5-Repetition Sit-to-Stand Test in Subjects With Chronic Stroke: Reliability and Validity

Mong Y, Teo TW, Ng SS. 5-repetition sit-to-stand test in subjects with chronic stroke: reliability and validity.

Objectives

To examine the (1) intrarater, interrater, and test-retest reliability of the 5-repetition sit-to-stand test (5-repetition STS test) scores, (2) correlation of 5-repetition STS test scores with lower-limb muscle strength and balance performance, and (3) cut-off scores among the 3 groups of subjects: the young, the healthy elderly, and subjects with stroke.

Design

Cross-sectional study.

Setting

University-based rehabilitation center.

Participants

A convenience sample of 36 subjects: 12 subjects with chronic stroke, 12 healthy elderly subjects, and 12 young subjects.

Interventions

Not applicable.

Main Outcome Measures

5-Repetition STS test time scores; hand-held dynamometer measurements of hip flexors, and knee flexors and extensors; ankle dorsiflexors and plantarflexors muscle strength; Berg Balance Scale (BBS); and limits of stability (LOS) test using dynamic posturography.

Results

Excellent intrarater reliability of intraclass correlation coefficient (ICC) (range, .970-.976), interrater reliability (ICC=.999), and test-retest reliability (ICC range, .989-.999) were found. Five-repetition STS test scores were also found to be significantly associated with the muscle strength of affected and unaffected knee flexors (ρ=-.753 to -.830; P<.00556) of the subjects with stroke. No significant associations were found between 5-repetition STS test and BBS and LOS tests in subjects with stroke. Cut-off scores of 12 seconds were found to be discriminatory between healthy elderly and subjects with stroke at a sensitivity of 83% and specificity of 75%.

Conclusions

The 5-repetition STS test is a reliable measurement tool that correlates with knee flexors muscle strength but not balance ability in subjects with stroke.     

The Effects of Foot Position on the Performance of the Sit-To-Stand Movement With Chronic Stroke Subjects

Camargos AC, Rodrigues-de-Paula-Goulart F, Teixeira-Salmela LF. The effects of foot position on the performance of the sit-to-stand movement with chronic stroke subjects.

Objective

To investigate the effects of different foot positions during the sit-to-stand (STS) movements with stroke subjects.

Design

Cross-sectional.

Setting

Research laboratory.

Participants

Twelve chronic stroke subjects (N=12).

Interventions

Not applicable.

Main Outcome Measures

Differential latency and electromyography (EMG) activity of the tibialis anterior, soleus, quadriceps, and hamstring muscles of the affected leg as well as the movement time, time of seat-off, weight symmetry, and rising index were obtained while the subjects performed the STS movements by using 4 different strategies: spontaneous; symmetric; asymmetric-1, with the affected foot behind; and asymmetric-2, with the unaffected foot behind.

Results

Compared with the spontaneous strategy, the soleus showed the greatest differential latency in the asymmetric-2 strategy, the hamstrings had lower EMG activity in the symmetric strategy, and the movement time was greater in the asymmetric strategies.

Conclusions

The asymmetric 2 strategy appeared to be the least favorable, whereas the spontaneous and the symmetric strategies appeared to be more favorable in improving the STS performance. Based on these findings, allowing the subjects to adopt the spontaneous strategy or training of the symmetric strategy could result in greater benefits for subjects with higher chronicity and higher functional levels, such as those evaluated in the present study.     

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.     

A True Blind for Subjects Who Receive Spinal Manipulation Therapy

Kawchuk GN, Haugen R, Fritz J. A true blind for subjects who receive spinal manipulation therapy.

Objective

To determine if short-duration anesthesia (propofol and remifentanil) can blind subjects to the provision or withholding of spinal manipulative therapy (SMT).

Design

Placebo control.

Setting

Day-procedure ward, University of Alberta Hospital.

Participants

Human subjects with uncomplicated low back pain (LBP) (n=6).

Interventions

In each subject, propofol and remifentanil were administered intravenously. Once unconsciouness was achieved (3-5min), subjects were placed in a lateral recumbent position and then randomized to either a control group (n=3) or an experimental group (with SMT, n=3); subjects received a single SMT to the lumbar spine. Subjects were given a standardized auditory and visual cue and then allowed to recover from anesthesia in a supine position (3-5min).

Main Outcome Measures

Before anesthesia and 30 minutes after recovery, a blinded evaluator asked each subject to quantify their LBP by using an 11-point scale. This same evaluator then assessed the ability of each subject to recall specific memories while under presumed anesthesia including events related to treatment and specific auditory and visual cues.

Results

In either the experimental or control group, subjects could not recall any event while under anesthesia. Some SMT subjects reported pain reduction greater than the minimally important clinical difference and greater than control subjects. No adverse events were reported.

Conclusions

Short-duration, low-risk general anesthesia can create effective blinding of subjects to the provision or withholding of SMT. An anesthetic blind for SMT subjects solves many, if not all, problems associated with prior SMT blinding strategies. Although further studies are needed to refine this technique, the potential now exists to conduct the first placebo-controlled randomized controlled trial to assess SMT efficacy.     

Effects of ankle joint mobilizations in adults poststroke: a pilot study

Kluding PM, Santos M. Effects of ankle joint mobilizations in adults poststroke: a pilot study.

Objective

To compare the effect of 2 interventions on ankle mobility, ankle kinematics, and weight-bearing symmetry during functional activities in subjects with hemiparesis after a stroke.

Design

Randomized trial.

Setting

Academic medical center.

Participants

A convenience sample of 16 subjects with hemiparesis after stroke (mean age, 55.2y; mean time since stroke, 21.4mo).

Intervention

Subjects received 8 sessions over 4 weeks of either functional task practice combined with ankle joint mobilizations, or functional task practice only.

Main Outcome Measures

Changes in ankle range of motion (ROM) (not blinded), ankle kinematics during sit-to-stand (STS) and gait, and lower-extremity weight-bearing symmetry during STS and static standing.

Results

The combined intervention group gained 5.7°±3.1° in passive ankle ROM compared with 0.2°±2.6° in the functional practice only group (95% confidence interval [CI], 2.5-8.6; P<.01). No significant changes in ankle kinematics or weight bearing during static standing were noted in either group. The functional practice group decreased differences in weight bearing during STS by 9.5%±6.47%, whereas the combined intervention group increased this difference by 3.37%±5.29% (95% CI, 3.26-19.46; P=.01).

Conclusions

The increase in ankle motion did not improve joint kinematics and may have prevented improvement in weight-bearing symmetry.     

The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson's disease

Fisher BE, Wu AD, Salem GJ, Song J, Lin C-H, Yip J, Cen S, Gordon J, Jakowec M, Petzinger G. The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson's disease.

Objectives

To obtain preliminary data on the effects of high-intensity exercise on functional performance in people with Parkinson's disease (PD) relative to exercise at low and no intensity and to determine whether improved performance is accompanied by alterations in corticomotor excitability as measured through transcranial magnetic stimulation (TMS).

Design

Cohort (prospective), randomized controlled trial.

Setting

University-based clinical and research facilities.

Participants

Thirty people with PD, within 3 years of diagnosis with Hoehn and Yahr stage 1 or 2.

Interventions

Subjects were randomized to high-intensity exercise using body weight-supported treadmill training, low-intensity exercise, or a zero-intensity education group. Subjects in the 2 exercise groups completed 24 exercise sessions over 8 weeks. Subjects in the zero-intensity group completed 6 education classes over 8 weeks.

Main Outcome Measures

Unified Parkinson's Disease Rating Scales (UPDRS), biomechanic analysis of self-selected and fast walking and sit-to-stand tasks; corticomotor excitability was assessed with cortical silent period (CSP) durations in response to single-pulse TMS.

Results

A small improvement in total and motor UPDRS was observed in all groups. High-intensity group subjects showed postexercise increases in gait speed, step and stride length, and hip and ankle joint excursion during self-selected and fast gait and improved weight distribution during sit-to-stand tasks. Improvements in gait and sit-to-stand measures were not consistently observed in low- and zero-intensity groups. The high-intensity group showed lengthening in CSP.

Conclusions

The findings suggest the dose-dependent benefits of exercise and that high-intensity exercise can normalize corticomotor excitability in early PD.     

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

Objective

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

Methods

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

Results

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

Conclusions

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

Effect of Hamstring Flexibility on Hip and Lumbar Spine Joint Excursions During Forward-Reaching Tasks in Participants With and Without Low Back Pain

Johnson EN, Thomas JS. Effect of hamstring flexibility on hip and lumbar spine joint excursions during forward-reaching tasks in participants with and without low back pain.

Objective

To examine the correlation between hamstring flexibility and hip and lumbar spine joint excursions during standardized reaching and forward-bending tasks.

Design

Retrospective analysis of data obtained during 2 previous prospective studies that examined kinematics and kinetics during forward-reaching tasks in participants with and without low back pain (LBP).

Setting

The 2 previous studies were conducted in the Motor Control Lab at Ohio University and the Orthopaedic Ergonomics Laboratory at The Ohio State University.

Participants

Data from a total of 122 subjects from 2 previous studies: study 1: 86 subjects recovered from an episode of acute LBP (recovered) and study 2 (A.I. McCallum, unpublished data): 18 chronic LBP subjects and 18 healthy-matched controls (healthy).

Interventions

Not applicable.

Main Outcome Measure

Correlation values between hamstring flexibility as measured by straight leg raise (SLR) and amount of hip and lumbar spine joint excursions used during standardized reaching and forward-bending tasks.

Results

No significant correlation was found between hamstring flexibility and hip and lumbar joint excursions during forward-bending tasks in the LBP or recovered groups. The SLR had a significant negative correlation with lumbar spine excursions during reaching tasks to a low target in the healthy group (right SLR: P=.011, left SLR: P=.004).

Conclusions

Hamstring flexibility is not strongly related to the amount of lumbar flexion used to perform forward-reaching tasks in participants who have chronic LBP or who have recovered from LBP. More research needs to be conducted to examine the influence of hamstring flexibility on observed movement patterns to further evaluate the efficacy of flexibility training in the rehabilitation of patients with LBP.     

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

Objectives

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

Design

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

Setting

An outpatient physiotherapy department.

Participants

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

Interventions

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

Main outcome measures

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

Results

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

Conclusions

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

Relationship between low back pain and life-stressing events among Nigerian and Caucasian patients

Objectives

Socio-economic status and life-stressing events have been shown to have ethnic and racial differences that exert a strong influence on care-seeking habits and recovery from low back pain (LBP). This study examined the relationship between life-stressing events and sensory and psychological attributes among Nigerian and Caucasian patients with LBP, and the influence of socio-economic status on this relationship.

Design

Stratified, single cohort questionnaire study.

Setting

Three outpatient physiotherapy clinics in Nigeria.

Participants

One hundred and sixty-five patients, including 107 Black Nigerians (age range 26-65 years, mean 52 years) and 58 Caucasians (age range 25-62 years, mean 41 years), with LBP of at least 6 weeks duration were recruited over a 9-year period.

Main outcome measures

The Low Back Pain Questionnaire, Social Re-adjustment Rating Scale, State-Trait Anxiety Inventory and Multiple Affect Adjective Check List. Socio-economic status and pain levels, on a 0-100 numerical rating scale, were also recorded. Questionnaires were administered within 5 days of the patient reporting at the clinic.

Results

Recorded pain intensity was similar in Nigerian [mean pain score 78, 95% confidence interval (CI) 73.4 to 83.4] and Caucasian (mean pain score 79, 95% CI 74.8 to 84.8) patients. Subjects who recorded higher numbers of life-stressing events on the Social Re-adjustment Rating Scale also recorded higher scores on a number of LBP attributes including hot, burning, bright, throbbing and pressure qualities. Pain intensity and state anxiety correlated significantly with life-stressing event scores among Caucasian patients, who were mainly of high socio-economic status. State and trait anxiety and emotional discomfort scores correlated significantly with life-stressing event scores among Nigerian patients, who were mainly of low to medium socio-economic status.

Conclusion

Most patients had experienced a number of life-stressing events, particularly those classified as being of low socio-economic status. Low socio-economic status patients who had experienced a high number of life-stressing events were more likely to show emotional and psychological symptoms, which may have influenced the reporting of the characteristics and history of their LBP. There is a need to assess these issues when managing LBP patients. Further research is required to determine how the outcome of treatment may be influenced by these factors.     

The reliability and validity of the brief symptom inventory-18 in persons with traumatic brain injury

Meachen S-J, Hanks RA, Millis SR, Rapport LJ. The reliability and validity of the Brief Symptom Inventory−18 in persons with traumatic brain injury.

Objective

To investigate the psychometric properties of the Brief Symptom Inventory−18 (BSI-18) among persons with traumatic brain injury (TBI).

Design

Inception cohort design with cross-sectional follow-up of 6 months to 15 years.

Setting

Rehabilitation hospital.

Participants

Adults (N=257) with moderate to severe TBI (81 inpatients and 176 follow-up participants, analyzed separately).

Interventions

Not applicable.

Main Outcome Measures

The BSI-18 is a brief screen of psychologic distress with a Global Severity Index (GSI), and 3 clinical subscales: somatization, anxiety, and depression.

Results

Internal consistency of the GSI was high in both follow-up participants (α=.91) and inpatients (α=.84), whereas estimates for the somatization, anxiety, and depression subscales were more variable (α range, .61-.84). As would be expected for a measure of affective state, retest reliability estimates were only moderate. The BSI-18 GSI correlated with multiple measures of psychosocial adjustment. After accounting for demographics, injury severity, inpatient functional status, years since injury, and various psychosocial factors, the BSI-18 showed incremental validity in predicting concurrent functional, psychosocial, and psychologic status.

Conclusions

The BSI-18 GSI had excellent reliability and validity among inpatients and follow-up participants. Modest reliability estimates may place an upper bound on the validity of the BSI-18 clinical subscales in inpatient TBI populations.     

A Chinese version of Iowa Infant Feeding Attitude Scale: reliability and validity assessment

Background

To achieve the goal of increasing the proportion and duration of breastfeeding in Taiwan, it is essential to assess the role of attitudes in determining which method of infant feeding will be chosen. Understanding maternal attitudes toward infant feeding methods may have utility in the development and implementation of public health policy and interventions facilitating increasing breastfeeding rates. However, no validated instrument to assess breastfeeding attitudes is available in Chinese for use in Taiwan.

Objective

To translate the Iowa Infant Feeding Attitude Scale (IIFAS) into Chinese and assess its psychometric properties among Taiwanese breastfeeding women.

Design

Methodological study.

Setting

One public hospital in Taichung city, Taiwan.

Participants

A convenience sample of 140 in-hospital breastfeeding women was recruited.

Methods

The IIFAS was translated into Chinese using forward translation, back-translation, semantic equivalence, and pilot testing. Predict validity and internal consistency was assessed. The final sample consisted of 120 women (14% attrition) that were interviewed by telephone at 6 weeks postpartum to record the breastfeeding duration and infant feeding method.

Results

One item was modified to better reflect the item content. In-hospital IIFAS scores significantly predicted breastfeeding duration as well as exclusive breastfeeding at 6 weeks postpartum. The Cronbach's alpha coefficient for internal consistency was 0.74.

Conclusions

This study provides evidence that the Chinese version of the IIFAS can be considered valid and reliable scale for assessing attitudes toward breastfeeding among breastfeeding women in Taiwan.     

Multiple Sclerosis and Postural Control: The Role of Spasticity

Sosnoff JJ, Shin S, Motl RW. Multiple sclerosis and postural control: the role of spasticity.

Objectives

To examine the association between spasticity and postural control in subjects with multiple sclerosis (MS).

Design

Cross-sectional.

Setting

Motor control laboratory.

Participants

Subjects with MS (n=16, 2 male) and age and sex-matched subjects (n=16) participated in the investigation. All subjects with MS had Expanded Disability Status Scale scores between 0 and 4.5 and modified Ashworth scale scores between 1 and 3.

Interventions

Not applicable.

Main Outcome Measures

Postural control was measured with a force platform that quantifies ground reaction forces and moments in mediolateral and anteroposterior directions. Postural control was indexed with anterior-posterior sway range, medial-lateral sway range, 95% elliptical area of the deviations of center of pressure (COP), velocity of COP sway, and the frequency at which 95% of spectral profile was contained. Participants with MS further underwent assessment of the soleus Hoffman reflex (H-reflex) as an index of spasticity.

Results

Cluster analysis on H-reflex data identified groups of MS participants with high spasticity (n=7) and low spasticity (n=9). There were no differences in age, duration of MS, and disease severity between MS groups. There were no differences in anterior-posterior sway range between any of the groups. The high spasticity group had greater COP area, velocity, and mediolateral sway compared with the low spasticity and control group, and the low spasticity group had postural control values between the high spasticity and control groups.

Conclusions

The pattern of results suggests that spasticity contributes to postural deficits observed in MS.     

A Prospective Outcome Study on the Effects of Facet Joint Radiofrequency Denervation on Pain, Analgesic Intake, Disability, Satisfaction, Cost, and Employment

Burnham RS, Holitski S, Dinu I. A prospective outcome study on the effects of facet joint radiofrequency denervation on pain, analgesic intake, disability, satisfaction, cost, and employment.

Objective

To assess the effect of radiofrequency denervation (RFD) on patients with chronic low back pain (LBP) of facet joint origin.

Design

Prospective cohort study.

Setting

Interventional pain management program.

Participants

Consecutive subjects (N=44; 101 facet joints) over 2 years with chronic refractory mechanical LBP of facet origin established by 2 local anesthetic blocks (medial branch ± intra-articular) resulting in more than 50% pain relief.

Intervention

RFD of the symptomatic lumbar facet joints.

Main Outcome Measures

Self-reported pain intensity, frequency, bothersomeness, analgesic intake, satisfaction, disability, back pain-related costs, and employment twice prior to and at 1, 3, 6, 9, and 12 months post-RFD.

Results

Post-RFD, significant improvements in pain, analgesic requirement, satisfaction, disability, and direct costs occurred. They peaked at 3 to 6 months and gradually diminished thereafter. Satisfaction with medical care and living with current symptoms improved similarly. Overall, satisfaction with the RFD procedure was high, and no complications were reported.

Conclusions

RFD provides safe and significant short-term improvement in pain, analgesic requirements, function, satisfaction, and direct costs in patients with chronic LBP of facet origin.     

Outcomes after a prone lumbar traction protocol for patients with activity-limiting low back pain: a prospective case series study

Beattie PF, Nelson RM, Michener LA, Cammarata J, Donley J. Outcomes after a prone lumbar traction protocol for patients with activity-limiting low back pain: a prospective, case series study.

Objective

To determine outcomes after administration of a prone lumbar traction protocol.

Design

Prospective, longitudinal, case series.

Setting

Suburban, chiropractic practice.

Participants

A total of 296 subjects with low back pain (LBP) and evidence of a degenerative and/or herniated intervertebral disk at 1 or more levels of the lumbar spine. We excluded patients involved in litigation and those receiving workers’ compensation.

Intervention

An 8-week course of prone lumbar traction, using the vertebral axial decompression (VAX-D) system, consisting of five 30-minute sessions a week for 4 weeks, followed by one 30-minute session a week for 4 additional weeks.

Main Outcome Measures

The numeric pain rating scale and the Roland-Morris Disability Questionnaire (RMDQ) were completed at preintervention, discharge (within 2 weeks of the last visit), and at 30 days and 180 days after discharge. Intention-to-treat strategies were used to account for those subjects lost to follow-up.

Results

A total of 250 (84.4%) subjects completed the treatment protocol. On the 30-day follow-up, 247 (83.4%) subjects were available; on the 180-day follow-up, data were available for 241 (81.4%) subjects. We noted significant improvements for all postintervention outcome scores when compared with preintervention scores (P<.01).

Conclusions

Traction applied in the prone position using the VAX-D for 8 weeks was associated with improvements in pain intensity and RMDQ scores at discharge, and at 30 and 180 days after discharge in a sample of patients with activity-limiting LBP. Causal relationships between these outcomes and the intervention should not be made until further study is performed using randomized comparison groups.     

Validity of the straight-leg raise test for patients with sciatic pain with or without lumbar pain using magnetic resonance imaging results as a reference standard

Objective

The aim of this retrospective study was to assess validity of the straight-leg raise (SLR) test using magnetic resonance imaging (MRI) results as a reference standard in a group of patients with L4-L5 and L5-S1 lumbar-herniated disks and sciatic pain. The relationship between diagnostic accuracy of this test, age classes, and grade of lumbar disk displacement was investigated.

Methods

The charts of 2352 patients with sciatic pain with/without lumbar pain were examined. Results of the SLR were then compared with previous spinal MRI. A 2 × 2 contingency table was created, and analysis of sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio, likelihood ratio (LR), and receiver operating characteristic (ROC) curve was carried out. Homogeneous age classes were created to compare them statistically.

Results

Magnetic resonance imaging findings showed lumbar disk herniation (LDH) in 1305 patients. Of these subjects, 741 were positive on SLR testing. Sensitivity was 0.36, whereas specificity was 0.74. Positive and negative predictive values were 0.69 and 0.52, respectively. Positive LR was 1.38, and negative LR was 0.87. Diagnostic odds ratio was 1.59, and ROC analysis showed an area under the curve (AUC) of 0.596. The AUC decreased from 0.730 in the 16- to 25-year subgroup to 0.515 in the 76- to 85-year subgroup. Similar results were obtained in subjects with LDH and nerve root compression.

Conclusions

Our results indicate low accuracy of the SLR in diagnosis of LDH if compared with MRI results. The discriminative power of the SLR seemed to decrease as age increased; thus, positive and negative results may be less conclusive in older patients.     

Inoculation Against Falls: Rapid Adaptation by Young and Older Adults to Slips During Daily Activities

Pai Y-C, Bhatt T, Wang E, Espy D, Pavol MJ. Inoculation against falls: rapid adaptation by young and older adults to slips during daily activities.

Objective

To determine whether aging diminishes one's ability to rapidly learn to resist falls on repeated-slip exposure across different activities of daily living.

Design

Quasi-experimental controlled trial.

Setting

Two university-based research laboratories.

Participants

Young (n=35) and older (n=38) adults underwent slips during walking. Young (n=60) and older (n=41) adults underwent slips during a sit-to-stand task. All (N=174) were healthy and community dwelling.

Intervention

Low-friction platforms induced unannounced blocks of 2 to 8 repeated slips interspersed with blocks of 3 to 5 nonslip trials during the designated task.

Main Outcome Measures

The incidence of falls and balance loss. Dynamic stability (based on center of mass position and velocity) and limb support (based on hip height) 300ms after slip onset.

Results

Under strictly controlled, identical low-friction conditions, all participants experienced balance loss, but older adults were over twice as likely as young to fall on the first, unannounced, novel slip in both tasks. Independent of age or task, participants adapted to avoid falls and balance loss, with most adaptation occurring in early trials. By the fifth slip, the incidence of falls and balance loss was less than 5% and 15%, respectively, regardless of age or task. Reductions in falls and balance loss for each task were accomplished through improved control of stability and limb support in both age groups. A rapidly reversible age- and task-dependent waning of motor learning occurred after a block of nonslip trials. Adaptation to walk slips reached a steady state in the second slip block regardless of age.

Conclusions

The ability to rapidly acquire fall-resisting skills on repeated-slip exposure remains largely intact at older ages and across functional activities. Thus, repeated-slip exposure might be broadly effective in inoculating older adults against falls.     

Muscle activation changes after exercise rehabilitation for chronic low back pain

Marshall PW, Murphy BA. Muscle activation changes after exercise rehabilitation for chronic low back pain.

Objective

To investigate the changes in 2 electromyographic measures, flexion relaxation (FR) response and feed-forward activation of the deep abdominals, associated with low back pain (LBP) after different rehabilitation interventions.

Design

A 2×2 factorial design with subjects' self-selecting treatment with randomization after 4 weeks to either the specific exercise group or exercise advice group for a further 12-week period.

Setting

General community practitioners and university training center.

Participants

Subjects with chronic nonspecific LBP were recruited for this study. A total of 112 people were initially screened, and 60 were recruited for the study, with 50 being available for long-term follow-up.

Intervention

Four weeks of treatment (manipulative or nonmanipulation) and 12 weeks of subsequent exercise (supervised Swiss ball training or exercise advice).

Main Outcome Measures

The Oswestry Disability Index, FR response measured at T12-L1 and L4-5, and feed-forward activation of the deep abdominal muscles.

Results

More rapid improvements in disability were identified for subjects who received the supervised exercise program. The FR response at L4-5 also increased more for those who received directly supervised exercise. Long-term follow-up showed that there was still a between-group difference in the FR response, despite no difference in self-rated disability. Long-term changes were observed for the feed-forward activation of the deep abdominals; however, no exercise or treatment effects were identified.

Conclusions

Supervised exercise rehabilitation leads to more rapid improvements in self-rated disability, which were associated with greater improvement in the low back FR response.     

The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation

Miller CA, Forrester GA, Lewis JS. The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation.

Objective

To investigate whether the lag signs were valid tools in diagnosing full-thickness tears of the rotator cuff.

Design

A same-subject, correlation, double-blinded design was used. The results of the external rotation lag sign, drop sign, and internal rotation lag sign were compared with the criterion standard of diagnostic ultrasound to establish their accuracy.

Setting

A regional orthopedic hospital.

Participants

Consecutive subjects (N=37), 21 women and 16 men, with shoulder pain referred to a consultant orthopedic surgeon specializing in shoulder conditions were recruited for this investigation.

Interventions

Not applicable.

Main Outcome Measures

Sensitivity, specificity, and positive and negative likelihood ratios of the lag signs when using ultrasound as the reference test.

Results

The specificities of the drop sign and internal rotation lag sign were 77% and 84%, respectively, which, together with low positive likelihood ratios 3.2 (95% confidence interval [CI], 1.5-6.7) and 6.2 (95% CI, 1.9-12.0), indicate that a positive result was poor at recognizing the presence of full-thickness tears. The drop sign had a sensitivity of 73% with a negative likelihood ratio of .34 (95% CI, 0.2-0.8), suggesting that a negative test was fair at ruling out the presence of full-thickness tears. The sensitivity of the internal rotation lag sign (100%) supported by the negative likelihood ratio of 0 (95% CI, 0.0-2.5) suggests that a negative test will effectively rule out the presence of full-thickness tears of the subscapularis. A positive external rotation lag sign is the clinical test most likely to indicate that full-thickness tears of the supraspinatus and infraspinatus are present (specificity, 94%). However, the external rotation lag sign did demonstrate a low sensitivity score of 46% and negative likelihood ratio of .57 (95% CI, 0.4-0.9), which means that a negative test will not rule out the presence of full-thickness tears.

Conclusions

The findings of this investigation suggest that a clinical diagnosis of a full-thickness tear of the rotator cuff cannot be conclusively reached using one or more of the lag signs.     

Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial

Bürge E, Kupper D, Finckh A, Ryerson S, Schnider A, Leemann B. Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial.

Objective

To quantify the preventive effect of a neutral functional realignment orthosis on pain, mobility, and edema of the hand in subacute hemiparetic poststroke patients with severe motor deficits.

Design

Randomized trial.

Setting

Rehabilitation center.

Participants

Poststroke patients (N=30) with subacute hemiparesis and severe deficits of the upper limb were enrolled. Fifteen patients were randomized to a standard rehabilitation program without orthosis and 15 patients received an experimental orthosis in addition to their standard rehabilitation program.

Intervention

The orthosis group wore the neutral functional realignment orthosis for at least 6 hours daily.

Main Outcome Measures

Hand pain at rest (visual analog scale), wrist range of motion (Fugl-Meyer Assessment subscale), and edema of hand and wrist (circumferences). Outcome measures were assessed at time of randomization and after 13 weeks between groups.

Results

At baseline, 2 patients in each group complained about a painful hand. After 13 weeks, 8 subjects in the control group and 1 subject in the orthosis group complained of hand pain (P=.004). Mobility and edema evolved similarly in both groups.

Conclusions

Neutral functional realignment orthoses have a preventive effect on poststroke hand pain, but not on mobility and edema in the subacute phase of recovery.