was of moderate clinical significance for diagnosis [κ = 0.55, P < 0.001, confidence intervals (CI) 0.52 to 0.58, 67%], derangement subcategory (κ = 0.47, CI 0.44 to 0.50, P < 0.001; 63%) and directional preference of treatment (κ = 0.46, CI 0.43 to 0.49, P < 0.05; 70%).

Conclusions

Clinicians trained in MDT for neck pain demonstrate moderate agreement when classifying the diagnostic category and treatment for neck pain.     

Mapping placement educators’ conceptions of teaching

Objectives

This study sought to better understand the complexities of the placement learning environment and its possible influence on students’ learning development. Specifically, the study maps placement educators’ perceived conceptions of teaching and teaching in practice.

Design and participants

All placement educators across Wales (n = 266) were invited to complete a demographic questionnaire, the Lecturers’ Conception of Teaching and Learning questionnaire, and the Trainer Type Inventory via an anonymous postal route.

Results

Responses from 141 placement educators enabled the respondents’ inventory scores to be mapped across clinical disciplines, motivation for engaging with placement education and role perception. The results suggest that within a highly motivating and pastoral-care aware environment, undergraduate physiotherapy students are experiencing placement education that is predominantly underpinned by a knowledge transmission conception of teaching.

Conclusion

These are changing times for placement education development and it is important for those involved in education to work together, within the placement and academic learning environments, to articulate and contribute to a common learning goal for undergraduate students.     

Apport de l’exercice physique et du régime dans la prise en charge de la gonarthrose chez l’obèse

Objective

Our objective was to determine whether exercise and weight loss are more effective either separately or in combination, in improving pain and physical function in obese adults with moderate knee osteoarthritis (OA).

Patients and methods

Forty-five obese adults, with a body mass index greater than 35 kg/m² or 30 ≤ BMI < 35 associated to at least one cardiovascular risk factor, suffering from knee pain with evident radiographic signs of knee OA, were involved in our study. All patients were evaluated at baseline and at the end of the study. The assessment parameters were weight loss, the bioelectric impedance analysis, pain, six-minute walk distance, cardiovascular parameters, and muscular strength. The physical function was measured with the Womac and the Lequesne indexes. Patients were randomized into four groups, a control group (G1), exercise only group (G2), diet plus exercise group (G3) and diet only group (G4).

Results

There was no difference between the four groups at baseline. Significant improvement of function (Womac) was noticed in groups performing exercise only (G2) (26 %), diet plus exercise (G3) (37,89 %) and diet only (G4) (18,34 %). We also noticed an improvement in pain in G2 (p = 0.04), G3 (p < 0.001) and G4 (p = 0.02). The improvement of quadriceps strength was noted only in G2 (p = 0.01) et G3 (p = 0.001) without any change in control group and diet only group (G4). The improvement of cardiovascular parameters was observed only in G2 and G3. Weight loss, decreased BMI and waist circumference was more important in diet plus exercise group (G3).

Conclusion

The combination of weight loss and exercise provide better improvements in physical function and pain in obese adults with knee OA compared with either intervention alone. Exercise used alone or associated to dietary provides better improvements in physical capacity and muscle strength.     

Living with an unfixable heart: A qualitative study exploring the experience of living with advanced heart failure

Background

Nurses working with patients with advanced heart failure need knowledge that will help us to help patients cope with their situations of chronic illness. However, our knowledge bank is deficient due to the scarcity of inquiry that takes the affected person's point of view as its central focus.

Aim

The aim of this study was to describe patients' experiences of living with advanced heart failure.

Methods

The study sample (N = 9) consisted of male (N = 6) and female (N = 3) patients with advanced (NYHA classes III-IV) heart failure. The design was qualitative and open unstructured interviews were audio-taped and transcribed verbatim during 2006.

Results

Four main themes emerged: Living in the Shadow of Fear; Running on Empty; Living a Restricted life; and Battling the System. The experience of living with advanced heart failure was described as a fearful and tired sort of living characterised by escalating impotence and dependence.

Conclusions

The findings suggest that there may be an illogical but enduring ethos of ‘cure’ pervading health care worker's attitudes to advanced heart failure care. This mindset might be working to hinder the application of additional or alternative therapies, which might better palliate the physical and psychosocial distress of patients.     

Reproducibility and validity of the incremental shuttle walking test in patients following coronary artery bypass surgery

Objective

The incremental shuttle walking test (ISWT) is widely used to assess patients with chronic obstructive pulmonary disease. We hypothesised that it would be an appropriate tool to assess patients with coronary heart disease following coronary artery bypass grafts. We therefore explored the reproducibility, validity and sensitivity of the ISWT following rehabilitation.

Design

Participants completed three ISWTs and an incremental treadmill test over 7 days. Eleven patients repeated the ISWT following rehabilitation.

Setting

Cardiac rehabilitation department.

Participants

Thirty-nine patients, 34 of whom were male, with a mean age of 61.2 years (S.D. 8.5), 6-8 weeks after coronary artery bypass graft surgery.

Main outcome measures

Maximum oxygen uptake (O_2 peak, ml/min/kg) and ISWT.

Results

Mean (S.D.) distances for the three ISWTs were 448 m (137.8), 487 m (147.6) and 481 m (138.2). There was no statistically significant difference between the three ISWTs. The mean difference between Tests 1 and 2 was 42.8 m (95% confidence interval 59.1-26.5 m) compared with 1.7 m (95% confidence interval −1.86-5.29) between Tests 2 and 3. The mean O_2 peak was 21.0 (S.D. 4.5) ml/min/kg. There was a significant relationship between the results for the three ISWTs and O_2 peak (r = 0.79, r = 0.86 and r = 0.87 for Tests 1-3, respectively). Following rehabilitation, there was a significant increase in the distance walked; the mean difference between the second ISWT and the post-rehabilitation ISWT was 81.8 m (95% confidence interval 53.2-110.4, P < 0.001).

Conclusions

The ISWT correlates well with O_2 peak and is a reliable measure of cardiorespiratory fitness in this population after one practice walk.     

Do parents of children with cerebral palsy express different concerns in relation to their child's type of cerebral palsy, age and level of disability?

Objectives

To investigate the range of parents’ concerns for their children with cerebral palsy, and whether concerns varied according to type of cerebral palsy, age and level of disability.

Design

A retrospective study was undertaken analysing information from past medical records of children with cerebral palsy. Information was collected from 170 visits, including child's age, type of cerebral palsy, level of disability and the parents’ current concerns. Data were analysed using conceptual analysis to search for common themes, and quantitatively using cross-tabulation and Chi-squared tests to determine if differences existed between the concerns for different ages, diagnoses or disability levels.

Participants

Parents of children with cerebral palsy from 121 families who attended for therapy between January 2003 and December 2004.

Setting

Bobath Centre, London.

Results

Twelve specific categories of concerns were identified: activities of daily living; hand function; eating/drinking; floor mobility; sitting; standing/walking; transfers; stiffness; communication; therapy; visual perception; and behaviour. Significant differences were found to exist between the concerns of parents of children of different ages, diagnoses and levels of disability. For example, parents of children with spastic diplegia expressed more concerns about standing/walking [χ² = 41.45, degrees of freedom (df) = 3, P < 0.001], whereas concerns about sitting (χ² = 17.65, df = 3, P = 0.001), communication (χ² = 32.28, df = 3, P = 0.0001), floor mobility (χ² = 16.89, df = 3, P < 0.001) and eating/drinking (χ² = 10.06, df = 3, P = 0.018) were more common among parents of children with spastic quadriplegia and athetosis.

Conclusion

Within this sample, parents demonstrated that they have specific concerns, with clear themes emerging about parents’ concerns related to their child's diagnosis, age and level of disability.     

Physiotherapy management of osteoarthritis of the hip: a survey of current practice in acute hospitals and private practice in the Republic of Ireland

Objective

To identify the current management of osteoarthritis of the hip by physiotherapists in private practice and acute hospital settings in the Republic of Ireland.

Design

Cross-sectional postal questionnaire survey.

Participants

Physiotherapists in 35 acute hospitals (n = 150) and a random selection of physiotherapists in private practice (n = 172) in the Republic of Ireland were surveyed.

Results

A valid response rate of 65% (n = 210) was achieved. The most common intervention used by therapists was exercise therapy (210/210, 100%), followed by education (207/210, 99%), manual therapy (202/210, 96%), thermal agents (154/210, 73%) and electrotherapy (130/210, 62%). Hydrotherapy and acupuncture were used by 29% (61/210) and 18% (38/210) of respondents, respectively. Statistical differences in these interventions between public and private settings existed only for thermal agents (P = 0.001) and acupuncture (P = 0.002). A total of 84% (177/210) of those surveyed used outcome measures, most commonly pain severity scales (163/210, 78%). Osteoarthritis-specific questionnaires (33/210, 16%) and quality of life (16/210, 8%) measures were used less frequently.

Conclusions

The importance of exercise therapy, education and manual therapy in the management of osteoarthritis of the hip was demonstrated. There was little difference overall in the physiotherapy management of osteoarthritis of the hip between public and private settings. The use of these interventions compared to known scientific evidence is discussed. Although there was high usage of outcome measures, hip osteoarthritis-specific outcomes and quality of life measures were not commonly used. This survey identified interventions most commonly used in clinical practice including exercise, education and manual therapy, and highlights a need for further research to evaluate the effectiveness of such interventions.     

Bandura's exercise self-efficacy scale: Validation in an Australian cardiac rehabilitation setting

Background

Despite the established benefits of cardiac rehabilitation (CR) in improving health outcomes for people with cardiovascular disease, adherence to regular physical activity at recommended levels remains suboptimal. Self-efficacy has been shown to be an important mediator of health behaviour, including exercise.

Objectives

To assess the psychometric properties of Bandura's exercise self-efficacy (ESE) scale in an Australian CR setting.

Design

Validation study.

Setting

Cardiac rehabilitation.

Participants

One hundred and ten patients (Mean: 60.11, S.D.: 10.57 years).

Methods

Participants completed a six-minute walk test (6MWT) and Bandura's exercise self-efficacy scale at enrolment and on completion of a 6-week CR program.

Results

Bandura's ESE scale had a single factor structure with high internal consistency (0.95), and demonstrated no floor or ceiling effects. A comparison of ESE scores by distance walked on 6MWT indicated those who recorded more than 500 m at baseline had significantly higher ESE scores (Mean: 116.26, S.D.: 32.02 m) than those patients who only achieved up to 400 m on the 6MWT at baseline (Mean: 89.94, S.D.: 29.47 m) (p = 0.044). A positive and significant correlation between the change in scores on the ESE scale and the change in the 6MWT distance (r = 0.28, p = 0.035) was seen.

Conclusions

The ESE scale was a robust measure of exercise self-efficacy over the range of patients attending this outpatient cardiac rehabilitation program. Interventions to improve self-efficacy may increase CR patient's efficacy for regular physical activity.     

Effects of obesity on inpatient rehabilitation outcomes following total knee arthroplasty

Objective

To investigate the effects of obesity on inpatient rehabilitation outcomes following total knee arthroplasty.

Participants

Two hundred and thirty-nine total knee arthroplasty patients (12 men and 227 women).

Interventions

Patients were divided in two groups (non-obese and obese) according to pre-operative body mass index (BMI). After surgery, all patients received standard post-operative treatment from a physiotherapist, including continuous passive motion, active-assistive and active range of motion exercises, isometric and isotonic strengthening exercises, gait training and transfer training.

Main outcome measures

Patients were evaluated pre-operatively and at discharge using BMI, knee function score [Hospital for Special Surgery (HSS) score], pain and range of motion of knee flexion. Functional activities were evaluated using the Iowa Level of Assistance Scale, and walking speed was evaluated using the Iowa Ambulation Velocity Scale.

Results

There were no statistically or clinically significant differences between the two groups of patients at discharge, with obese patients recording a mean HSS score of 62.6 points (95% confidence interval 61.3 to 63.9) and non-obese patients recording a mean HSS score of 62.6 (95% confidence interval 61.6 to 63.7, P = 0.950). Both groups improved in all parameters at the time of discharge compared with pre-operative values, with the exception of walking speed and the range of knee flexion. There was no significant difference in length of hospital stay between obese (median 9 days, interquartile range 4-22) and non-obese (median 9 days, interquartile range 4-23) patients.

Conclusions

Obesity had no negative effects on inpatient rehabilitation outcomes following total knee arthroplasty. This finding is significant given implementation of the prospective payment system in rehabilitation hospitals in parts of Turkey, and the effect that this will have on length of hospital stay for patients who have undergone total knee arthroplasty.