The effect of whole-body vibration therapy on bone metabolism,motor function,and anthropometric parameters in women with postmenopausal osteoporosis

Purpose: To review the research literature on the effectiveness of whole-body vibration (WBV) therapy in women with postmenopausal osteoporosis.

Methods: A systematic review was conducted by two independent reviewers. Mean differences (MDs), standardized mean differences (SMDs), and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed with the I² test. The Cochrane risk of bias tool was used to assess the methodological quality of the selected studies.

Results: Nine randomized controlled trials involving 625 patients met the inclusion criteria. No significant improvement was found in bone mineral density (BMD) (SMD?=??0.06, 95%CI=??0.22–0.11, p?=?0.50); bone turnover markers (MD?=??0.25, 95%CI=??0.54–0.03, p?=?0.08); anthropometric parameters, including muscle mass, fat mass, body mass index (BMI), and weight (SMD?=?0.02, 95%CI=??0.16–0.21, p?=?0.81); or maximal isotonic knee extensor strength (SMD?=?0.16, 95%CI=??0.63–0.95, p?=?0.69). However, maximal isometric knee extensor strength improved (SMD?=?0.71, 95%CI?=?0.34–1.08, p?=?0.0002).

Conclusions: WBV is beneficial for enhancing maximal isometric knee extensor strength, but it has no overall treatment effect on BMD, bone turnover markers, anthropometric parameters, or maximal isotonic knee extensor strength in women with postmenopausal osteoporosis.

• Implication of rehabilitation

• Osteoporosis is the leading underlying cause of fractures in postmenopausal women, whole body vibration (WBV) has received much attention as a potential intervention for the management of osteoporosis in recent years.

• Whole body vibration is beneficial for enhancing maximal isometric knee extensor strength in women with postmenopausal osteoporosis.

• Whole body vibration has no overall treatment effect on bone mineral density, bone turnover markers, anthropometric parameters and maximal isotonic knee extensor strength in women with postmenopausal osteoporosis.

     

An exploration of knowledge and practice of patient handling among undergraduate occupational therapy students

Abstract

Purpose: To explore knowledge and practice relating to patient handling among final year occupational therapy students in the Republic of Ireland. Method: We conducted a survey of final year students in three out of four occupational therapy programs in the Republic of Ireland (n?=?81). The survey measured students’ knowledge of manual handling principles and techniques and explored their experiences and ability to apply this knowledge to clinical situations. Results: All students (n?=?81) had undertaken training in patient handling. Just under half of students (n?=?35, 43.2%) had received additional training outside of the university setting. Overall knowledge of safe patient handling principles techniques and risk assessment was low (Mean Score?=?15.71/28; SD?=?3.81). Participants who received additional training achieved a lower mean total score (M?=?13.89, SD?=?3.54) than those who only undertook university-based training (M?=?18.11; SD?=?2.66; t(79)?=??5.87; p?<?0.05). The majority of participants reported intermittent use of taught principles while on clinical practice placements (n?=?50, 61.8%) Reasons for not using taught principles included; selection of alternative technique by supervisor (n?=?30, 56.6%); lack of available equipment (n?=?13, 24.5%) and lack of time (n?=?13, 24.5%). Conclusions: While occupational therapy students in Ireland receive training in safe patient handling they appear to have limited knowledge of best practice and experience difficulties in applying their learning to clinical situations. There is an urgent need to consider the effectiveness of current educational strategies in this area.

• Implications for Rehabilitation

• Safe patient handling is a key component in preventing musculoskeletal injury among rehabilitation professionals

• The extent to which pre-professional training prepares rehabilitation professionals to practice safe patient handling is unclear

• Occupational therapy students in this study had limited knowledge of safe patient handling and had difficulty applying their learning to clinical practice

• Alternative education models are required to support development of safe patient handling skills.

• Educators may wish to consider how safe patient handling can be embedded across curricula to avoid the challenges of once off instruction and massed practice.

     

Limited value of NT-proBNP as a prognostic marker of all-cause mortality in patients with heart failure with preserved and mid-range ejection fraction in primary care: A report from the swedish heart failure register

Abstract

Aim: The prognostic value of natriuretic peptides in the management of heart failure (HF) patients with ejection fraction (EF) <40% is well established, but is less known for those with EF ≥40% managed in primary care (PC). Therefore, the aim of this study is to describe the prognostic significance of plasma NT-proBNP in such patients managed in PC.

Subjects: We included 924 HF patients (48% women) with EF ≥40% and NT-proBNP registered in the Swedish Heart Failure Registry. Follow-up was 1100?±?687?days.

Results: One-, three- and five-year mortality rates were 8.1%, 23.9% and 44.7% in patients with EF 40–50% (HFmrEF) and 7.3%, 23.6% and 37.2% in patients with EF ≥50% (HFpEF) (p?=?0.26). Patients with the highest mean values of NT-proBNP had the highest all-cause mortality but wide standard deviations (SDs). In univariate regression analysis, there was an association only between NT-proBNP quartiles and all-cause mortality. In HFmrEF patients, hazard ratio (HR) was 1.96 (95% CI 1.60–2.39) p?<?0.0001) and in HFpEF patients, HR was 1.72 (95% CI 1.49–1.98) p?<?0.0001). In a multivariate Cox proportional hazard regression analysis, adjusted for age, NYHA class, atrial fibrillation and GFR class, this association remained regarding NT-proBNP quartiles [HR 1.83 (95% CI 1.38–2.44), p?<?0.0001] and [HR 1.48 (95% CI 1.16–1.90), p?=?0.0001], HFmrEF and HFpEF, respectively.

Conclusion: NT-proBNP has a prognostic value in patients with HF and EF ≥40% managed in PC. However, its clinical utility is limited due to high SDs and the fact that it is not independent in this population which is characterized by high age and much comorbidity.

• Key points

• It is uncertain whether NT-proBNP predicts risk in heart failure with preserved ejection fraction (EF?>?40%, HFpEF) managed in primary care.

• We show that high NT-proBNP predicts increased all-cause mortality in HFpEF-patients managed in primary care.

• The clinical use is however limited due to large standard deviations, many co-morbidities and high age.

• Many of these co-morbidities contribute to all-cause mortality and management of these patients should also focus on these co-morbidities.

     

Integrative group-based cognitive rehabilitation efficacy in multiple sclerosis: a randomized clinical trial

Purpose: This study aimed to determine the efficacy of the integrative group-based cognitive rehabilitation programme, REHACOP, on improving cognitive functions in multiple sclerosis (MS).

Methods: Fourty-two MS patients were randomized to the treatment programme REHACOP (n?=?21) or waiting list control condition (n?=?21). The REHACOP group received cognitive rehabilitation in group format for three months focused on attention, processing speed, learning and memory, language, executive functioning, and social cognition. Patients completed a neuropsychological assessment at baseline and follow-up, which included tests of attention, processing speed, working memory, verbal memory, verbal fluency, and executive functioning. Repeated measures multivariate analysis of covariance (MANCOVA) was used to determine the efficacy of the cognitive rehabilitation programme.

Results: Group?×?Time interactions revealed significant improvements in the REHACOP group as compared with the control group for processing speed (p?=?0.011, n_p²?=?0.16), working memory (p?=?0.014, n_p²?=?0.15), verbal memory (p?=?0.025, n_p²?=?0.13), and executive functioning (p?=?0.024, n_p²?=?0.13), showing medium–large effect sizes.

Conclusions: Patients receiving REHACOP showed improvements in several cognitive domains. This preliminary study thus provides evidence supporting the efficacy of this integrative group-based cognitive rehabilitation intervention in MS. Future research should confirm these findings, examine the impact of the treatment on everyday life functioning and explore the presence of brain changes associated with cognitive rehabilitation.

• Implications for rehabilitation

• This study provides initial evidence for integrative group-based cognitive rehabilitation efficacy in MS patients through the implementation of the REHACOP cognitive rehabilitation programme.

• Patients received cognitive rehabilitation for three months (3 one-hour-sessions per week) focused on training attention, learning and memory, language, executive functioning, and social cognition.

• Patients attending REHACOP sessions showed medium to large and statistically significant improvements in processing speed, working memory, verbal memory, and executive functioning.

     

Examining the relationship between post-traumatic stress disorder and social participation among Veterans with spinal cord injuries and disorders

Abstract

Purpose: The objectives of this study were to examine differences in social participation among Veterans with spinal cord injuries/disorders with and without post-traumatic stress disorder, and determine if lower social participation was independently associated with having post-traumatic stress disorder.

Methods: A cross-sectional mailed national survey was sent to a national sample of Veterans with spinal cord injuries/disorders who received prior-year Veterans Affairs healthcare. Surveys provided data on: demographics, health conditions, injury characteristics, and social participation. Analyses included bivariate comparisons, and multivariate logistic regression to determine if lower social participation was independently associated with post-traumatic stress disorder.

Results: Veterans with (vs. without) post-traumatic stress disorder (n?=?896) reported lower social participation (40.2 vs. 43.9, p?<?0.0001). Multivariate analyses showed that longer duration of injury (OR?=?0.98, 95% CI: 0.97–1.00, p?=?0.04) and white race (OR?=?0.62, 95% CI: 0.38–1.01, p?=?0.05) were associated with lower odds of post-traumatic stress disorder, while a greater number of health conditions (OR?=?1.43, 95% CI: 1.25–1.64, p?<?0.0001) was associated with greater odds. When controlling for covariates, lower social participation was independently associated with post-traumatic stress disorder (OR?=?0.94, 95% CI: 0.90–0.98, p?=?0.003).

Conclusions: Results indicate post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation. Efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation.

• Implications for Rehabilitation

• Individuals with spinal cord injuries/disorders often have post-traumatic stress disorder; in Veterans with spinal cord injuries/disorders this may be compounded by trauma incurred through military experiences.

• Social participation, an important aspect of rehabilitation and community integration following spinal cord injury or disorder, may be hindered by symptoms of post-traumatic stress disorder.

• Our data show that post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation.

• These results indicate that efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation in this patient population.

     

Potentially severe drug–drug interactions among older people and associations in assisted living facilities in Finland: a cross-sectional study

Objective: This study aims to assess potentially severe class D drug–drug interactions (DDDIs) in residents 65 years or older in assisted living facilities with the use of a Swedish and Finnish drug–drug interaction database (SFINX).

Design: A cross-sectional study of residents in assisted living facilities in Helsinki, Finland.

Setting: A total of 1327 residents were assessed in this study. Drugs were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and DDDIs were coded according to the SFINX.

Main outcome measures: Prevalence of DDDIs, associated factors and 3-year mortality among residents.

Results: Of the participants (mean age was 82.7 years, 78.3% were females), 5.9% (N?=?78) are at risk for DDDIs, with a total of 86 interactions. Participants with DDDIs had been prescribed a higher number of drugs (10.8 (SD 3.8) vs. 7.9 (SD 3.7), p?p?=?0.030). The most frequent DDDIs were related to the concomitant use of potassium with amiloride (N?=?12) or spironolactone (N?=?12). Carbamazepine (N?=?13) and methotrexate (N?=?9) treatments were also frequently linked to DDDIs. During the follow-up, no differences in mortality emerged between the participants exposed to DDDIs and the participants not exposed to DDDIs.

Conclusions: Of the residents in assisted living, 5.9% were exposed to DDDIs associated with the use of a higher number of drugs. Physicians should be trained to find safer alternatives to drugs associated with DDDIs.

• KEY POINTS

• Potentially severe, class D drug–drug interactions (DDDIs) have been defined in the SFINX database as clinically relevant drug interactions that should be avoided.

• ???Of the residents in assisted living, 5.9% were exposed to DDDIs that were associated with the use of a higher number of drugs.

• ???The most frequent DDDIs were related to the concomitant use of potassium with amiloride or spironolactone. Carbamazepine and methotrexate were also linked to DDDIs.

• ???No difference in mortality was observed between residents exposed to DDDIs and residents not exposed to DDDIs.

     

Level of agreement between physical activity levels measured by ActiHeart and the International Physical Activity Questionnaire in persons with intellectual disability

Purpose: The purpose of this study was to determine the level of agreement between objective physical activity (PA) (ActiHeart^®) and subjective proxy-respondent International Physical Activity Questionnaire-short version (IPAQ-S) data in adults with intellectual disabilities (IDs).

Method: Fifty-eight participants wore ActiHeart^® monitors for seven consecutive days. Caregivers of each participant completed the IPAQ-S on behalf of the participant. Total PA, time spent in light, moderate, and vigorous activity as well as time spent being sedentary were assessed by the IPAQ-S and the ActiHeart^®. Results were compared by means of correlation analyses. The level of agreement was presented with Bland–Altman plots.

Results: Objective PA (ActiHeart^®) was higher (225.57?±?91.96?min/week) than IPAQ-S PA reported by care-givers (177.06?±?309.17?min/week). Weak significant correlations were observed between the ActiHeart^® and IPAQ-S instruments for sedentary behavior (r?=?0.31; p?=?0.04); no significant correlations for light (r=??0.04; p?=?0.8), moderate (r=??0.07; p?=?0.63), or vigorous PA (r=??0.2; p?=?0.18) were found. Limited agreement between objectively determine PA (ActiHeart^®) and IPAQ-S was found.

Conclusion: IPAQ-S is inaccurate when determining PA in persons with ID as it significantly underestimates the true levels of PA in this cohort.

• Implications for Rehabilitation

• Persons with intellectual disability (ID) report insufficient physical activity for health benefits.

• Physical activity is often determined by means of subjective proxy reporting.

• Objective physical activity measurements by means of combined heart rate and accelerometer are necessary to determine accurate levels of physical activity in persons with ID.

• Exercise interventions should be based on objective physical activity measurements.

     

The impact of Professional Boundaries for Health Professionals (PBHP) training on knowledge,comfort, experience,and ethical decision-making: a longitudinal randomized controlled trial

Purpose: A randomized controlled trial was conducted to evaluate the impact of Professional Boundaries for Health Professionals (PBHP) training program on the knowledge, comfort, experience, and ethical decision-making of multidisciplinary practitioners facing client–practitioner boundary dilemmas.

Methods: In all, 36 rehabilitation practitioners from an Australian state-wide spinal cord injuries service were assigned to experimental and control groups. The Boundaries in Practice (BIP) Scale measured outcomes at four points: pre, post, 3 months, and 1 year. The control group received the training after 3 months. Nonparametric Friedman’s two-way analysis of variance was used to examine the trajectories over time.

Results: Analysis was conducted using the data of 10 experimental and 13 control group participants who responded at four data collection points. The experimental group showed significant improvement in knowledge (χ²?=?10.673, p?=?0.014) and comfort (χ²?=?9.727, p?=?0.021) managing professional boundaries post-training. The control group showed no significant change in knowledge or comfort. No significant change was seen in experience across either experimental (χ²?=?3.609, p?=?0.307) or control group (χ²?=?7.800, p?=?0.050). Ethical decision-making improved in the control group (χ²?=?13.188, p?=?0.004) following training, however remained unchanged in the experimental group.

Conclusions: The findings do not definitively support this training approach. Ethical decision-making may improve more substantially within the practice context and organizational culture change. Multifaceted approaches are indicated.

• Implications for Rehabilitation

• Ethical dilemmas related to boundaries between clients and practitioners are a frequent occurrence in the rehabilitation setting.

• In a relatively small sample, the current randomized trial provided inconclusive evidence on the benefit of a 1-day needs-oriented training program to improve knowledge, comfort, and ethical decision-making.

• Randomized trials of education and training for rehabilitation practitioners are fraught with challenges in the clinical environment of the rehabilitation setting.

• Multifaceted training approaches, management support and training as well as changes to policy and organizational context in the rehabilitation setting may be needed to more holistically address the issues surrounding professional boundaries in the rehabilitation setting.

     

Mastery motivation: a way of understanding therapy outcomes for children with unilateral cerebral palsy

Abstract

Purpose: To investigate the impact of mastery motivation on occupational performance outcomes immediately following upper limb (UL) training and 6 months post-intervention for school-aged children with unilateral cerebral palsy. Method: This prediction study was a post-hoc analysis of a matched pairs randomized comparison trial (COMBiT Trial Registration: ACTRN12613000181707). The Canadian Occupational Performance Measure (COPM) was administered at baseline, 13 and 26 weeks post-intervention. Parents completed the Dimensions of Mastery Questionnaire (DMQ), Parenting Scale and a demographic questionnaire. Children’s UL capacity and performance was assessed using the Melbourne Assessment of Unilateral UL Function and assisting hand assessment (AHA). Regression models were fitted using generalized estimating equations to baseline, 13 and 26 week measurements. Results: Forty-six children (7.78 years SD 2.27 years, 31 males, Manual Ability Classification System I?=?23, II?=?23) participated. Higher levels of bimanual performance (AHA: β?=?0.03, p?<?0.001), greater object-oriented persistence (DMQ: β?=?0.31, p?=?0.05), and treatment group allocation (Standard Care: β?=?0.24, p?=?0.01) were positively associated with COPM performance scores post-intervention. Conclusions: Children’s bimanual performance and persistence with object-oriented tasks significantly impact occupational performance outcomes following UL training. Predetermining children’s mastery motivation along with bimanual ability may assist in tailoring of intervention strategies and models of service delivery to improve effectiveness.

• Implications for Rehabilitation

• Children’s object persistence and bimanual performance both impact upper limb training outcomes

• Working with children’s motivational predispositions may optimize engagement and therapy outcomes.

• Supporting positive parenting styles may enhance a child’s mastery motivation and persistence with difficult tasks.

     

Rehabilitation of activities of daily living in virtual environments with intuitive user interface and force feedback

Purpose: To investigate the feasibility of using a virtual rehabilitation system with intuitive user interface and force feedback to improve the skills in activities of daily living (ADL).

Method: A virtual training system equipped with haptic devices was developed for the rehabilitation of three ADL tasks – door unlocking, water pouring and meat cutting. Twenty subjects with upper limb disabilities, supervised by two occupational therapists, received a four-session training using the system. The task completion time and the amount of water poured into a virtual glass were recorded. The performance of the three tasks in reality was assessed before and after the virtual training. Feedback of the participants was collected with questionnaires after the study.

Results: The completion time of the virtual tasks decreased during the training (p?<?0.01) while the percentage of water successfully poured increased (p?=?0.051). The score of the Borg scale of perceived exertion was 1.05 (SD?=?1.85; 95% CI?= 0.18–1.92) and that of the task specific feedback questionnaire was 31 (SD?= 4.85; 95% CI?= 28.66–33.34). The feedback of the therapists suggested a positive rehabilitation effect. The participants had positive perception towards the system.

Conclusions: The system can potentially be used as a tool to complement conventional rehabilitation approaches of ADL.

• Implications for rehabilitation

• Rehabilitation of activities of daily living can be facilitated using computer-assisted approaches.

• The existing approaches focus on cognitive training rather than the manual skills.

• A virtual training system with intuitive user interface and force feedback was designed to improve the learning of the manual skills.

• The study shows that system could be used as a training tool to complement conventional rehabilitation approaches.

     

Place orientation and visual construction subdomains of the Mini Mental State Examination test as predictors of rehabilitation outcome of post-acute hip-fractured patients

Purpose: The study aimed at assessing the relationship between various Mini Mental State Examination (MMSE) subdomains and rehabilitation achievements in post-acute hip-fractured patients.

Method: Six hundred and five hip-fractured patients admitted during 2010–2013 to a post-acute geriatric rehabilitation center were included in the study. Main outcome measures were the Functional Independence Measure (FIM) instrument, the motor FIM (mFIM), the Montebello Rehabilitation Factor Score (MRFS) on the mFIM and length of stay (LOS). A logistic regression analysis tested the predictive value of MMSE subdomains for achieving a satisfactory functional gain (mFIM MRFS >30%) on operated patients admitted from community.

Results: Of all the six MMSE subdomains, place orientation and visual construction demonstrated significant predictive values for rehabilitation outcome. Patients who did not err on place orientation and visual construction MMSE domains had better probabilities [(OR 1.28, 95%CI, 1.05–1.58; p?=?0.017); (OR 2.15, 95%CI, 1.28–3.59; p?=?0.004), respectively] of achieving better rehabilitation achievements. Similar results were obtained for cognitively impaired patient groups [(OR 1.40 95%CI, 1.11–1.77; p?=?0.005); (OR 2.47, 95%CI, 1.15–5.30; p?=?0.021), respectively]. For the cognitively intact patient group, the variables with significant predictive value were time orientation and visual construction MMSE subdomains [(OR 2.26, 95%CI, 1.18–4.33; p?=?0.014); (OR 2.87, 95%CI, 1.16–7.09; p?=?0.022), respectively].

Conclusions: Post-acute hip-fractured patients scoring normally on place orientation and visual construction MMSE subdomains have a better chance of achieving favorable rehabilitation outcome.

• Implications for Rehabilitation

• Post-acute hip-fractured patients have a better chance to achieve a favorable rehabilitation outcome when scoring normally on place orientation and visual construction MMSE subdomains.

• Patients having difficulties in orientation and visual construction may need more rehabilitation time as they lack planning and organizational capacity to follow instructions.

• Assessing MMSE subdomains may reveal subtle cognitive impairment in patients scored within the normal range on the MMSE test.

• Identifying subtle cognitive impairment may assist in coordinating the patients and their caregivers' expectations, efficiently allocating resources and help in advanced care planning.

     

Applicability,validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions

Purpose: To verify the applicability, reproducibility and validity of the SCIM III patients with non-traumatic spinal cord injury.

Method: The cross-sectional study included 30 patients (66% females; 41.5?±?14.7 yo) with non-traumatic spinal cord injury of any etiology. Subjects were subjected by computerized gait analysis and answered the Brazilian versions of SCIM III (0–100 points) and FIM? (18–126 points) by two raters (A and B) at the same day and 1 week later (A).

Results: The intraclass correlation coefficient for the use of SCIM III indicated appropriated intra- and inter-evaluator reproducibility (ICC?=?0.9). Correlation between the SCIM III and the motor FIM? was appropriate (r?=?0.6; p?=?0.0). SCIM III subscales and FIM? domains correlated strongly for self-care (r?=?0.8; p?≤?0.001), moderately for transfers (r?=?0.6; p?=?0.0005) and locomotion (r?=?0.6; p?=?0.0006). SCIM III mobility subscale positively correlated with the cadence (r?=?0.8; p?≤?0.01), gait speed (r?=?0.7; p?≤?0.01) and step length (r?=?0.6; p?≤?0.01).

Conclusions: SCIM III is a reproducible functional assessment instrument and capable of evaluating the level of independence of the individual with non-traumatic spinal cord injury. The SCIM III is more sensitive than the MIF? for non-traumatic spastic paraplegic patients with higher levels of independence, particularly if they can walk independently. Linear gait parameters correlated with its mobility subscale.

• Implications for Rehabilitation

• Applicability, validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions.

• There are not many studies focused on patients with non-traumatic spinal cord lesion.

• Disability varies in severity, but frequently contributes to limitations in the activities of daily living (ADL) and participation.

• We do not find in the literature studies that assess the functionality of these individuals as comprehensive as ours.

     

Are the changes in observed functioning after multi-disciplinary rehabilitation of patients with fibromyalgia associated with changes in pain self-efficacy?

Objective: To examine the hypothesis that change in pain self-efficacy is associated with observed and self-reported activity, pain intensity, catastrophizing, and quality of life after multi-disciplinary rehabilitation of fibromyalgia patients.

Design: In-depth analyses of secondary outcomes of a randomized-controlled trial.

Subjects: Women (N?=?187) with fibromyalgia.

Methods: Outcomes were Pain Self-Efficacy, Assessment of Motor and Process Skills (AMPS), SF-36 Physical Function (SF-36-PF), pain intensity, and SF-36 Mental Composite Score (SF-36-MCS) to assess quality of life and pain catastrophizing. Individual and group associations between outcomes were examined.

Results: Individual changes in pain self-efficacy were not associated with changes in observed activity: AMPS motor (r_s?=?0.08, p?=?0.27) and process (r_s?=?0.12, p?=?0.11), not even in those patients with a clinically relevant improvement in observed functioning (38.5%), and only weakly or moderatly with changes in SF-36-PF; (r_s?=?0.31, p?r_s?=?0.41, p?r_s?=??0.31, p?p?=?0.24). However, a subgroup (34%) had a clinically relevant improvement in pain self-efficacy. This group was younger (mean age 41.4 vs. 45.8, p?=?0.01), more recently diagnosed (1.8 vs. 2.8 years, p?=?0.003), but had an unresolved welfare situation (59% vs. 40%, p?=?0.02).

Conclusion: The main hypothesis was falsified, as there was no association between pain self-efficacy and actual performance of activity. The relation to functioning may be limited to perceived, cognitive-emotional aspects, as indicated by the weak to moderate correlations to the self-reported measures.

• Implications for Rehabilitation

• Improvement in observed activity post multi-disciplinary rehabilitation was not associated with change in pain self-efficacy.

• Patients performed better after rehabilitation, but did not perceive to have improved their capacity.

• The relationship between pain self-efficacy and functioning may be limited to cognitive-emotional aspects rather than actual activity.

• Both observational and self-reported measures should be included in evaluating outcomes of rehabilitation for patients with fibromyalgia.

     

Oropharyngeal dysphagia in children with cerebral palsy: comparisons between a high- and low-resource country

Purpose: There is paucity of research investigating oropharyngeal dysphagia (OPD) in young children with cerebral palsy (CP), and most studies explore OPD in high-resource countries. This study aimed at determining the proportion and severity of OPD in preschool children with CP in Bangladesh, compared to Australia.

Method: Cross-sectional, comparison of two cohorts. Two hundred and eleven children with CP aged 18–36 months, 81 in Bangladesh (mean?=?27.6 months, 61.7% males), and 130 in Australia (mean?=?27.4 months, 62.3% males). The Dysphagia Disorders Survey (DDS) – Part 2 was the primary OPD outcome for proportion and severity of OPD. Gross motor skills were classified using the Gross Motor Function Classification System (GMFCS), motor type/distribution.

Results: (i) Bangladesh sample: proportion OPD?=?68.1%; severity?=?10.4 SD?=?7.9. Australia sample: proportion OPD?=?55.7%; severity?=?7.0 SD?=?7.5. (ii) There were no differences in the proportion or severity of OPD between samples when stratified for GMFCS (OR?=?2.4, p?=?0.051 and β?=?1.2, p?=?0.08, respectively).

Conclusions: Despite overall differences in patterns of OPD between Bangladesh and Australia, proportion and severity of OPD (when adjusted for the functional gross motor severity of the samples) were equivalent. This provides support for the robust association between functional motor severity and OPD proportion/severity in children with CP, regardless of the resource context.

• Implications for Rehabilitation

• The proportion and severity of OPD according to gross motor function level were equivalent between high- and low-resource countries (LCs).

• Literature from high-resource countries may be usefully interpreted by rehabilitation professionals for low-resource contexts using the GMFCS as a framework.

• The GMFCS is a useful classification in LCs to improve earlier detection of children at risk of OPD and streamline management pathways for optimal nutritional outcomes.

• Rehabilitation professionals working in LCs are likely to have a caseload weighted towards GMFCS III–V, with less compensatory OPD management options available (such as non-oral nutrition through tubes).

     

Short stick exercises for fall prevention among older adults: a cluster randomized trial

Abstract

Purpose: To investigate the effects of short stick exercise (SSEs) on fall prevention and improvement of physical function in older adults. Methods: A cluster randomized trial was conducted in five residential care facilities. The intervention group (n?=?51) practiced SSEs for six months, followed by routine care for six more months. The control group (n?=?54) received ordinary care for 12 months. The primary outcome measure was the number of fallers, taking into account the time to first fall using the Kaplan–Meier method. The secondary outcome measures were physical and mental functions. Results: The number of fallers was significantly lower in the intervention group (n?=?6) than in the control group (n?=?16) during the 12 months. The adjusted hazard ratio for a first fall in the intervention group compared with the control group was 0.15 (CI, 0.03 to 0.74, p?=?0.02). The fall-free period was significantly longer in the intervention group than in controls (mean?±?SD, 10.1?±?3.0 versus 9.0?±?4.1 months, p?=?0.027). The functional reach and sit and reach tests were significantly improved at three and six months. Conclusion: The SSEs appeared effective for fall prevention and improvement of physical function in older adults.

• Implications for Rehabilitation

• The newly developed short stick exercises appear an effective means of reducing falls among older adults in residential care facilities.

• The short stick exercises seem to have an immediate effect on improving physical functions.

• Effects gained by performing the short stick exercises, such as static balance, flexibility and agility may last for six months.

• The short stick exercises were found to be easy for older adults to practice continuously in residential care facilities.

     

The therapeutic role of motor imagery on the functional rehabilitation of a stage II shoulder impingement syndrome

Abstract

Purpose: Motor imagery (MI) has been used as a complementary therapeutic tool for motor recovery after central nervous system disease and peripheral injuries. However, it has never been used as a preventive tool. We investigated the use of MI in the rehabilitation of stage II shoulder impingement syndrome. For the first time, MI is used before surgery. Method: Sixteen participants were randomly assigned to either a MI or control group. Shoulder functional assessment (Constant score), range of motion and pain were measured before and after intervention. Results: Higher Constant score was observed in the MI than in the control group (p?=?0.04). Participants in the MI group further displayed greater movement amplitude (extension (p?<?0.001); flexion (p?=?0.025); lateral rotation (p?<?0.001). Finally, the MI group showed greater pain decrease (p?=?0.01). Conclusion: MI intervention seems to alleviate pain and enhance mobility, this is probably due to changes in muscle control and consequently in joint amplitude. MI might contribute to postpone or even protect from passing to stage III that may require surgery.

• Implications for Rehabilitation

• Adding motor imagery training to classical physical therapy in a stage II impingement syndrome:

• Helps in alleviating pain

• Enhances shoulder mobility

• Motor imagery is a valuable technique that can be used as a preventive tool before the stage III of the impingement syndrome.

     

Validity of the shuttle walk test as a functional assessment of walking ability in individuals with polyneuropathy

Purpose: This study assessed the validity of the shuttle walk test (SWT) to evaluate walking ability in patients with polyneuropathy.

Methods: Forty-one patients with chronic idiopathic axonal polyneuropathy (CIAP) and 49 patients with multifocal motor neuropathy (MMN) performed both the 10-meter walk test (10MWT) and the SWT. Face validity was assessed by evaluating whether patients considered both tests to reflect their walking ability (Likert scale: 1?=?not at all, 10?=?very well). Concurrent validity was determined by Spearman rank-correlation analyses performed on the outcomes of both tests.

Results: Mean (SD) scores for how well the 10MWT and SWT reflected daily walking ability were 6.8 (1.3) and 7.4 (1.6) (p?=?0.117) in patients with CIAP and 6.9 (1.2) and 7.9 (1.0) (p?=?0.001) in patients with MMN, respectively. Correlation scores between both tests ranged from ?0.70 to ?0.82, except for 18 patients with MMN with a “normal” walking speed at the 10MWT (?0.21).

Conclusion: The SWT seems a valid instrument for assessing walking ability in individuals with CIAP and MMN. Moreover, the SWT seems to be useful for investigating the symptoms elicited by walking long distances and may be more sensitive to changes when compared to the 10MWT.

• Implications for Rehabilitation

• Patients with polyneuropathy mainly experience problems when walking long distances.

• The 10-meter walk test does not possess sufficient psychometrics to diagnose walking abilities in these circumstances.

• The shuttle walk test is a valid instrument for assessing walking ability in individuals with polyneuropathy and might be the preferred instrument of choice when compared to the 10-meter walk test.

     

Effect of mirror therapy on hand function in patients with hand orthopaedic injuries: a randomized controlled trial

Abstract

Purpose: To investigate the effects of mirror therapy (MT) in restoring hand function in patients with active range of motion (AROM) impairments following orthopaedic injuries. Method: In a randomized controlled trial (RCT), 30 patients with active ROM impairment (8 men and 22 women; mean age: 38 years) were measured. Intervention group received MT, 30?min a day, five days a week for three weeks, as well, half an hour conventional rehabilitation after each MT session. Patients in the control group received the same treatment programme, but instead of mirror, they observed directly the affected hand. In addition, both groups performed a 15?min home programme, including MT for intervention group and AROM with direct observation of the affected hand for control group, twice daily. Outcome measures, including total active motion (TAM) and Disabilities of Arm, Shoulder and Hand (DASH) questionnaire, were administered pre- and post-treatment and three weeks later. This study was registered as an RCT, no. NCT01503762 in http://clinicaltrials.gov/. Results: Final analysis was performed on 23 patients. The mean (SD) changes at post-test from baseline TAM was 154 (32) in the MT (N?=?12) and 61 (24) in the control group (N?=?11); mean difference (95% CI) 93 (68–118), p?=?0.001. The mean (SD) change at post-test from baseline DASH was ?34 (7) in the MT (N?=?12) and ?15 (11) in the control group (N?=?11); mean difference (95% CI) 19 (?27 to ?11), p?=?0.001. Conclusions: Despite significant improvement at post-test in both groups and maintenance of improvement during the follow-up period, MT combined with conventional rehabilitation produced more improvement in hand function than control group.

• Implications for Rehabilitation

• Hand orthopaedic injuries can result in disabilities in activities of daily living.

• Mirror therapy (MT) provides perception of two healthy limbs through reflection of the healthy limb as the injured limb.

• In a randomized controlled trial, our study shows positive effects of MT combined with a classical rehabilitation programme to improve hand function in patients with orthopaedic injuries.

     

Basic body awareness therapy or exercise therapy for the treatment of chronic whiplash associated disorders: a randomized comparative clinical trial

Purpose: Chronic whiplash-associated disorders (WAD) incur both costs and suffering. Treatments that can relieve chronic WAD are therefore needed. Exercise therapy (ET) has been shown to provide pain relief. Another often used treatment for chronic pain in Scandinavia is basic body awareness therapy (BAT). We compared the effectiveness of 10 weeks of twice-weekly, 90-min sessions of either ET or BAT in a randomized comparative trial. Method: We recruited 113 patients suffering from chronic WAD grades I–III and several years’ duration of symptoms in a primary health care setting. 57 were allocated to ET and 56 to BAT. Primary outcome measures were Neck Disability Index and SF-36 v.2. Results: From baseline to post-treatment, the BAT group increased their physical functioning (median 5, IQR?=?15) more than the ET group (median?=?0, IQR?=?15), p?=?0.032, effect size ?0.54. Three months after the end of treatment, the BAT group had less bodily pain (m?=?17.5, 95% CI 6.9–17.6) than the ET group (m =?4.9, 95% CI ?0.1 to 9.8), p?=?0.044, effect size ?0.4. The BAT group had also increased their social functioning (m?=?13.3, 95% CI 6.6–19.9) more than the ET group (m?=?3.5, 95% CI ?3 to 9.9), p?=?0.037, effect size ?0.41. No statistically significant differences between groups were found for the change of other outcomes. No serious adverse effects were found in either groups. Conclusions: The present trial indicates that BAT led to greater improvements than ET for the patients with chronic WAD.

• Implications for Rehabilation

• Chronic whiplash-associated disorders are disabling and incur great costs to society often through inability to work.

• Exercise therapy (ET) may alleviate symptoms of chronic WAD.

• Basic body awareness therapy (BAT) is often a component of multimodal pain rehabilitation programs.

• In this randomized comparative trial, BAT increased physical functioning and led to greater pain reduction and social functioning 3 months after the end of treatment.