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.     

Energy Transfer Across the Lumbosacral and Lower-Extremity Joints in Patients With Low Back Pain During Sit-to-Stand

Shum GL, Crosbie J, Lee RY. Energy transfer across the lumbosacral and lower-extremity joints in patients with low back pain during sit-to-stand.

Objective

To examine the transfer of energy through the pelvis and the lower limb during sit-to-stand (STS) in low back pain (LBP) subjects with or without a straight-leg raise sign.

Design

Cross-sectional.

Setting

Biomechanics laboratory.

Participants

Three groups, each of 20 subjects, participated. The first group consisted of asymptomatic subjects, and the other 2 groups of consisted of LBP subjects (duration between 7 days and 12 weeks) with and without a straight-leg raise sign.

Interventions

Not applicable.

Main Outcome Measures

The work done and the power of the pelvis, thigh, and leg segments during STS were determined.

Results

Energy was transferred from the pelvis to the thigh segment and then to the leg segment, and this was achieved mainly by passive mechanisms. The power flow of the pelvis segment was significantly decreased in subjects with LBP. Although the power of the lower-limb segments was decreased, the total work done of these segments was increased.

Conclusions

STS is a more energy-demanding and less efficient task for subjects with LBP, either with or without a positive straight-leg raise sign. Such increases in energy demand may further exacerbate back pain, and treatment should be developed to restore a more efficient energy transfer pattern.     

Differences in Preferred Walking Speeds in a Gait Laboratory Compared With the Real World After Total Hip Replacement

Foucher KC, Thorp LE, Orozco D, Hildebrand M, Wimmer MA. Differences in preferred walking speeds in a gait laboratory compared with the real world after total hip replacement.

Objective

To evaluate the relation between walking speeds measured in a gait laboratory and those measured in real-world settings (habitual speed) in subjects with total hip replacements (THRs) and control subjects. The secondary objective is to determine whether the relationship between gait laboratory and habitual speeds was affected by recovery time or related to clinical indices.

Design

Cohort study.

Setting

Academic medical center.

Participants

Experimental subjects (n=26) evaluated 3 weeks and 12 months after THR and control subjects (n=24).

Interventions

None.

Main Outcome Measures

Walking speed measured in the gait laboratory, walking speed measured in the field by using activity monitors, Harris Hip Score (HHS), and the Western Ontario and McMaster Osteoarthritis Index (WOMAC).

Results

Laboratory speeds were significantly faster than habitual speeds in all groups (P<.001), but the 2 correlated significantly. The laboratory versus habitual-speed difference was unaffected by recovery time within the THR group (P=.180) but was larger for control subjects (.32±.21m/s) than for THR subjects (.19±.15m/s 1 year after surgery). Habitual speed significantly correlated with total WOMAC scores and with WOMAC stiffness and function subscores 3 weeks after THR. The HHS weakly correlated with 3-week laboratory speed. No speed and clinical correlations were seen 1 year after THR.

Conclusions

Although subjects may exaggerate walking speeds in laboratory settings, laboratory-based data accurately reflect real-world activity. Setting affected speeds most in the control group. It is important to consider potential discrepancies between speeds walked in a laboratory versus in the real world when interpreting gait studies comparing 2 or more populations. Finally, analysis of these data suggests that clinical indices may more accurately reflect biomechanical function during early recovery after THR than after full recovery.     

A study to determine the reliability of an ankle dorsiflexion weight-bearing device

Objectives

To investigate the inter-observer and intra-observer reliability of measurement of ankle movement during a weight-bearing dorsiflexion lunge in healthy and injured groups.

Setting

Defence Medical Rehabilitation Centre, UK.

Participants

Seventeen healthy subjects, 11 subjects with ankle injuries and three trained observers.

Design

Each observer assessed subjects on two separate test days, 7 days apart. Each measurement was repeated six times and the results were averaged. Limits of agreement and intra-class correlation coefficients were calculated to give a measure of reliability.

Main outcome measures

A measurement tool designed at the Defence Medical Rehabilitation Centre, UK.

Results

Intra-observer 95% limits of agreement ranged from ±3.30 to ±3.66 cm for the healthy group and from ±2.35 to ±3.85 cm for patients. The inter-observer limits of agreement ranged from ±1.57 to ±2.65 cm for healthy subjects and from ±0.87 to ±3.46 cm for patients.

Conclusions

Results indicate acceptable inter-observer and intra-observer reliability for use of this rehabilitation assessment tool to measure the weight-bearing dorsiflexion lunge range of ankle motion when results are averaged over six repetitions.     

Trunk Muscle Activity During Wheelchair Ramp Ascent and the Influence of a Geared Wheel on the Demands of Postural Control

Howarth SJ, Polgar JM, Dickerson CR, Callaghan JP. Trunk muscle activity during wheelchair ramp ascent and the influence of a geared wheel on the demands of postural control.

Objectives

To quantify levels of torso muscular demand during wheelchair ramp ascent and the ability of a geared wheel to influence trunk muscle activity.

Design

Repeated-measures design. Each participant completed manual wheelchair ramp ascents for each combination of 4 ramp grades (1:12, 1:10, 1:8, and 1:6) and 3 wheel conditions (in gear, out of gear, and a standard spoked wheel) in a block randomized order by wheel condition.

Setting

Biomechanics laboratory.

Participants

Healthy novice wheelchair users (N=13; 6 men) from a university student population.

Interventions

Not applicable.

Main Outcome Measures

Peak electromyographic activity, expressed as a percentage of maximal voluntary isometric contraction (MVIC) of the abdominals, latissimus dorsi, and erector spinae during ramp ascent. Temporal location of peak electromyographic activity (EMG) within a propulsive cycle and integrated electromyographic activity for a single propulsive cycle.

Results

Abdominal peak activity increased 13.9% MVIC while peak posterior trunk muscle activity increased 4.9% MVIC between the shallowest and steepest ramp grades (P<.05). The geared wheel prevented increased peak activity of the rectus abdominis and external oblique (P>.05). Only peak electromyographic timing of the erector spinae was influenced during the push phase by increasing ramp slope.

Conclusions

Increased trunk muscular demand as a result of increasing ramp slope is required to enhance stiffness of the spinal column and provide a stable base during manual propulsion. Manual wheelchair users with compromised activity capacity, compromised abdominal muscle strength, or both, may be able to navigate more difficult terrains while using a geared wheelchair wheel because of reduced demands from the abdominal musculature in the geared wheel condition.     

Evaluating Displacement of the Coracoacromial Ligament in Painful Shoulders of Overhead Athletes Through Dynamic Ultrasonographic Examination

Wu C-H, Wang Y-C, Wang H-K, Chen W-S, Wang T-G. Evaluating displacement of the coracoacromial ligament in painful shoulders of overhead athletes through dynamic ultrasonographic examination.

Objective

To evaluate displacement of the coracoacromial ligament (CAL), using dynamic ultrasonography (US), for detecting instability-related impingement caused by overhead activities.

Design

Between-group survey.

Setting

Department of Physical Medicine and Rehabilitation in a tertiary care center.

Participants

Volunteer high school volleyball players with unilateral shoulder pain (n=10) and volunteer asymptomatic high school volleyball players with identical training activities as control subjects (n=16).

Interventions

Not applicable.

Main Outcome Measure

The displacement of the CAL was measured during throwing simulation using dynamic US. Both shoulders of all subjects were evaluated.

Results

During throwing simulation, the displacement of the CAL in the painful shoulders of overhead athletes increased significantly greater than the displacement in the asymptomatic shoulder (3.0±0.7mm and 2.2±0.4mm, respectively; P=.017). No difference was identified between the displacements of the CALs of bilateral shoulders of the control group subjects.

Conclusions

Dynamic US, by measuring the displacement of the CAL during simulation of throwing, may be helpful in detecting abnormal humeral head upward migration in overhead athletes.     

Role of arterial embolization on blunt hepatic trauma patients with type I contrast extravasation

Background

Our aim was to evaluate the clinical effectiveness of transcatheter arterial embolization (TAE) in the management of hemodynamically stable blunt hepatic trauma (BHT) patients with contrast material extravasation into the peritoneal cavity, known as type I contrast material extravasation, on computed tomography (CT) scan.

Methods

Adult patients who sustained BHT and who were hemodynamically stable after initial resuscitation underwent abdominal CT scan. If the abdominal CT scan revealed type I contrast material extravasation, patients who remained hemodynamically stable were sent for angiography.

Results

During a 30-month period, 8 patients were identified with type I contrast material extravasation. Three received immediate celiotomy because of hemodynamic instability. Five patients received angiography and subsequent TAE. One patient received celiotomy after TAE. The success rate of TAE was 50% (4/8).

Conclusion

With TAE, nonoperative management of hemodynamically stable BHT patients with type I contrast material extravasation on CT scan was achieved in half patients.     

Validity of a Functional Dynamic Walking Test for the Elderly

Lark SD, Pasupuleti S. Validity of a functional dynamic walking test for the elderly.

Objective

To determine the validity of a safe, quick, and simple method of measuring dynamic balance in the elderly during gait called the parallel walk test.

Design

Control study.

Setting

Outpatient clinic, community.

Participants

Twenty-seven elderly fallers (age 82±6y) registered at a falls clinic and 34 elderly nonfallers (age 76±7y) were recruited to this study based on Mini Mental State Examination and Barthel Index scores.

Interventions

Subjects were timed as they walked 6m between 2 parallel lines on the floor at 3 different widths (20, 30.5, 38cm) in their own footwear. They were scored for foot placement on the line (1 point) or outside the lines (2 points). Participants also performed a timed 6-m tandem walk test, a 30-second tandem stance, and a 30-second parallel stance.

Main Outcome Measures

Scores and time to complete the parallel walk test and tandem walk test along with the time of standing for tandem and parallel stance. Validity coefficients were calculated for the sensitivity and specificity of the parallel walk test.

Results

All subjects completed the parallel walk test, but few attempted and completed the tandem walk test. The fallers had significantly greater scores at 20 and 30.5cm and took significantly longer to complete the 6m at all widths. The 20-cm width was most discriminatory. The parallel walk test showed a significant correlation with the tandem stance.

Conclusions

All subjects attempted and completed the parallel walk test but not the tandem walk test. The time to completion and scoring accurately measures dynamic balance during gait in elderly fallers. The parallel walk test could be a useful tool in the clinical setting for assessing balance in gait pre- and postintervention.     

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.     

Selective Tibial Neurotomy in the Treatment of Spastic Equinovarus Foot in Hemiplegic Patients: A 2-Year Longitudinal Follow-Up of 30 Cases

Deltombe T, Gustin T. Selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients: a 2-year longitudinal follow-up of 30 cases.

Objective

To assess the long-term efficacy of selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients.

Design

Intervention study (before-after trial) with an observational design and 2-year follow-up.

Setting

Spasticity group in a university hospital.

Participants

Hemiplegic patients (N=30) with spastic equinovarus foot.

Intervention

A selective neurotomy was performed at the level of the motor nerve branches of the tibial nerve.

Main Outcome Measures

Spasticity (Ashworth scale), muscle strength (Medical Research Council scale), passive ankle dorsiflexion, gait parameters (6 min walking test), and gait kinematics (video assessment) were assessed before and at 2 months, 1 year, and 2 years after selective tibial neurotomy.

Results

Compared with preoperative values, there was a statistically significant decrease in triceps surae spasticity, an increase in gait speed, and a reduction in equinus and varus in swing and stance phases at 2 months postoperatively. This improvement persisted at 1 and 2 years after selective tibial neurotomy. Selective tibial neurotomy does not induce permanent triceps muscle weakness or triceps surae-Achilles' tendon complex shortening.

Conclusion

This study confirms the long-lasting beneficial effect of selective tibial neurotomy on spasticity, gait speed, and equinovarus deformity in the treatment of spastic equinovarus foot in hemiplegic patients.     

Validation of the Revised Quick Cognitive Screening Test

Mate-Kole CC, Conway J, Catayong K, Bieu R, Sackey NA, Wood R, Fellows R. Validation of the revised Quick Cognitive Screening Test.

Objective

To validate the revised version of the Quick Cognitive Screening Test (QCST).

Design

Cross-sectional.

Setting

Senior homes; hospital; college campus.

Participants

Participants (N=377; 114 men, 263 women) were recruited comprising healthy controls (n=201; 40 men, 161 women), subjects with dementia (n=93; 34 men, 59 women) including Alzheimer disease (n=73) and vascular dementia (n=20); subjects with psychiatric illness (n=35, 15 men, 20 women), specifically schizophrenia or bipolar disorder; and subjects with other neurologic conditions (n=48, 25 men, 23 women) such as traumatic brain injury (n=12) and cerebrovascular disease (n=31). Diagnoses were confirmed by physicians using appropriate criteria. Recruitment was done in the northeastern region.

Interventions

Not applicable.

Main Outcome Measures

In an effort to examine the reliability and validity of the revised QCST, participants were administered the revised QCST with a number of standardized measures (ie, Alzheimer's Disease Assessment Scale-Cognitive, Mini-Mental State Examination, Tests of Oral Fluency, Trail-Making Test, and Functional Activities Questionnaire).

Results

The results revealed that the revised QCST discriminated between healthy controls and the neuropsychiatric participants. Additionally, the revised QCST significantly correlated with other standardized measures, confirming the revised QCST's reliability and validity as a screening instrument for subjects with cognitive deficits.

Conclusions

The revised QCST provides the clinician with a short yet reliable screening instrument in detecting cognitive deficits in subjects with dementia and other neurologic conditions.     

The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system

Stineman MG, Kwong PL, Kurichi JE, Prvu-Bettger JA, Vogel WB, Maislin G, Bates BE, Reker DM. The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system.

Objective

To compare outcomes between lower-extremity amputees who receive and do not receive acute postoperative inpatient rehabilitation within a large integrated health care delivery system.

Design

An observational study using multivariable propensity score risk adjustment to reduce treatment selection bias.

Setting

Data compiled from 9 administrative databases from Veterans Affairs Medical Centers.

Participants

A national cohort of veterans (N=2673) who underwent transtibial or transfemoral amputation between October 1, 2002, and September 30, 2004.

Interventions

Not applicable.

Main Outcome Measures

One-year cumulative survival, home discharge from the hospital, and prosthetic limb procurement within the first postoperative year.

Results

After reducing selection bias, patients who received acute postoperative inpatient rehabilitation compared to those with no evidence of inpatient rehabilitation had an increased likelihood of 1-year survival (odds ratio [OR]=1.51; 95% confidence interval [CI], 1.26-1.80) and home discharge (OR=2.58; 95% CI, 2.17-3.06). Prosthetic limb procurement did not differ significantly between groups.

Conclusions

The receipt of rehabilitation in the acute postoperative inpatient period was associated with a greater likelihood of 1-year survival and home discharge from the hospital. Results support early postoperative inpatient rehabilitation following amputation.     

Pulsed Electromagnetic Fields to Reduce Diabetic Neuropathic Pain and Stimulate Neuronal Repair: A Randomized Controlled Trial

Weintraub MI, Herrmann DN, Smith AG, Backonja MM, Cole SP. Pulsed electromagnetic fields to reduce diabetic neuropathic pain and stimulate neuronal repair: a randomized controlled trial.

Objective

To determine whether repetitive and cumulative exposure to low-frequency pulsed electromagnetic fields (PEMF) targeting painful feet can reduce neuropathic pain (NP), influence sleep in symptomatic diabetic peripheral neuropathy (DPN), and influence nerve regeneration.

Design

Randomized, double-blind, placebo-controlled parallel study.

Setting

Sixteen academic and clinical sites in 13 states.

Participants

Subjects (N=225) with DPN stage II or III were randomly assigned to use identical devices generating PEMF or sham (placebo) 2 h/d to feet for 3 months.

Interventions

Nerve conduction testing was performed serially.

Main Outcome Measures

Pain reduction scores using a visual analog scale (VAS), the Neuropathy Pain Scale (NPS), and the Patient's Global Impression of Change (PGIC). A subset of subjects underwent serial 3-mm punch skin biopsies from 3 standard lower limb sites for epidermal nerve fiber density (ENFD) quantification.

Results

Subjects (N=225) were randomized with a dropout rate of 13.8%. There was a trend toward reductions in DPN symptoms on the PGIC, favoring the PEMF group (44% vs 31%; P=.04). There were no significant differences between PEMF and sham groups in the NP intensity on NPS or VAS. Twenty-seven subjects completed serial biopsies. Twenty-nine percent of PEMF subjects had an increase in distal leg ENFD of at least 0.5 SDs, while none did in the sham group (P=.04). Increases in distal thigh ENFD were significantly correlated with decreases in pain scores.

Conclusions

PEMF at this dosimetry was noneffective in reducing NP. However neurobiological effects on ENFD, PGIC and reduced itching scores suggest future studies are indicated with higher dosimetry (3000-5000 G), longer duration of exposure, and larger biopsy cohort.     

The Effects of Scapulothoracic Bursa Injections in Patients With Scapular Pain: A Pilot Study

Chang WH, Im SH, Ryu JA, Lee SC, Kim JS. The effects of scapulothoracic bursa injections in patients with scapular pain: a pilot study.

Objective

To assess the effects of steroid plus hyaluronate injections for scapulothoracic bursitis in patients with scapular pain.

Design

Prospective open-label unicenter trial with a 3-month follow-up.

Setting

University rehabilitation hospital.

Participants

Twenty-two cases of suspected scapulothoracic bursitis.

Intervention

Injections into scapulothoracic bursa were performed with steroid plus hyaluronate. Injections were administered once a week for 3 weeks.

Main Outcome Measures

Visual analog scale (VAS), Rubin scale, adverse events, and injection-associated complications.

Results

Mean outcome scores at 3-month follow-up visits showed significant improvements versus baseline (mean VAS increased from 7.8 to 2.2) (P<.05). Furthermore, mean VAS scores at 1, 2, and 3 weeks after treatment commencement showed significant improvements versus baseline (P<.05). No serious complication occurred during the study.

Conclusions

Scapulothoracic bursitis should be considered when treating patients with perimarginal scapular pain or subscapular pain. Our findings show that steroid plus hyaluronate injections into the scapulothoracic bursa provide an effective means of treating patients with scapulothoracic bursitis.     

Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study

McCain KJ, Pollo FE, Baum BS, Coleman SC, Baker S, Smith PS. Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study.

Objective

To investigate the impact of locomotor treadmill training with partial body-weight support (BWS) before the initiation of overground gait for adults less than 6 weeks poststroke.

Design

Parallel group, posttest only.

Setting

Inpatient rehabilitation center.

Participants

Adults after first stroke admitted to an inpatient rehabilitation unit: treadmill group (n=7) and comparison group (n=7).

Interventions

Locomotor treadmill training with partial BWS or traditional gait training methods.

Main Outcome Measures

Gait kinematics, symmetry, velocity, and endurance at least 6 months postinsult.

Results

Data from 3-dimensional gait analysis and 6-minute walk test (6MWT) supported improved gait for adults postacute stroke who practiced gait on a treadmill before walking over ground. Gait analysis showed increased knee flexion during swing and absence of knee hyperextension in stance for the treadmill group. In addition, more normal ankle kinematics at initial contact and terminal stance were observed in the treadmill group. Improved gait symmetry in the treadmill group was confirmed by measures of single support time, hip flexion at initial contact, maximum knee flexion, and maximum knee extension during stance. The treadmill group also walked further and faster in the 6MWT than the comparison group.

Conclusions

Application of locomotor treadmill training with partial BWS before overground gait training may be more effective in establishing symmetric and efficient gait in adults postacute stroke than traditional gait training methods in acute rehabilitation.     

Differences in gait characteristics between persons with bilateral transtibial amputations, due to peripheral vascular disease and trauma, and able-bodied ambulators

Su P-F, Gard SA, Lipschutz RD, Kuiken TA. Differences in gait characteristics between persons with bilateral transtibial amputations, due to peripheral vascular disease and trauma, and able-bodied ambulators.

Objectives

To examine differences in gait characteristics between persons with bilateral transtibial amputations because of trauma and peripheral vascular disease (PVD); and to compare that with data from able-bodied controls that were previously collected and maintained in a laboratory database.

Design

Observational study of persons with bilateral transtibial amputations.

Setting

A motion analysis laboratory.

Participants

Nineteen bilateral transtibial amputees.

Intervention

No experimental intervention was performed. To standardize the effect of prosthetic foot type, subjects were fitted with Seattle Lightfoot II feet 2 weeks before quantitative gait analyses.

Main Outcome Measures

Temporospatial, kinematic, and kinetic gait data were recorded and analyzed.

Results

Results showed that the freely selected walking speeds of subjects with PVD and trauma were 0.69m/s and 1.11m/s, respectively, while that of able-bodied control subjects was 1.20m/s. When data were compared on the basis of freely selected walking speed, numerous differences were found in temporospatial, kinematic, and kinetic parameters between the PVD and trauma groups. However, when data from similar speeds were compared, the temporospatial, kinematic, and kinetic gait data demonstrated no statistically significant differences between the 2 amputee groups. Although not statistically significant, the PVD group displayed increased knee (P=.09) and hip (P=.06) flexion during the swing phase, whereas the trauma group displayed increased pelvic obliquity (P=.06). These actions were believed to represent different strategies to increase swing phase foot clearance. Also, the PVD group exhibited slightly greater hip power (P=.05) before toe-off.

Conclusions

Many of the differences observed in the quantitative gait data between the trauma and PVD groups appeared to be directly associated with their freely selected walking speed; the trauma group walked at significantly faster freely selected speeds than the PVD group. When their walking speeds were matched, both amputee groups displayed similar gait characteristics, with the exception that they might use slightly different strategies to increase foot clearance.     

Assistive Walking Devices in Nonambulant Patients Undergoing Rehabilitation After Stroke: The Effects on Functional Mobility, Walking Impairments, and Patients' Opinion

Tyson SF, Rogerson L. Assistive walking devices in nonambulant patients undergoing rehabilitation after stroke: the effects on functional mobility, walking impairments, and patients' opinion.

Objective

To assess the immediate effects of assistive walking devices on functional mobility, walking impairments, and patients' opinions in nonambulant patients after stroke.

Design

Randomized crossover trial.

Setting

Inpatient rehabilitation units of 3 United Kingdom hospitals.

Participants

Twenty nonambulant patients with stroke undergoing rehabilitation to restore walking.

Interventions

Five walking conditions: (1) Walking with no device (the control condition), (2) walking with a walking cane, (3) ankle foot orthosis, (4) slider shoe, and (5) a combination of all 3 devices.

Main Outcome Measures

Functional mobility (functional ambulation categories), walking impairments (speed, step length of the weak leg), and patients' opinions.

Results

Functional mobility improved with all assistive devices (P<.0001-.005; effect sizes 1.68-0.52; number needed to treat=2-5). Walking impairments were unchanged (P<.800-.988). Participants were generally positive about the devices. They felt their walking, confidence, and safety improved and found the appearance and comfort of the devices acceptable. They would rather walk with the devices than delay walking until a normative gait pattern was achieved without them.

Conclusions

Assistive walking devices improved functional mobility in nonambulant rehabilitation patients with stroke. No changes in walking impairments were found. Participants were generally positive about using the devices. The results support the use of assistive walking devices to enable early mobilization after stroke; 2 patients would need to be treated with a cane or combined devices for 1 to improve functional mobility.     

Patient-centredness in physiotherapy from the perspective of the chronic low back pain patient

Objective

To define patient-centredness from the patient's perspective in the context of physiotherapy for chronic low back pain (CLBP).

Design

Qualitative study using semi-structured interviews to explore perceptions of various aspects of physiotherapy management of CLBP.

Setting

Physiotherapy departments in one geographical area of the UK National Health Service.

Participants

Twenty-five individuals who had received physiotherapy for CLBP within the previous 6 months.

Results

Six key themes emerged as the dimensions that the participants perceived to be important for patient-centred physiotherapy: communication; individual care; decision-making; information; the physiotherapist; and organisation of care. Communication was the most important dimension, underpinning the five other dimensions as well as being a distinct dimension of patient-centred physiotherapy.

Conclusions

Physiotherapists should have an understanding of the six dimensions of patient-centred physiotherapy for CLBP. Improving physiotherapists’ communication skills may better facilitate patient-centred physiotherapy, and therefore enhance the experience of physiotherapy for this client group.     

Static and Dynamic Postural Balance After Successful Mobile-Bearing Total Ankle Arthroplasty

Lee KB, Park YH, Song EK, Yoon TR, Jung KI. Static and dynamic postural balance after successful mobile-bearing total ankle arthroplasty.

Objective

To investigate static and dynamic postural balance after successful total ankle arthroplasty by using dynamic posturography.

Design

A controlled trial study.

Setting

A national university orthopedic and rehabilitation hospital.

Participants

Patients (n=30, 21 men, 9 women; mean age, 58y) and age- and sex-matched healthy controls (n=30).

Interventions

Thirty patients who underwent unilateral total ankle arthroplasty with a cementless mobile-bearing ankle prosthesis and 30 age- and sex-matched healthy control subjects were included.

Main Outcome Measures

Using computerized dynamic posturography, sensory (sensory organization test [SOT]), and motor (limit of stability [LOS], rhythmic weight shift [RWS], and weight bearing) impairment assessments were performed at an average of 15 months after total ankle arthroplasty.

Results

In the SOT, results of the SOT-2 test reflecting mainly proprioception showed no significant difference between patients and controls, but patients demonstrated significantly lower scores for SOT-4, -5, and -6 as a measure of dynamic postural balance and required more hip movement to maintain balance. In the motor-control tests, patients showed significantly lower measures in indices of LOS test except the mean reaction time and the forward/backward directional control and on-axis velocity of the RWS test. Weight bearing was observed asymmetrically in patients.

Conclusions

Patients had a higher degree of dynamic postural imbalance and relied less on ankle strategy to maintain balance than controls. Also, patients showed the deficit of motor control ability as compared with age- and sex-matched healthy controls.