Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement

Bell DR, Padua DA, Clark MA. Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement.

Objective

To determine differences in strength and range of motion (ROM) between participants who exhibit medial knee displacement (MKD) during a squat that is corrected by a heel lift and those who do not.

Design

Case control.

Setting

Sports medicine research laboratory.

Participants

Thirty-seven healthy subjects (control, 19; MKD, 18) with no lower-extremity injury in the past 6 months volunteered to participate.

Interventions

Not applicable.

Main Outcome Measures

Peak force was measured in newtons using a hand-held dynamometer and passive ROM was measured in degrees with a goniometer. Separate multivariate analyses of variance were used to determine differences in strength and ROM between groups. Post hoc testing was used to elucidate differences between groups.

Results

The MKD group had the following: greater hip external rotation strength (P=.03), increased hip extension strength (P=.01), less plantarflexion strength (P=.007), and increased hip external rotation ROM (P=.008).

Conclusions

The MKD group exhibited tight and weak ankle musculature. Interventions focusing on improving strength and ROM of the ankle may improve kinematics during a squat.     

Can the Six-Minute Walk Test Predict Peak Oxygen Uptake in Men With Heart Transplant?

Doutreleau S, Di Marco P, Talha S, Charloux A, Piquard F, Geny B. Can the six-minute walk test predict peak oxygen uptake in men with heart transplant?

Objective

To determine whether the six-minute walk test (6MWT) might predict peak oxygen consumption (Vo₂peak) after heart transplantation.

Design

Case-control prospective study.

Setting

Public hospital.

Participants

Patients with heart transplant (n=22) and age-matched sedentary male subjects (n=13).

Interventions

Not applicable.

Main Outcome Measures

Exercise performance using a maximal exercise test, distance walked using the 6MWT, heart rate, and Vo₂peak.

Results

Compared with controls, exercise performance was decreased in patients with heart transplant with less distance ambulated (516±13m vs 592±13m; P<.001) and a decrease in mean Vo₂peak (23.3±1.3 vs 29.6±1mL·min⁻¹·kg⁻¹; P<.001). Patients with heart transplant showed an increased resting heart rate, a response delayed both at the onset of exercise and during recovery. However, the patient's heart rate at the end of the 6MWT was similar to that obtained at the ventilatory threshold. The formula did not predict measured V?o₂, with a weak correlation observed between the six-minute walk distance and both Vo₂peak (r=.53; P<.01) and ventilatory threshold (r=.53; P<.01) after heart transplantation. Interestingly, when body weight was considered, correlations coefficient increased to .74 and .77, respectively (P<.001).

Conclusions

In heart transplant recipients, the 6MWT is a safe, practical, and submaximal functional test. The distance-weight product can be used as an alternative method for assessing the functional capacity after heart transplantation but cannot totally replace maximal V?o₂ determination.     

Validity of the Fingertip-To-Floor Test and Straight Leg Raising Test in Patients With Acute and Subacute Low Back Pain: A Comparison by Sex and Radicular Pain

Ekedahl KH, Jönsson B, Frobell RB. Validity of the fingertip-to-floor test and straight leg raising test in patients with acute and subacute low back pain: a comparison by sex and radicular pain.

Objective

To use self-reported disability (Roland-Morris Disability Questionnaire [RMDQ]) to assess the criterion validity of straight leg raising (SLR) test and flexion range of motion (ROM) (fingertip-to-floor test) before and after stratification by sex and presence/absence of radicular pain.

Design

Cross-sectional study.

Setting

Outpatient physical therapy clinic.

Participants

Subjects with acute/subacute low back pain with (n=40) and without (n=35) radicular pain.

Interventions

Not applicable.

Main Outcome Measures

We examined the relationship between RMDQ (reference variable) and SLR test and fingertip-to-floor test. The sample was stratified by presence/absence of radicular pain (categorized by the dichotomous slump test).

Results

In the entire sample, fair correlations were found between both physical impairment tests (ie, SLR test and flexion ROM) and self-reported disability (.27<r>.44). After stratification by sex, the correlation between RMDQ and flexion ROM and between RMDQ and nonside-specific SLR test increased in women but decreased in men. In those with radicular pain, good correlations were found between RMDQ and flexion ROM (r=.68 for men and r=.70 for women), and moderate correlation was found between the RMDQ and SLR tests of the affected side in women (r=.60), but only fair correlation was found between the RMDQ and SLR tests of the affected side in men (r=.28).

Conclusions

After stratification by sex and presence/absence of radicular pain, the present study supports a good validity of the fingertip-to-floor test for both men and women with radicular pain. The SLR test, however, was of less value as an indicator of self-reported disability after stratification, especially for men.     

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

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.     

Action Observation Treatment Improves Recovery of Postsurgical Orthopedic Patients: Evidence for a Top-Down Effect?

Bellelli G, Buccino G, Bernardini B, Padovani A, Trabucchi M. Action observation treatment improves recovery of postsurgical orthopedic patients: evidence for a top-down effect?

Objective

To assess whether action observation treatment (AOT) may also improve motor recovery in postsurgical orthopedic patients, in addition to conventional physiotherapy.

Design

Randomized controlled trial.

Setting

Department of rehabilitation.

Participants

Patients (N=60) admitted to our department postorthopedic surgery were randomly assigned to either a case (n=30) or control (n=30) group. Exclusion criteria were age 18 years or younger and 90 years or older, Mini-Mental State Examination score of 21 of 30 or lower, no ambulating order, advanced vision impairment, malignancy, pneumonia, or heart failure.

Interventions

All participants underwent conventional physiotherapy. In addition, patients in the case group were asked to observe video clips showing daily actions and to imitate them afterward. Patients in the control group were asked to observe video clips with no motor content and to execute the same actions as patients in the case group afterward. Participants were scored on functional scales at baseline and after treatment by a physician blinded to group assignment.

Main Outcomes Measures

Changes in FIM and Tinetti scale scores, and dependence on walking aids.

Results

At baseline, groups did not differ in clinical and functional scale scores. After treatment, patients in the case group scored better than patients in the control group (FIM total score, P=.02; FIM motor subscore, P=.001; Tinetti scale score, P=.04); patients in the case group were assigned more frequently to 1 crutch (P=.01).

Conclusions

In addition to conventional physiotherapy, AOT is effective in the rehabilitation of postsurgical orthopedic patients. The present results strongly support top-down effects of this treatment in motor recovery, even in nonneurologic patients.     

The efficacy of a multidisciplinary falls prevention clinic with an extended step-down community program

Sze P-C, Cheung W-H, Lam P-S, Lo HS-D, Leung K-S, Chan T. The efficacy of a multidisciplinary falls prevention clinic with an extended step-down community program.

Objective

To investigate the efficacy of a falls prevention clinic and a community step-down program in reducing the number of falls among community-dwelling elderly at high risk of fall.

Design

Prospective cohort.

Setting

Community.

Participants

Community-dwelling elderly (N=200) were screened for risk of fall; 60 were identified as being at high risk and were referred to the intervention program.

Intervention

Twelve sessions of a once-a-week falls prevention clinic, including fall evaluation, balance training, home hazard management program, and medical referrals, were provided in the first 3 months. The community step-down program, including falls prevention education, a weekly exercise class, and 2 home visitations, was provided in the following 9 months.

Main Outcome Measures

Fall rate, injurious fall, and its associated medical consultation were recorded during the intervention period and the year before intervention. Balance tests included the Berg Balance Scale (BBS), Sensory Organization Test, and limits of stability test; fear of falling, as evaluated using the Activities-specific Balance Confidence (ABC) scale, was measured at baseline and after the training in the falls prevention clinic.

Results

Significant reductions in fall rate (74%), injurious falls (43%), and fall-associated medical consultation (47%) were noted. Significant improvement in balance scores (BBS, P<.001; endpoint excursion in limits of stability test, P=.004) and fear of falling (ABC scale, P=.001) was shown.

Conclusions

The programs in the falls prevention clinic were effective in reducing the number of falls and injurious falls. The community step-down programs were crucial in maintaining the intervention effects of the falls prevention clinic.     

Intrinsic Properties of the Knee Extensor Muscles After Subacute Stroke

Horstman AM, Gerrits KH, Beltman MJ, Koppe PA, Janssen, TW, de Haan A. Intrinsic properties of the knee extensor muscles after subacute stroke.

Objective

To characterize muscle properties of paretic lower-limb (PL) and nonparetic lower-limb (NL) knee extensors in patients with subacute stroke.

Design

Case-control study.

Setting

Rehabilitation center research laboratory.

Participants

Patients with subacute stroke (n=14) and able-bodied age-matched control subjects (n=12).

Interventions

Not applicable.

Main Outcome Measures

Half relaxation times (HRTs) and maximal rates of torque development (MRTDs) were assessed as indicators of contractile speed using both voluntary and electrically evoked contractions. Moreover, changes in torque were measured during a fatigue protocol (35 electrically evoked intermittent contractions; 1.5s on, 2s off) and recovery.

Results

No differences among groups were found for normalized MRTDs during electrically evoked contractions (P=.117). However, during voluntary contractions both PLs (53% of control, P=.022) and NL (71% of control, P<.001) had significantly lower MRTD compared with control. Both PL (134% of control, P=.001) and NL (123% of control, P=.032) had significantly higher HRTs than control, indicating muscle slowing in patients with subacute stroke. PLs fatigued more and faster than control (P=.011) and both PL and NL recovered slower (P<.001).

Conclusions

The changes in HRTs and fatigue suggest adaptations in muscle properties toward slower, more fatigable muscle shortly after stroke. The inability to make use of contractile speed because of impaired neural activation seems the most limiting factor during the initial phase of torque development in PL. Thus, besides strengthening, muscle endurance and speed should also be addressed during rehabilitation.     

Effects of concurrent strength and endurance training on physical fitness and symptoms in postmenopausal women with fibromyalgia: a randomized controlled trial

Valkeinen H, Alén M, Häkkinen A, Hannonen P, Kukkonen-Harjula K, Häkkinen K. Effects of concurrent strength and endurance training on physical fitness and symptoms in postmenopausal women with fibromyalgia: a randomized controlled trial.

Objective

To examine the effectiveness of concurrent strength and endurance training on muscle strength, aerobic and functional performance, and symptoms in postmenopausal women with fibromyalgia (FM).

Design

Randomized controlled trial.

Setting

Local gym and university research laboratory.

Participants

Twenty-six women with FM.

Intervention

Progressive and supervised 21-week concurrent strength and endurance training.

Main Outcome Measures

Muscle strength of leg extensors, upper extremities, and trunk; peak oxygen uptake (Vo₂peak), maximal workload (Wmax), and work time; 10-m walking and 10-step stair-climbing time and self-reported functional capacity (Health Assessment Questionnaire); and symptoms of FM.

Results

After concurrent strength and endurance training, the groups differed significantly in Wmax (P=.001), work time (P=.001), concentric leg extension force (P=.043), walking (P=.001) and stair-climbing (P<.001) time, and fatigue (P=.038). The training led to an increase of 10% (P=.004) in Wmax and 13% (P=.004) in work time on the bicycle but no change in Vo₂peak.

Conclusions

Concurrent strength and endurance training in low to moderate volume improves the muscle strength of leg extensors, Wmax, work time, and functional performance as well as perceived symptoms, fatigue in particular. Concurrent strength and endurance training is beneficial to postmenopausal women with FM without adversities, but more extensive studies are needed to confirm the results.     

Factor Structure and Predictive Validity of Somatic and Nonsomatic Symptoms From the Patient Health Questionnaire-9: A Longitudinal Study After Spinal Cord Injury

Krause JS, Reed KS, McArdle JJ. Factor structure and predictive validity of somatic and nonsomatic symptoms from the Patient Health Questionnaire-9: a longitudinal study after spinal cord injury.

Objective

To investigate the factor structure and predictive validity of somatic and nonsomatic depressive symptoms over the first 2.5 years after spinal cord injury (SCI) using the Patient Health Questionnaire-9 (PHQ-9).

Design

Somatic and nonsomatic symptoms were assessed at baseline during inpatient hospitalization (average of 50 days after onset) and during 2 follow-ups (average of 498 and 874 days after onset).

Setting

Data were collected at a specialty hospital in the Southeastern United States and analyzed at a medical university. We performed time-lag regression between inpatient baseline and follow-up somatic and nonsomatic latent factors of the PHQ-9.

Participants

Adults with traumatic SCI (N=584) entered the study during inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measure

PHQ-9, a 9-item measure of depressive symptoms.

Results

The inpatient baseline nonsomatic latent factor was significantly predictive of the nonsomatic (r=.40; P=.000) and somatic latent factors at the second follow-up (r=.29; P=.006), whereas the somatic factor at inpatient baseline did not significantly predict either factor. In contrast, when regressing latent factors between the 2 follow-ups, the nonsomatic factor predicted only the nonsomatic factor (r=.66; P=.002), and the somatic factor predicted only future somatic symptoms (r=.66; P=.000). In addition, the factor structure was not stable over time. Item analysis verified the instability of somatic items between inpatient baseline and follow-up and also indicated that self-harm at inpatient baseline was highly predictive of future self-harm.

Conclusions

Nonsomatic symptoms are better predictors of future depressive symptoms when first assessed during inpatient rehabilitation, whereas somatic symptoms become stable predictors only after inpatient rehabilitation. Self-harm (suicidal ideation) is the most stable symptom over time. Clinicians should routinely assess for suicidal ideation and use nonsomatic symptoms when performing assessments during inpatient rehabilitation.     

Comparison of Telecommunication, Community, and Home-Based Tai Chi Exercise Programs on Compliance and Effectiveness in Elders at Risk for Falls

Wu G, Keyes L, Callas P, Ren X, Bookchin B. Comparison of telecommunication, community, and home-based Tai Chi exercise programs on compliance and effectiveness in elders at risk for falls.

Objective

To compare the adherence to and effectiveness of Tai Chi exercise program through a live, interactive, telecommunication-based exercise (Tele-ex) with that of a similar program through a community center-based exercise (Comm-ex) and a home video-based exercise (Home-ex) among community-dwelling elders who are at risk for falls.

Design

Three groups randomized controlled trial with pretests and posttests.

Setting

Exercise programs were community-based, and the outcome measures were laboratory-based.

Participants

Adults (N=64) age 65+ years with positive fall history in the previous year and/or significant fear of falling.

Intervention

A 24-form, Yang-style Tai Chi for 15 weeks, 3 hours a week.

Main Outcome Measures

Exercise compliance, number of falls, fear of falling (Activities-specific Balance Confidence [ABC] score), self-perceived health (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]), Timed Up & Go (TUG), single leg stance (SLS), and body sway during quiet stance (medial-lateral foot center of pressure [ML-COP]).

Results

Tele-ex and Comm-ex groups demonstrated significantly higher exercise attendance and in-class practice time than the Home-ex group (P<.01) and significant reductions in the mean number of falls and injurious falls (P<.01). There were significant improvements posttraining in SLS, ABC, ML-COP, and Physical Health subscore of the SF-36 (P<.05). Both Tele-ex and Comm-ex groups demonstrated larger improvements than the Home-ex group in TUG, ML-COP, and the Social Function, Mental Health, and Physical Health subscores of the MOS SF-36.

Conclusion

Compared with the Home-ex, the Tele-ex and Comm-ex groups are better in exercise compliance, fall reduction and balance and health improvements. Tele-ex is an effective, affordable, and acceptable choice of exercise for elders.     

Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy

Monga U, Garber SL, Thornby J, Vallbona C, Kerrigan AJ, Monga TN, Zimmermann KP. Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy.

Objective

To show fatigue prevention and quality of life (QOL) improvement from cardiovascular exercise during radiotherapy.

Design

Prospective enrollment (n=21), randomized to exercise (n=11) and control groups (n=10), with pre- and post-radiotherapy between- and within-group comparisons.

Setting

Academic medical center.

Participants

Localized prostate cancer patients undergoing radiotherapy.

Interventions

The interventional group received radiotherapy plus aerobic exercise 3 times a week for 8 weeks whereas the control group received radiotherapy without exercise.

Main Outcome Measures

Pre- and post-radiotherapy differences in cardiac fitness, fatigue, depression, functional status, physical, social, and functional well-being, leg strength, and flexibility were examined within and between 2 groups.

Results

No significant differences existed between 2 groups at pre-radiotherapy assessment. At post-radiotherapy assessment, the exercise group showed significant within group improvements in: cardiac fitness (P<.001), fatigue (P=.02), Functional Assessment of Cancer Therapy-Prostate (FACT-P) (P=.04), physical well-being (P=.002), social well-being (P=.02), flexibility (P=.006), and leg strength (P=.000). Within the control group, there was a significant increase in fatigue score (P=.004) and a decline in social well-being (P<.05) at post-radiotherapy assessment. Between-group differences at post-radiotherapy assessment were significant in cardiac fitness (P=.006), strength (P=.000), flexibility (P<.01), fatigue (P<.001), FACT-P (P=.006), physical well-being (P<.001), social well-being (P=.002), and functional well-being (P=.04).

Conclusions

An 8-week cardiovascular exercise program in patients with localized prostate cancer undergoing radiotherapy improved cardiovascular fitness, flexibility, muscle strength, and overall QOL and prevented fatigue.     

Measuring health in patients with cervical and lumbosacral spinal disorders: is the 12-item short-form health survey a valid alternative for the 36-item short-form health survey?

Lee CE, Browell LM, Jones DL. Measuring health in patients with cervical and lumbosacral spinal disorders: is the 12-Item Short-Form Health Survey a valid alternative for the 36-Item Short-Form Health Survey?

Objectives

To determine the convergent validity of the 12-Item Short-Form Health Survey, version 2 (SF-12v2), with 36-Item Short-Form Health Survey, version 2 (SF-36v2), in patients with spinal disorders, and to determine other key factors that might further explain the variances between the 2 surveys.

Design

Cross-sectional study.

Setting

Orthopedic ambulatory care.

Participants

Eligible participants (N=98; 24 with cervical, 74 with lumbosacral disorders) who were aged 18 years and older, scheduled to undergo spinal surgery, and completed the SF-36v2.

Interventions

Not applicable.

Main Outcome Measures

SF-36v2 and SF-12v2 (extracted from the SF-36v2).

Results

The 2 summary scores, physical and mental component scores (r range, .88-.97), and most of the scale scores (r range, .81-.99) correlated strongly between the SF-12v2 and SF-36v2, except for the general health score (cervical group, r=.69; lumbosacral group, r=.76). Stepwise linear regression analyses showed the SF-12v2 general health scores (cervical: β=.61, P<.001; lumbosacral: β=.68, P<.001) and the level of comorbidities (cervical: β=−.37, P=.014; lumbosacral: β=−.18, P=.039) were significant predictors of the SF-36v2 general health score in both groups, whereas age (β=.32, P<.001) and smoking history (β=−.22, P=.005) were additional predictors in the lumbosacral group.

Conclusions

SF-12v2 is a practical and valid alternative for the SF-36v2 in measuring health of patients with cervical or lumbosacral spinal disorders. The validity of the SF-12v2 general health score interpretation is further improved when the level of comorbidities, age, and smoking history are taken into consideration.     

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

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

Objective

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

Design

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

Setting

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

Participants

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

Interventions

Not applicable.

Main Outcome Measures

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

Results

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

Conclusions

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

Validity and Responsiveness of the Care and Needs Scale for Assessing Support Needs After Traumatic Brain Injury

So C, Tate RL, Aird V, Allaous J, Browne S, Carr B, Coulston C, Diffley L, Gurka J, Hummell J. Validity and responsiveness of the Care and Needs Scale for assessing support needs after traumatic brain injury.

Objective

To investigate the validity and responsiveness of the Care and Needs Scale (CANS), which was designed to assess support needs of people with traumatic brain injury (TBI).

Design

Two samples of community clients (n=38, n=30) were recruited to examine concurrent, convergent/divergent, and discriminant validity. The ability of the CANS to detect change over a 6-month period from the time of inpatient rehabilitation discharge (predictive validity and responsiveness) was investigated in a third sample of 40 rehabilitation inpatients.

Setting

Two Brain Injury Rehabilitation Units in Sydney, Australia.

Participants

People (N=108) aged between 16 and 70 years admitted for rehabilitation after TBI.

Interventions

Not applicable.

Main Outcome Measures

The CANS, Supervision Rating Scale, FIM, Sydney Psychosocial Reintegration Scale, and Disability Rating Scale.

Results

Evidence for concurrent validity was shown with fair to moderate correlation coefficients between the CANS and measures of supervision, functional independence, and psychosocial functioning (absolute value, r_s=.43-.68; P<.01). Support for convergent and divergent validity was provided by correlation coefficients that were higher for measures tapping similar constructs (absolute value, r_s=46; P<.01) but lower for measures of dissimilar constructs (absolute value, r_s=.07-.26; not significant). In addition, the CANS discriminated between levels of injury severity, functional independence, and overall functioning (P<.01). In terms of predictive validity and responsiveness, CANS scores at inpatient rehabilitation discharge predicted the participant's functioning 6 months later.

Conclusions

These results show the CANS is a valid and responsive tool and, together with its previously shown reliability, is suitable for routine application in clinical and research practice.     

Effect of Taping on Actual and Perceived Dynamic Postural Stability in Persons With Chronic Ankle Instability

Delahunt E, McGrath A, Doran N, Coughlan GF. Effect of taping on actual and perceived dynamic postural stability in persons with chronic ankle instability.

Objective

To investigate whether 2 different mechanisms of ankle joint taping ([1] lateral subtalar sling or [2] fibular repositioning) can enhance actual and perceived dynamic postural stability in participants with chronic ankle instability (CAI).

Design

Laboratory-based repeated-measures study.

Setting

University biomechanics laboratory.

Participants

Participants (n=16) with CAI.

Interventions

Participants performed the Star Excursion Balance Test (SEBT) under 3 different conditions: (1) no tape, (2) lateral subtalar sling taping and (3) fibular repositioning taping.

Main Outcome Measures

Reach distances in the anterior, posteromedial, and posterolateral directions on the SEBT. Participants' perceptions of stability, confidence, and reassurance when performing the SEBT under 2 different taping conditions.

Results

Taping did not improve reach distance on the SEBT (P>.05). Feelings of confidence increased for 56% of participants (P=.002) under both tape conditions. Feelings of stability increased for 87.5% of participants (P<.001) using condition 2 (lateral subtalar sling taping) and 75% of participants (P=.001) using condition 3 (fibular repositioning taping). Feelings of reassurance increased for 68.75% of participants (P=.001) using condition 2 (lateral subtalar sling taping) and 50% of participants (P=.005) using condition 3 (fibular repositioning taping).

Conclusions

No significant change in dynamic postural stability was observed after application of either taping mechanism; however, participants' perceptions of confidence, stability, and reassurance were significantly improved. Further research is necessary to fully elucidate the exact mechanisms by which taping may help reduce the incidence of repeated injury in subjects with CAI.     

Skilled Hand Dexterity in Parkinson's Disease: Effects of Adding a Concurrent Task

Proud EL, Morris ME. Skilled hand dexterity in Parkinson's disease: effects of adding a concurrent task.

Objective

To compare the performance of people with Parkinson's disease (PD) and unimpaired participants on a timed dexterity task and to examine the effects of adding a secondary task.

Design

A repeated measures analysis of performance for the 2 groups under unitask and dual-task conditions.

Setting

All tests were conducted in a human movement laboratory.

Participants

People with idiopathic PD (n=22) and age-matched and sex-matched comparisons (n=22) volunteered for the study.

Interventions

Not applicable, although a verbal-cognitive secondary task was used.

Main Outcome Measures

The number of pegs placed in the Purdue Pegboard in 30 seconds, the number of correct verbal responses for the secondary task, scores on the Manual Ability Measure-16 test of hand function and, for the group with PD, ratings on the Unified Parkinson's Disease Rating Scale.

Results

For the pegboard task, people with PD had reduced dexterity (t=−5.289; P<.001) compared with the unimpaired group. When the secondary task was added, both groups placed fewer pegs (F_1,42=.652; P=.42). There were no differences between groups in scores for the subtraction task performed alone, but when this activity was carried out with the Purdue Pegboard Test, the number of correct responses declined only in the PD group (F_1,42=4.90; P=.032).

Conclusions

Manual dexterity was compromised in this group of people with mild-moderate PD when compared with an unimpaired group. When the concurrent verbal-cognitive task was added, dual-task interference occurred in both groups but to a greater extent in people with PD.     

Comparison of Trunk Proprioception Between Patients With Low Back Pain and Healthy Controls

Lee AS, Cholewicki J, Reeves NP, Zazulak BT, Mysliwiec LW. Comparison of trunk proprioception between patients with low back pain and healthy controls.

Objective

To determine whether proprioceptive impairments exist in patients with low back pain (LBP). We hypothesized that patients with LBP would exhibit larger trunk proprioception errors than healthy controls.

Design

Case-control study.

Setting

University laboratory.

Participants

24 patients with nonspecific LBP and 24 age-matched healthy controls.

Interventions

Not applicable.

Main Outcome Measures

We measured trunk proprioception in all 3 anatomical planes using motion perception threshold, active repositioning, and passive repositioning tests.

Results

LBP patients had significantly greater motion perception threshold than controls (P<.001) (1.3±0.9° vs 0.8±0.6°). Furthermore, all subjects had the largest motion perception threshold in the transverse plane (P<.001) (1.2±0.7° vs 1.0±0.8° for all other planes averaged). There was no significant difference between LBP and healthy control groups in the repositioning tasks. Errors in the active repositioning test were significantly smaller than in the passive repositioning test (P=.032) (1.9±1.2° vs 2.3±1.4°).

Conclusions

These findings suggest that impairments in proprioception may be detected in patients with LBP when assessed with a motion perception threshold measure.     

Does Rehabilitation Matter in Patients With Femoral Neck Fracture and Cognitive Impairment? A Prospective Study of 246 Patients

Al-Ani AN, Flodin L, Söderqvist A, Ackermann P, Samnegård E, Dalén N, Sääf M, Cederholm T, Hedström M. Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients.

Objective

To identify factors associated with preserved walking ability and Katz activities of daily living (ADLs) index at 4-month and 12-month follow-up in cognitively impaired patients with femoral neck fracture.

Design

Population-based cohort study.

Setting

A multicenter study of the Stockholm Hip Fracture Group including 4 university hospitals.

Participants

Consecutive patients (N=246) with femoral neck fracture, older than 65 years (mean, 84y; 72% women) with cognitive impairment (known dementia or low [0-2 points] score) in Short Portable Mental Status Questionnaire [0-10 points]) and able to walk before the fracture.

Interventions

Not applicable.

Main Outcome Measure

Walking ability and ADLs index at 4-month and 12-month follow-up.

Results

Significant predictors of preserved walking ability at 12-month follow-up were discharge to rehabilitation unit (odds ratio [OR]=2.83; confidence interval [CI], 1.1-7.26; P=.03) and walking ability before the fracture (OR=8.98; CI, 3.52-22.93; P<.001), while type of surgery was not (P=.197). Analyses were adjusted for age, sex, American Society of Anesthesiologists score, fracture type, and surgical method. Corresponding predictors of preserved Katz ADLs index at 12-month follow-up, after adjustment for age and sex, were discharge to rehabilitation unit (OR=5.33; CI, 1.44-19.65; P=.012) and ADLs index before fracture (OR=2.51; CI, 1.8-3.5; P<.001), while type of surgery was not (P=.376).

Conclusions

Discharge to rehabilitation unit, a factor we can influence, was associated with preserved walking ability and ADLs index in cognitively impaired patients with hip fracture.