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1.
Gary L. Shum Jack Crosbie Raymond Y. Lee 《Archives of physical medicine and rehabilitation》2009,90(1):127-1077
Shum GL, Crosbie J, Lee RY. Energy transfer across the lumbosacral and lower-extremity joints in patients with low back pain during sit-to-stand.
Objective
To examine the transfer of energy through the pelvis and the lower limb during sit-to-stand (STS) in low back pain (LBP) subjects with or without a straight-leg raise sign.Design
Cross-sectional.Setting
Biomechanics laboratory.Participants
Three groups, each of 20 subjects, participated. The first group consisted of asymptomatic subjects, and the other 2 groups of consisted of LBP subjects (duration between 7 days and 12 weeks) with and without a straight-leg raise sign.Interventions
Not applicable.Main Outcome Measures
The work done and the power of the pelvis, thigh, and leg segments during STS were determined.Results
Energy was transferred from the pelvis to the thigh segment and then to the leg segment, and this was achieved mainly by passive mechanisms. The power flow of the pelvis segment was significantly decreased in subjects with LBP. Although the power of the lower-limb segments was decreased, the total work done of these segments was increased.Conclusions
STS is a more energy-demanding and less efficient task for subjects with LBP, either with or without a positive straight-leg raise sign. Such increases in energy demand may further exacerbate back pain, and treatment should be developed to restore a more efficient energy transfer pattern. 相似文献2.
Sara R. Piva G. Kelley Fitzgerald James J. Irrgang Julie M. Fritz Stephen Wisniewski Gerald T. McGinty John D. Childs Manuel A. Domenech Scott Jones Anthony Delitto 《Archives of physical medicine and rehabilitation》2009,90(2):285-295
Piva SR, Fitzgerald GK, Irrgang JJ, Fritz JM, Wisniewski S, McGinty GT, Childs JD, Domenech MA, Jones S, Delitto A. Associates of physical function and pain in patients with patellofemoral pain syndrome.
Objectives
To explore whether impairment of muscle strength, soft tissue length, movement control, postural and biomechanic alterations, and psychologic factors are associated with physical function and pain in patients with patellofemoral pain syndrome (PFPS).Design
Cross-sectional study.Setting
Rehabilitation outpatient.Participants
Seventy-four patients diagnosed with PFPS.Interventions
Not applicable.Main Outcome Measures
Measurements were self-reported function and pain; strength of quadriceps, hip abduction, and hip external rotation; length of hamstrings, quadriceps, plantar flexors, iliotibial band/tensor fasciae latae complex, and lateral retinaculum; foot pronation; Q-angle; tibial torsion; visual observation of quality of movement during a lateral step-down task; anxiety; and fear-avoidance beliefs.Results
After controlling for age and sex, anxiety and fear-avoidance beliefs about work and physical activity were associated with function, while only fear-avoidance beliefs about work and physical activity were associated with pain.Conclusions
Psychologic factors were the only associates of function and pain in patients with PFPS. Factors related to physical impairments did not associate to function or pain. Our results should be validated in other samples of patients with PFPS. Further studies should determine the role of other psychologic factors, and how they relate to anxiety and fear-avoidance beliefs in these patients. 相似文献3.
Kristen A. Scopaz Sara R. Piva Stephen Wisniewski G. Kelley Fitzgerald 《Archives of physical medicine and rehabilitation》2009,90(11):1866-1873
Scopaz KA, Piva SR, Wisniewski S, Fitzgerald GK. Relationships of fear, anxiety, and depression with physical function in patients with knee osteoarthritis.
Objectives
To explore whether the psychologic variables anxiety, depression, and fear-avoidance beliefs, and interactions between these variables, are associated with physical function in patients with knee osteoarthritis (OA). We hypothesized lower levels of function would be related to higher anxiety, higher depression, and higher fear-avoidance beliefs, and that high levels of 2 of these factors simultaneously might interact to have a greater adverse effect on physical function.Design
Cross-sectional, correlational design.Setting
Institutional practice.Participants
Subjects included patients with knee OA (N=182; age, mean ± SD, 63.9±8.8y; 122 women).Interventions
Not applicable.Main Outcome Measures
Self-report measures of function included the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, the Lower Extremity Function Scale (LEFS), and the Knee Outcome Survey-Activity of Daily Living Scale. The Get Up and Go test was used as a physical performance measure of function. Self-report measures for psychologic variables included the Beck Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, and the Fear Avoidance Belief Questionnaire-Physical Activity Scale modified for the knee.Results
Higher anxiety was related to poorer function on the WOMAC physical function. Both high anxiety and fear-avoidance beliefs were related to poorer function on the LEFS and Knee Outcome Survey-Activity of Daily Living Scale. There was no association between the psychologic variables and the Get Up and Go test. The anxiety × depression interaction was associated with the LEFS.Conclusions
Anxiety and fear-avoidance beliefs are associated with self-report measures of function in patients with knee OA. Depression may influence scores on the LEFS under conditions of low anxiety. 相似文献4.
Background
Chronic knee pain is a major cause of disability in the elderly. Management guidelines recommend exercise and self-management interventions as effective treatments. The authors previously described a rehabilitation programme integrating exercise and self-management [Enabling Self-management and Coping with Arthritic knee Pain through Exercise (ESCAPE-knee pain)] that produced short-term improvements in pain and physical function, but sustaining these improvements is difficult. Moreover, the programme is untried in clinical environments, where it would ultimately be delivered.Objectives
To establish the feasibility of ESCAPE-knee pain and compare its clinical effectiveness and costs with outpatient physiotherapy.Design
Pragmatic, randomised controlled trial.Setting
Outpatient physiotherapy department and community centre.Participants
Sixty-four people with chronic knee pain.Interventions
Outpatient physiotherapy compared with ESCAPE-knee pain.Outcomes
The primary outcome was physical function assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Secondary outcomes included pain, objective functional performance, anxiety, depression, exercise-related health beliefs and healthcare utilisation. All outcomes were assessed at baseline and 12 months after completing the interventions (primary endpoint). ANCOVA investigated between-group differences.Results
Both groups demonstrated similar improvements in clinical outcomes. Outpatient physiotherapy cost £130 per person and the healthcare utilisation costs of participants over 1 year were £583. The ESCAPE-knee pain programme cost £64 per person and the healthcare utilisation costs of participants over 1 year were £320.Conclusions
ESCAPE-knee pain can be delivered as a community-based integrated rehabilitation programme for people with chronic knee pain. Both ESCAPE-knee pain and outpatient physiotherapy produced sustained physical and psychosocial benefits, but ESCAPE-knee pain cost less and was more cost-effective.Clinical Trial Registration No.: ISRCTN63848242. 相似文献5.
Derby R Lee SH Chen Y Kim BJ Lee CH Hong YK Lee JE Seo KS 《Archives of physical medicine and rehabilitation》2008,89(7):1300-1304
Derby R, Lee S-H, Chen Y, Kim B-J, Lee C-H, Hong Y-K, Lee J-E, Seo K-S. The influence of psychologic factors on diskography in patients with chronic axial low back pain.
Objective
To determine whether a patient's presenting psychometric scores affect the findings of a pressure and injection speed-controlled manometric lumbar diskography in patients with chronic low back pain (CLBP).Design
A prospective, correlation-based, investigative study.Setting
Free-standing ambulatory spine surgery center.Participants
Two hundred sixty-three disks from 81 patients (54 men, 27 women).Intervention
Diskography was performed using pressure and injection speed-controlled techniques. The patients were divided into psychometric subgroups (normal, at risk, abnormal) according to the Distress and Risk Assessment Method (DRAM).Main Outcome Measures
The diskography findings on each psychometric DRAM subgroup were evaluated.Results
Across the individual psychometric categories, the positive rates of diskography in the normal, at-risk, and abnormal subgroups were 75.0% (9/12), 59.5% (25/42), and 70.4% (19/27), respectively (P>.05). The mean numeric rating scores of pain at 15 and 50psi above the opening pressure were similar in the 3 psychometric subgroups. There was no correlation between the diskography results and the psychometric subgroupings.Conclusions
In patients with CLBP, there is no correlation between the presenting psychometric DRAM score and the findings from pressure and injection speed-controlled manometric lumbar diskography. 相似文献6.
Mohammad A. Mohseni-Bandpei Jacqueline Critchley Thomas Staunton Barbara Richardson 《Physiotherapy》2006,92(1):34-42
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. 相似文献7.
Stephen D. Gill Helen McBurney PhD Debra L. Schulz DPhysio 《Archives of physical medicine and rehabilitation》2009,90(3):388-394
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. 相似文献8.
Deutscher D Horn SD Smout RJ DeJong G Putman K 《Archives of physical medicine and rehabilitation》2010,91(11):1722-1730
Deutscher D, Horn SD, Smout RJ, DeJong G, Putman K. Black-white disparities in motor function outcomes taking into account patient characteristics, nontherapy ancillaries, therapy activities, and therapy interventions.
Objective
To assess black-white differences in functional outcomes, controlling for patient characteristics, use of nontherapy ancillaries (NTAs), and use of physical (PT) and occupational therapy (OT) activities and interventions.Design
Multicenter prospective observational cohort study of poststroke rehabilitation.Setting
Six U.S. inpatient rehabilitation facilities.Participants
Patients (N=732) subdivided into case-mix subgroups (CMGs; CMGs 104-107 for moderate strokes [n=397], CMGs 108-114 for severe strokes [n=335]).Interventions
Not applicable.Main Outcome Measure
Discharge Motor FIM.Results
Taking into account patient characteristics, NTAs, and therapy activities, multivariate regressions explained (R2) 54% and 69% of variation in outcomes between patients with moderate and severe stroke, respectively. Black race was associated with lower outcomes than white race in the severe group. However, race was no longer associated with outcomes after including interventions used within PT and OT activities. Including interventions within therapy activities increased R2 to 64% and 74% for moderate and severe strokes, respectively. Some PT and OT activities were provided more to blacks than whites and vice versa. Greater intensity sometimes was associated with better and sometimes with poorer functional outcomes.Conclusions
After controlling for interventions within activities, no racial differences were found in functional outcomes at discharge despite racial differences in rehabilitation care, possibly because each racial group received a mixture of interventions that were negatively and positively associated with outcome. Clinicians should provide therapies associated with better outcomes with high and similar intensities for black and white patients poststroke. 相似文献9.
Susan B. Williams Caroline A. Brand Keith D. Hill Susan B. Hunt Helen Moran 《Archives of physical medicine and rehabilitation》2010,91(1):106-114
Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study.
Objective
To evaluate the feasibility and gait stability and balance outcomes of a 4-month individualized home exercise program for women with arthritis.Design
Pre-post interventional study.Setting
General community.Participants
Women (N=49) (volunteers) with lower-limb osteoarthritis or lower-limb rheumatoid arthritis were enrolled. Only 39 subjects were eligible and completed the study.Intervention
After completion of the initial assessment, all participants received home balance exercises from an experienced physiotherapist based on assessment findings and exercises available from commercially available kits. All measures were repeated 4 months later.Main Outcome Measures
Falls risk (Falls Risk of Older People—Community Setting) and balance measures.Results
Thirty-nine women (mean age, 69.3y; 95% confidence interval, 65.7-72.9) completed the 4-month program. At baseline, 64% of participants reported falling in the preceding 12 months, and the average falls risk (Falls Risk of Older People—Community Setting) score was 14.5, with 42% rated as moderate risk (16-23). Participants achieved improved performance on most balance and related measures after the exercise program, including falls risk (P=.01), activity levels (P=.015), fear of falling (P=.022), functional reach test (P=.001), rising index for sit to stand (P=.001), step width in walking (P=.001), and body mass index (P=.006).Conclusions
An individualized balance training home exercise program is feasible for older women with osteoarthritis or rheumatoid arthritis and may improve stability during walking and other functional activities. 相似文献10.
Shuldham C Parkin C Firouzi A Roughton M Lau-Walker M 《International journal of nursing studies》2009,46(7):986-992
Background
Research has shown a direct relationship between staffing levels and patient outcomes for specific nurse-sensitive indicators, with lower patient to nurse ratios (i.e. less patients per nurse) associated with better outcomes.Objectives
To explore the relationship between nurse staffing characteristics (the nursing hours worked by permanent and temporary staff and nurse hours per patient day) and patient outcomes: pressure sores, patient falls, upper gastrointestinal bleed, pneumonia, sepsis, shock and deep vein thrombosis.Design
A case study using retrospective hospital data, at ward level.Setting
A tertiary cardio-respiratory NHS Trust in England, comprising two hospitals.Participants
All patients, including day cases, who were admitted to either hospital as an in-patient over 12 months.Methods
Data were extracted from corporate hospital systems. The clinical areas were categorised as lower dependency, i.e. wards, or critical care which included ICU and high dependency units. The relationship between nurse staffing characteristics and patient outcomes was assessed using either a Poisson or negative binomial regression model as appropriate. We sought to establish whether the outcomes were affected by the nurse hours per patient day, the permanent nurse hours worked as a percentage of the total hours, and the permanent nurse hours worked as a percentage of the permanent and bank hours combined.Results
In the lower dependency category wards there was only a weak association demonstrated between nurse staffing and the majority of the outcomes. The results from the high dependency critical care areas showed few significant results with only the rate of sepsis being significantly reduced as the ratio of permanent staff hours increased.Conclusions
The study demonstrated the possibility of using existing hospital data to examine the relationship between nurse staffing and patient outcomes, however the associations found were weak and did not replicate reliably the findings from previous work. 相似文献11.
Åsa Muntlin Marianne Carlsson Lena Gunningberg 《International journal of nursing studies》2011,48(1):13-23
Background
Abdominal pain is one of the most frequent reasons for seeking care in an emergency department. Surveys have shown that patients are not satisfied with the pain management they receive. Reasons for giving inadequate pain management may include poor knowledge about pain assessment, myths concerning pain, lack of communication between the patient and healthcare professional, and organizational limitations.Objectives
The aim of the study was to investigate the outcome of nursing assessment, pain assessment and nurse-initiated intravenous opioid analgesic compared to standard procedure for patients seeking emergency care for abdominal pain. Outcome measures were: (a) pain intensity, (b) frequency of received analgesic, (c) time to analgesic, (d) transit time, and (e) patients’ perceptions of the quality of care in pain management.Design
A quasi-experimental design with ABA phases was used.Setting
The study was conducted in an emergency department at a Swedish university hospital.Participants
Patients with abdominal pain seeking care in the emergency department were invited to participate. A total of 50, 100 and 50 patients, respectively, were included for the three phases of the study. The inclusion criteria were: ongoing abdominal pain not lasting for more than 2 days, ≥18 years of age and oriented to person, place and time. Exclusion criteria were: abdominal pain due to trauma, in need of immediate care and pain intensity scored as 9-10.Methods
The patients’ perceptions of the quality of care in pain management in the emergency department were evaluated by means of a patient questionnaire carried out in the three study phases. The intervention phase included education, nursing assessment protocol and a range order for analgesic.Results
The nursing assessment and the nurse-initiated intravenous opioid analgesic resulted in significant improvement in frequency of receiving analgesic and a reduction in time to analgesic. Patients perceived lower pain intensity and improved quality of care in pain management.Conclusions
The intervention improved the pain management in the emergency department. A structured nursing assessment could also affect the patients’ perceptions of the quality of care in pain management in the emergency department. 相似文献12.
Saavedra-Hernández M Ssavedra-Hernández M Castro-Sánchez AM Fernández-de-Las-Peñas C Cleland JA Ortega-Santiago R Arroyo-Morales M 《Journal of manipulative and physiological therapeutics》2011,34(3):127-152
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. 相似文献13.
Charrow A DiFazio M Foster L Pasquina PF Tsao JW 《Archives of physical medicine and rehabilitation》2008,89(7):1407-1409
Charrow A, DiFazio M, Foster L, Pasquina PF, Tsao JW. Intradermal botulinum toxin type A injection effectively reduces residual limb hyperhidrosis in amputees: a case series.
Objective
To study the effectiveness of botulinum toxin type A (BTX-A) therapy for residual limb hyperhidrosis, prosthesis fit and function, and residual and phantom limb pain in patients with limb amputation.Design
Consecutive case series.Setting
Outpatient physical medicine and rehabilitation clinic.Participants
Walter Reed Army Medical Center patients (N=8) with unilateral traumatic upper- or lower-limb amputation.Intervention
BTX-A was injected transdermally in a circumferential pattern around the residual limb by using a 1-cm matrix grid.Main Outcome Measure
A 10-cm continuous Likert visual analog scale was used to assess residual limb sweating and pain and prosthesis fit and function before and 3 weeks after BTX-A injections.Results
Patients reported a significant reduction in sweating and improvement in prosthesis fit and function after treatment. However, residual limb and phantom pain were unaffected by treatment.Conclusions
BTX-A may be an effective treatment for residual limb hyperhidrosis, resulting in subjective improvement in prosthesis fit and functioning. BTX-A should be considered as a method to manage excessive sweating in the residual limb of traumatic amputees. 相似文献14.
Adam T. Hirsh Aaron P. Turner Dawn M. Ehde Jodie K. Haselkorn 《Archives of physical medicine and rehabilitation》2009,90(4):646-651
Hirsh AT, Turner AP, Ehde DM, Haselkorn JK. Prevalence and impact of pain in multiple sclerosis: physical and psychologic contributors.
Objective
To characterize the prevalence and impact of pain in veterans with multiple sclerosis (MS) and to assess their association with demographic, biologic, and psychologic variables.Design
Cross-sectional cohort study linking computerized medical record information to mailed survey data.Setting
Veterans Health Administration (VHA).Participants
Sixty-four percent (2994/4685) of veterans with MS who received services in VHA and also returned survey questionnaires.Interventions
Not applicable.Main Outcome Measures
Items assessing pain intensity, pain interference, and physical and mental health functioning.Results
Ninety-two percent of participants reported bodily pain within the prior 4 weeks, with 69% of the total sample indicating pain of moderate or higher intensity. Eighty-five percent indicated that pain caused functional interference during the past 4 weeks, with 71% of the total sample reporting pain-related interference that was moderate or greater. No significant sex or race differences emerged for the pain indices. A significant but modest relationship between increasing age and pain interference emerged (r=.05, P<.01); however, age was not significantly related to pain intensity. Multivariate regression analyses identified pain intensity (β=.73), physical health functioning (β=-.07), and mental health functioning (β=-.13) variables as significant, unique contributors to the prediction of pain interference. The interaction of pain intensity and physical functioning was also significant but of minimal effect size (β=-.03).Conclusions
Pain is highly prevalent and causes substantial interference in the lives of veterans with MS. The functional impact of pain in veterans with MS is influenced by pain intensity, physical health, and emotional functioning. Clinical practice should take each of these domains into consideration and reflect a biopsychosocial conceptualization. 相似文献15.
Hart DL Wang YC Stratford PW Mioduski JE 《Archives of physical medicine and rehabilitation》2008,89(11):2129-2139
Hart DL, Wang Y-C, Stratford PW, Mioduski JE. A computerized adaptive test for patients with hip impairments produced valid and responsive measures of function.
Objectives
To describe the use of a computerized adaptive test (CAT) in routine clinical practice and evaluate content coverage and construct validity, sensitivity to change, and responsiveness of hip CAT functional status (FS) measures.Design
Longitudinal, prospective observational cohort study.Setting
Two hundred fifty-seven outpatient rehabilitation clinics in 31 states (United States).Participants
Two samples were examined: intake and discharge rehabilitation FS data from patients (N=8714) treated for hip impairments between January 2005 and June 2007 and data from patients (N=444) used to develop the hip CAT were examined for comparison (2002-2004).Interventions
Not applicable.Main Outcome Measures
Hip functional status and global rating of change.Results
The CAT used on average 7 items to produce precise estimates of FS that adequately covered the content range with negligible floor and slight ceiling effects. Test information functions and SEs supported FS measure precision. FS measures discriminated patients in clinically logical ways. Sixty-one percent of patients obtained discharge FS measures greater than or equal to minimal detectable change (95% confidence intervals). Change of 6 FS units (scale: 0-100) represented minimal clinically important improvement, which 64% of patients obtained.Conclusions
The hip CAT was efficient; produced valid, responsive measures of FS for patients receiving therapy for hip impairments; and functioned well in routine clinical application but would benefit from more difficult items. 相似文献16.
Objectives
Patellar taping is used by clinicians to reduce pain, increase strength and enhance neuromuscular recruitment in patients with patellofemoral pain. This study explored the effect of medial patellar taping on these parameters in physically active subjects with and without patellofemoral pain.Study design
A placebo-controlled clinical trial with randomised interventions.Setting
Sport Science Institute of South Africa.Participants
Fifteen subjects with patellofemoral pain (experimental group) and 20 subjects without patellofemoral pain (healthy cohort).Methods
Pain perception, quadriceps force output and electromyographic (EMG) data were collected during maximal quadriceps strength testing and submaximal step testing for each intervention.Intervention
Subjects were tested during three different knee taping conditions: (1) no tape; (2) placebo tape; and (3) medial tape, in a randomised order.Main outcome measures
Visual analogue scale (VAS), isokinetic and isometric force output, and EMG analysis.Results
Medial patellar tape did not result in a significant reduction in pain during the step testing (step-up) in the group with patellofemoral pain (no tape condition: mean VAS 1.0, 95% confidence interval 0.30-1.70; taped condition: mean VAS 1.07, 95% confidence interval 0.22-1.91) or an increase in quadriceps force output. However, there was a significant decrease in EMG activity of the vastus medialis oblique in both groups during the closed chain step test (e.g. group with patellofemoral pain, no tape condition: mean 77%, 95% confidence interval 62-92%; taped condition: mean 64%, 95% confidence interval 53-75%, P < 0.05).Conclusion
Although taping did not reduce pain in the patellofemoral pain group, it did enhance the efficiency of the vastus medialus oblique. Future studies should determine whether there are clinical benefits to these findings. 相似文献17.
Jeroen M.L. Hendriks Rianne de Wit Hubertus J.M. Vrijhoef Robert G. Tieleman 《International journal of nursing studies》2010,47(10):1310-1316
Background
Adherence to guidelines for the management of atrial fibrillation (AF) is often poor, although this is associated with improved morbidity and mortality in such patients. Increasing numbers of programs are designed to enhance appropriate counselling, treatment and coordinated care delivery including the nurse-led, guidelines-based, software-supported integrated chronic care program (ICCP) for patients with AF reported here.Objectives
This paper outlines the study protocol and methodology currently being used to evaluate the effectiveness of a newly developed nurse-led, guideline-based, software-supported ICCP for patients with AF.Design and methods
Evaluation of the ICCP is currently being carried out in the outpatient care setting known as the AF-Clinic. A prospective randomised controlled trial is currently underway in the outpatient AF-Clinic of a University Hospital in the Netherlands in cooperation with the collaborating university. The primary outcome measures are cardiovascular hospitalisation and/or death. Secondary outcome measures include guideline adherence, patient knowledge about their condition, quality of life, satisfaction and other outcome measurements such as cost-effectiveness.Participants
It was calculated that 698 participants are needed to demonstrate discernible outcomes in relation to the primary endpoint (349 patients in each group) with follow-up after 1 year.Results
The study started in January 2007 and the first results are expected in the beginning of 2010.Conclusions
It is hypothesised that the ICCP may contribute towards closing the gap between guideline recommendations and current practice in the management of atrial fibrillation. Furthermore, it is hypothesised that the program has the potential to optimise the management of AF patients and improve the efficiency and coordination of patient care. This may lead to better patient outcomes including improved quality of life and patient satisfaction in such patients. 相似文献18.
Seungcheol Lee Chan Sam Moon Donggeun Sul Jiyoung Lee Youngki Hong Seonyoung Choi Byung-Jo Kim Joon-Sik Yoon Jaemin Kim Sun-Wook Hwang Sang-Heon Lee 《Clinical biochemistry》2009,42(15):1504-39749
Objectives
This study was conducted to investigate the expression of cytokines and growth factors in disc specimens obtained from patients with herniated nucleus pulposus (HNP) and degenerated disc disease (DDD).Design and methods
MRI and Western blot analyses were performed to evaluate the levels of disc degeneration and the expression levels of cytokines and growth factors.Results
The levels of TNF-α and IL-8 were significantly greater in the DDD group than in the HNP group, but no statistical differences were observed in the expression of IL-1β, IL-6 and IL-12 between the HNP and DDD groups. In addition, the expression of TGF β, VEGF and NGF was significantly higher in the DDD group than in the HNP group.Conclusion
The greater levels of cytokine and growth factor expression in the DDD group than in the HNP explain why discogenic patients usually have more severe back pain than patients with herniated discs. 相似文献19.
Michael I. Weintraub David N. Herrmann A. Gordon Smith Misha M. Backonja Steven P. Cole 《Archives of physical medicine and rehabilitation》2009,90(7):1102-1109
Weintraub MI, Herrmann DN, Smith AG, Backonja MM, Cole SP. Pulsed electromagnetic fields to reduce diabetic neuropathic pain and stimulate neuronal repair: a randomized controlled trial.
Objective
To determine whether repetitive and cumulative exposure to low-frequency pulsed electromagnetic fields (PEMF) targeting painful feet can reduce neuropathic pain (NP), influence sleep in symptomatic diabetic peripheral neuropathy (DPN), and influence nerve regeneration.Design
Randomized, double-blind, placebo-controlled parallel study.Setting
Sixteen academic and clinical sites in 13 states.Participants
Subjects (N=225) with DPN stage II or III were randomly assigned to use identical devices generating PEMF or sham (placebo) 2 h/d to feet for 3 months.Interventions
Nerve conduction testing was performed serially.Main Outcome Measures
Pain reduction scores using a visual analog scale (VAS), the Neuropathy Pain Scale (NPS), and the Patient's Global Impression of Change (PGIC). A subset of subjects underwent serial 3-mm punch skin biopsies from 3 standard lower limb sites for epidermal nerve fiber density (ENFD) quantification.Results
Subjects (N=225) were randomized with a dropout rate of 13.8%. There was a trend toward reductions in DPN symptoms on the PGIC, favoring the PEMF group (44% vs 31%; P=.04). There were no significant differences between PEMF and sham groups in the NP intensity on NPS or VAS. Twenty-seven subjects completed serial biopsies. Twenty-nine percent of PEMF subjects had an increase in distal leg ENFD of at least 0.5 SDs, while none did in the sham group (P=.04). Increases in distal thigh ENFD were significantly correlated with decreases in pain scores.Conclusions
PEMF at this dosimetry was noneffective in reducing NP. However neurobiological effects on ENFD, PGIC and reduced itching scores suggest future studies are indicated with higher dosimetry (3000-5000 G), longer duration of exposure, and larger biopsy cohort. 相似文献20.
Nijs J Roussel N Vermeulen K Souvereyns G 《Archives of physical medicine and rehabilitation》2005,86(7):1349-1355
Nijs J, Roussel N, Vermuelen K, Souvereyns G. Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests.