The Relationship of Transversus Abdominis and Lumbar Multifidus Activation and Prognostic Factors for Clinical Success With a Stabilization Exercise Program: A Cross-Sectional Study

Hebert JJ, Koppenhaver SL, Magel JS, Fritz JM. The relationship of transversus abdominis and lumbar multifidus activation and prognostic factors for clinical success with a stabilization exercise program: a cross-sectional study.

Objective

To examine the relationship between prognostic factors for clinical success with a stabilization exercise program and lumbar multifidus (LM) and transversus abdominis (TrA) muscle activation assessed using rehabilitative ultrasound imaging (RUSI).

Design

Cross-sectional study.

Setting

Outpatient physical therapy clinic.

Participants

Volunteers with current low back pain (N=40).

Intervention

Not applicable.

Main Outcome Measures

We examined the relationship between prognostic factors associated with clinical success with a stabilization exercise program (positive prone instability test, age <40y, aberrant movements, straight leg raise >91°, presence of lumbar hypermobility) and degree of TrA and LM muscle activation assessed by RUSI.

Results

Significant univariate relationships were identified between LM muscle activation and the number of prognostic factors present (Pearson correlation coefficient [r] =−.558, P=.001), as well as the individual factors of a positive prone instability test (point biserial correlation coefficient [r_pbis]=.376, P=.018) and segmental hypermobility (r_pbis=.358, P=.025). The multivariate analyses indicated that after controlling for other variables, the addition of the variable “number of prognostic factors present” resulted in a significant increase in R² (P=.006). No significant univariate or multivariate relationships were observed between the prognostic factors and TrA muscle activation.

Conclusions

Decreased LM muscle activation, but not TrA muscle activation, is associated with the presence of factors predictive of clinical success with a stabilization exercise program. Our findings provide researchers and clinicians with evidence regarding the construct validity of the prognostic factors examined in this study, as well as the potential clinical importance of the LM muscle as a target for stabilization exercises.     

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.     

Intrarater test-retest reliability of hip range of motion and hip muscle strength measurements in persons with hip osteoarthritis

Pua YH, Wrigley TW, Cowan SM, Bennell KL. Intrarater test-retest reliability of hip range of motion and hip muscle strength measurements in persons with hip osteoarthritis.

Objective

To examine the relative and absolute intrarater test-retest reliability of muscle strength and range of motion (ROM) measurements of the hip performed in people with hip osteoarthritis.

Design

Repeated measures.

Setting

Human movement laboratory of a university.

Participants

Participants (N=22; 10 men, 12 women; age range, 50-84y) with hip osteoarthritis.

Interventions

On 2 separate occasions, at least 1 week apart, isometric torque measurements were obtained from the hip rotators, flexors, abductors, and extensors. Passive ROMs in hip rotation, flexion, abduction, and extension were also determined.

Main Outcome Measures

Relative reliability was estimated using the intraclass correlation coefficient, model 2,2 (ICC_2,2). Absolute reliability was estimated using the coefficient of variation (CV) and the standard error (SE) of measurement.

Results

For measurements of muscle strength, ICC_2,2 ranged from .84 to .97, and the CV ranged from 8% to 15.7%. Hip extensors and internal and external rotators showed high ICC_2,2 (>.96) and low CV (<9.8%); hip abductors showed the lowest ICC_2,2 (.84) and the highest CV (15.7%). For ROM measurements, ICC_2,2 ranged from .86 to .97 and SE ranged from 3.1° to 4.7°. Hip flexion ROM showed the highest ICC_2,2 (.97) and an SE of 3.5°; hip extension ROM showed the lowest ICC_2,2 (.86) and the highest SE (4.7°).

Conclusions

Strength and ROM testing of the hip in people with hip osteoarthritis can be performed with good to excellent reliability.     

The Effects of an 8-Week Stabilization Exercise Program on Lumbar Multifidus Muscle Thickness and Activation as Measured With Ultrasound Imaging in Patients With Low Back Pain: An Exploratory Study

Background

Lumbar stabilization exercise programs (LSEP) produce positive effects on clinical outcomes, but the underlying mechanisms remain relatively unexplored. Psychological and neuromuscular mechanisms can be involved, such as a better activation of the lumbar multifidus, which represents one possibility.

Characterizing wandering behaviors in persons with traumatic brain injury residing in veterans health administration nursing homes

Belanger HG, King-Kallimanis B, Nelson AL, Schonfeld L, Scott SG, Vanderploeg RD. Characterizing wandering behaviors in persons with traumatic brain injury residing in Veterans Health Administration nursing homes.

Objective

To examine the prevalence and correlates of wandering in persons with traumatic brain injury (TBI) in nursing homes (NHs).

Design

Using a cross-sectional design, logistic regression modeling was used to analyze a national database.

Setting

One hundred thirty-four NH facilities operated by the Veterans Health Administration.

Participants

NH residents (N=625) with TBI as well as a sample (n=164) drawn from a larger dataset of NH residents without TBI using 1:K matching on age.

Interventions

Not applicable.

Main Outcome Measure

Wandering.

Results

Wanderers with and without TBI did not differ significantly overall. The prevalence of wandering among patients with TBI was 14%, compared with 6.5% of the general nursing home population. The results of the multivariate logistic regression suggested that wandering was associated with poor memory, poor decision making, behavior problems, independence in locomotion and ambulation, and dependence in activities of daily living related to basic hygiene.

Conclusions

Wandering is relatively common in NH residents with TBI. As expected, it is associated with cognitive, social, and physical impairments. Further research with a larger sample should examine those with comorbid dementia and/or psychiatric diagnoses.     

A comparison between self-reported and observed activity limitations in adults with neuromuscular disorders

Vandervelde L, Dispa D, Van den Bergh PY, Thonnard J-L. A comparison between self-reported and observed activity limitations in adults with neuromuscular disorders.

Objective

To investigate the agreement between the self-reported and examiner-reported difficulties of patients with neuromuscular disorders (NMDs) in performing daily activities at home.

Design

A comparison between 2 methods of administering a measurement instrument.

Setting

Neuromuscular reference center in a university hospital.

Participants

Adult patients (N=57) with diagnosed NMDs living at home.

Interventions

Not applicable.

Main Outcome Measure

The ACTIVLIM questionnaire.

Results

The intraclass correlation coefficient, model 2,1 (ICC_2,1), between the measures was very good (ICC_2,1=.87), indicating a good agreement between self-perceived and observed measures.

Conclusions

The use of ACTIVLIM as a self-reporting questionnaire is a valid method for assessing activity limitations in patients with NMD.     

Psychometric Properties of the Community Integration Questionnaire Adjusted for People With Aphasia

Dalemans RJ, de Witte LP, Beurskens AJ, van den Heuvel WJ, Wade DT. Psychometric properties of the community integration questionnaire adjusted for people with aphasia.

Objectives

To describe the feasibility of the Community Integration Questionnaire (CIQ) adjusted for use in people with aphasia and to report its psychometric properties in people with aphasia (internal consistency, factor analysis, test-retest reliability, convergent validity).

Design

A cross-sectional, interview-based psychometric study. Test-retest reliability was evaluated in 20 people (minimal to severe aphasia) by 2 different interviewers within a 2-week period.

Setting

Community.

Participants

In total 490 stroke survivors with (minimal to severe) aphasia were approached, of which 165 (34%) participants returned the answering letter. Participants (N=150) agreed to take part and were interviewed using a structured interview format.

Interventions

Not applicable.

Main Outcome Measures

Community Integration Questionnaire (CIQ), Frenchay Aphasia Screening Test, Barthel Index, Dartmouth Coop Functional Health Assessment Charts (COOP)-World Organisation of Family Doctors (WONCA) Charts, Life Satisfaction Questionnaire.

Results

A total of 150 stroke survivors with aphasia completed the CIQ adjusted for people with aphasia. The CIQ adjusted for people with aphasia was a feasible instrument. Results showed good internal consistency for the CIQ total (standardized Cronbach α=.75), excellent test-retest reliability (intraclass correlation coefficient=.96), moderate correlations with the Barthel Index, the COOP-WONCA, and the Life Satisfaction Questionnaire with regard to construct validity. Significant relations were found with regard to age and aphasia severity.

Conclusions

The CIQ adjusted for people with aphasia seems to be an adequate instrument to assess participation in people with aphasia.     

Intratester Reliability and Validity of Concentric Measurements Using a New Hand-Held Dynamometer

Janssen JC, Le-Ngoc L. Intratester reliability and validity of concentric measurements using a new hand-held dynamometer.

Objective

To assess the reliability of a new hand-held dynamometer (HHD) to perform concentric measurements, and to determine the agreement between the HHD and the criterion standard isokinetic dynamometer.

Design

Elbow flexion concentric measurements were performed on a mechanical arm using the HHD and the isokinetic dynamometer.

Setting

Engineering laboratory and university strength-testing facility.

Participants

Three patient profiles, differing in range of motion (ROM) and strength, were simulated by a mechanical arm.

Interventions

Not applicable.

Main Outcome Measures

Peak torque and ROM obtained from concentric elbow flexion profiles.

Results

Intratester reliabilities, measured with the intraclass correlation coefficient (ICC_1,1), of the peak torque and start and end ROM are excellent for both the HHD (.99, .98, and .99, respectively) and the isokinetic dynamometer (.99 for all 3 variables). The angle of peak torque was rated fair to good in intrareliability for both devices, at .64 (HHD) and .69 (isokinetic dynamometer). Validity, measured within the limits of agreement (LOA) between the 2 devices, was clinically acceptable for peak torque and start ROM, although not for end ROM and angle of peak torque.

Conclusions

It is possible to use the new HHD to obtain dynamic measurements of joint motion. Intratester reliability of the HHD is excellent and is in clinical acceptable agreement with the isokinetic dynamometer for peak torque and start ROM. End ROM was, however, not in agreement because of a systematic error in the isokinetic dynamometer measurement for 1 of the 3 tested profiles. Intratester reliabilities of the angle of peak torque were fair to good for both the HHD and isokinetic dynamometer, but the LOA were not clinically acceptable. Stability of the arm and speed of measurement might be confounding factors in this study.     

The Validity and Reliability of the Motor Point Detection System: A Preliminary Investigation of Motor Points of the Triceps Surae Muscles

Lee NG, You JH, Park HD, Myoung HS, Lee SE, Hwang JH, Kim HS, Kim SS, Lee KJ. The validity and reliability of the motor point detection system: a preliminary investigation of motor points of the triceps surae muscles.

Objective

To investigate the validity and reliability of the motor point detection system in cadavers and healthy young adults.

Design

Correlation statistics.

Setting

University research laboratory.

Participants

Sixty-two lower limbs of 31 healthy young adults (mean age, 22.3±1.8) and 10 size-matched lower limbs from cadavers were used.

Interventions

Not applicable.

Main Outcome Measures

The validity of the motor point detection system's motor point measure was determined by comparing the motor point locations of the lower-leg muscles obtained from the motor point detection system with the established anatomic motor point locations from our previous cadaveric dissection study. The anatomic motor points were determined by tracing the terminal motor nerve branches on soleus, medial, and lateral gastrocnemius muscles through the dissection of adult cadavers. The test-retest reliability was determined by repeatedly measuring the locations of motor points in healthy young adults on 2 separate occasions, approximately 24 hours apart. The intraclass correlation coefficient (ICC) was computed to determine correlation, and an independent t test was used to determine the difference between the demographic and clinical variables at the significance level (P<.05).

Results

Correlation analysis revealed relatively high validity between the motor point detection system and cadaver-dissected motor point location measurements (ICC_2,1=.71-.92, P<.05). The test-retest reliability showed excellent correlation between the repeated measures (range, ICC_1,2=.90-.95 at P<.05).

Conclusions

Our results showed that the motor point detection system was accurate and consistent in the measurement of motor point locations of the lower-leg muscles. This system can be considered as an alternative device to localize motor points in clinical settings. Our motor point detection system warrants further investigation in pathologic population.     

Measurement properties of the pressure biofeedback unit in the evaluation of transversus abdominis muscle activity: a systematic review

Background

Measurements from pressure biofeedback units (PBUs) can be used to evaluate the activity of the transversus abdominis (TrA) muscle indirectly. These measurements can classify patients or monitor the progress of treatment programmes for people with low back pain.

Objective

To systematically review studies on the measurement properties of PBUs for the assessment of TrA activity.

Data sources

Eligible studies were identified through searches of PUBMED, CINAHL and BIREME (1990 to 2009). In addition, hand searches of journals and citation tracking were performed.

Study selection

Full-text studies involving any type of clinimetric tests of PBU measurement for the assessment of TrA activity were selected.

Data extraction

Two independent reviewers selected the studies, extracted the data and assessed methodological quality.

Data synthesis

Due to the heterogeneity of study designs and statistical analysis, it was not possible to pool the data for a meta-analysis.

Results

Six studies met the inclusion criteria. These studies were typically of low quality and recruited healthy subjects rather than patients with low back pain. The studies found moderate to good reproducibility (intra-class correlation coefficients from 0.47 to 0.82) and acceptable construct validity (intra-class correlation coefficients from 0.48 to 0.90).

Conclusions

The current evidence about the measurement properties of PBUs for the assessment of TrA activity is mainly based on studies with suboptimal designs, and the findings from these studies are likely to be overly optimistic. The most important clinical questions about the measurement properties of PBUs for the assessment of TrA activity are yet to be answered.     

Ultrasound Characteristics of the Deep Abdominal Muscles During the Active Straight Leg Raise Test

Teyhen DS, Williamson JN, Carlson NH, Suttles ST, O'Laughlin SJ, Whittaker JL, Goffar SL, Childs JD. Ultrasound characteristics of the deep abdominal muscles during the active straight leg raise test.

Objective

To determine whether changes in the transversus abdominis (TrA) and internal oblique (IO) muscles, as seen on ultrasound imaging, during the active straight leg raise (ASLR) test differ between subjects with and without unilateral lumbopelvic pain.

Design

Cross-sectional, case-control study.

Setting

Clinical laboratory.

Participants

Subjects (n=15) with unilateral symptoms in the lumbopelvic region and age-matched and sex-matched control subjects (n=15).

Interventions

Bilateral measurements of the deep abdominal muscles (TrA and IO) were obtained simultaneously using ultrasound imaging to compare the percent change in muscle thickness from rest with (1) immediately on raising, (2) after a 10-second hold, and (3) within 5 seconds after returning the lower extremity to the plinth.

Main Outcome Measure

Percent change in muscle thickness of both muscles from rest to the other 3 time intervals during the ASLR test.

Results

The 3-way group × side measured × time and 2-way side measured × time interactions were not significant for either the TrA (P≥.34) or the IO (P≥.14) muscles. The 2-way interaction group × time was significant for both the TrA (P=.003) and the IO (P=.02) muscles. On lifting the lower extremity, the control group demonstrated a 23.7% and 11.2% increase in TrA and IO muscle thickness, respectively, while those with lumbopelvic pain demonstrated a 6.4% and 5.7% increase in TrA and IO muscle thickness, respectively.

Conclusions

Although subjects with unilateral lumbopelvic pain demonstrated a smaller increase in muscle thickness, during the ASLR test there appears to be a symmetrical response in both of the deep abdominal muscles regardless of which lower extremity is lifted during the ASLR test or the unilateral nature of the symptoms. This study attests to the potential construct validity of using the ASLR test to assess different motor control strategies of the TrA and IO muscles in subjects with unilateral lumbopelvic pain.     

A Preliminary Assessment of the Benefits of the Addition of Botulinum Toxin A to a Conventional Therapy Program on the Function of People With Longstanding Stroke

Meythaler JM, Vogtle L, Brunner RC. A preliminary assessment of the benefits of the addition of botulinum toxin A to a conventional therapy program on the function of people with longstanding stroke.

Objective

To determine if botulinum toxin type A (BTX-A) combined with therapy can facilitate improved upper-extremity (UE) functional status versus therapy alone.

Design

Double-blind randomized crossover trial.

Setting

Tertiary care outpatient rehabilitation center.

Participants

Convenience sample of 21 men and women (ages 19-80y) with stroke more than 6 months after insult who had tone greater than 3 on the Ashworth Scale for 2 joints in the involved UE.

Intervention

Subjects were consecutively recruited and randomized to a double-blind crossover trial. Subjects received either BTX-A combined with a defined therapy program or placebo injection combined with a therapy program in two 12-week sessions.

Main Outcome Measures

The primary functional outcome measure was the Motor Activity Log (MAL). Subjects were also assessed on physiologic measures including tone (Ashworth Scale), range of motion, and motor strength.

Results

Improvements were noted in the functional status of the subjects in both arms of the study as measured by the MAL. All subjects had a significant change in functional status on MAL with therapy (P<.05). The use of BTX-A combined with therapy as compared with therapy only improved the functional status of the subjects on the MAL Quality of Movement subscale (P=.0180, t test) and showed a trend toward significance in the Amount of Use subscale (P=.0605, analysis of variance). Six weeks after treatment, the BTX-A combined with therapy decreased the Ashworth score statistically (P=.0271), but the therapy alone group decreased a similar amount at 6 weeks (P=.0117), indicating that most of the physiologic tone change could be attributed to therapy. After each 12-week period, tone had largely returned to baseline (P>.05).

Conclusion

A focused therapy program showed the most improvement in function in this defined stroke population. BTX-A combined with a focused traditional therapy program slightly enhanced the functional status of stroke subjects beyond that obtained with therapy alone 12 weeks after injection.     

Intraobserver reliability of angular and linear measurements of scapular position in subjects with and without symptoms

Lewis JS, Valentine RE. Intraobserver reliability of angular and linear measurements of scapular position in subjects with and without symptoms.

Objective

To assess intraobserver reliability of angular and linear clinical measurements of scapular position.

Design

Test-retest analyses.

Setting

Outpatient department in National Health Service teaching hospital in the United Kingdom.

Participants

Subjects (n=45) without symptoms (21 men, 24 women; age range, 23-56y) and 45 subjects (22 men, 23 women; age range, 19-84y) with shoulder symptoms (defined as pain in the C5-6 dermatome reproduced by shoulder movement and not reproduced with cervical movement).

Interventions

Not applicable.

Main Outcome Measures

Intraclass correlation coefficient (ICC) models 2,1 and 2,3, 95% confidence intervals (CIs), and SE of measurements for 68% confidence and 2 SEs of measurement (for the 95% CI) for the bilateral angular measurements of scapular rotation and tilt, and the bilateral linear measurements of lateral scapular displacement (protraction) and vertical displacement (elevation).

Results

For subjects without symptoms, ICC_2,3 results ranged from .75 to .98. The 2 SE results for the angular movements ranged from 1.8° to 2.4° and from 0.4 to 1.0cm for the direct linear measurements. Subjects with symptoms: ICC_2,3 results ranged from .61 to .98. The 2 SE results for the angular movements ranged from 1.4° to 2° and from 0.6 to 1cm for the direct linear measurements.

Conclusions

Repeated-measure (ICC_2,3) results were more reliable than single-measure (ICC_2,1) results. Very good to excellent intraobserver reliability was demonstrated for the angular and linear measurements of interest in both shoulders of subjects with and without symptoms. The 2 SE results provide guidance about the error associated with the individual measurements and will assist the clinician determining whether a change in the static position of the scapula has occurred as a result of intervention or over time. (National Research Register identifier N0060148286.)     

Effectiveness of community-based rehabilitation after traumatic brain injury for 489 program completers compared with those precipitously discharged

Altman IM, Swick S, Parrot D, Malec JF. Effectiveness of community-based rehabilitation after traumatic brain injury for 489 program completers compared with those precipitously discharged.

Objective

To evaluate outcomes of home- and community-based postacute brain injury rehabilitation (PABIR).

Design

Retrospective analysis of program evaluation data for treatment completers and noncompleters.

Setting

Home- and community-based PABIR conducted in 7 geographically distinct U.S. cities.

Participants

Patients (N=489) with traumatic brain injury who completed the prescribed course of rehabilitation (completed-course-of-treatment [CCT] group) compared with 114 who were discharged precipitously before program completion (precipitous-discharge [PD] group).

Intervention

PABIR delivered in home and community settings by certified professional staff on an individualized basis.

Main Outcome Measures

Mayo-Portland Adaptability Inventory (MPAI-4) completed by means of professional consensus on admission and at discharge; MPAI-4 Participation Index at 3- and 12-month follow-up through telephone contact.

Results

Analysis of covariance (CCT vs PD group as between-subjects variable, admission MPAI-4 score as covariate) showed significant differences between groups at discharge on the full MPAI-4 (F=82.25; P<.001), Ability Index (F=50.24; P<.001), Adjustment Index (F=81.20; P<.001), and Participation Index (F=59.48; P<.001). A large portion of the sample was lost to follow-up; however, available data showed that group differences remained statistically significant at follow-up.

Conclusions

Results provided evidence of the effectiveness of home- and community-based PABIR and that treatment effects were maintained at follow-up.     

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.     

The segway personal transporter as an alternative mobility device for people with disabilities: a pilot study

Sawatzky B, Denison I, Langrish S, Richardson S, Hiller K, Slobogean B. The Segway Personal Transporter as an alternative mobility device for people with disabilities: a pilot study.

Objectives

To determine the functional measures that best correlate with the skill levels of people with disabilities who operate a Segway Personal Transporter, and—using a qualitative analysis—to explore subjects’ experience with the Segway.

Design

A prospective study encompassing 3 training sessions with the Segway to correlate subjects’ functional ability (eg, cognition, balance, mobility, muscle strength) with their skill level on the device.

Setting

A provincial adult rehabilitation center.

Participants

Twenty-three subjects (age range, 19−65y) with a wide range of disabilities (eg, multiple sclerosis, spinal cord injury, amputation) who could walk at least 6m with or without assistance.

Interventions

Not applicable.

Main Outcome Measures

Segway Task Assessment, Berg Balance Scale, and Timed Up & Go test.

Results

No correlation was found because all participants successfully completed the final Segway Task Assessment, regardless of scores on functional assessments.

Conclusions

The Segway is a useful device for a broad range of populations with functional disabilities. Subjects found the Segway easy to use and were excited about its potential as an assistive device for use in their communities.     

How Reproducible Is Home-Based 24-Hour Ambulatory Monitoring of Motor Activity in Patients With Multiple Sclerosis?

Rietberg MB, van Wegen EE, Uitdehaag BM, de Vet HC, Kwakkel G. How reproducible is home-based 24-hour ambulatory monitoring of motor activity in patients with multiple sclerosis?

Objective

To determine the reproducibility of 24-hour monitoring of motor activity in patients with multiple sclerosis (MS).

Design

Test-retest design; 6 research assistants visited the participants twice within 1 week in the home situation.

Setting

General community.

Participants

A convenience sample of ambulatory patients (N=43; mean age ± SD, 48.7±7.0y; 30 women; median Expanded Disability Status Scale scores, 3.5; interquartile range, 2.5) were recruited from the outpatient clinic of a university medical center.

Interventions

Not applicable.

Main Outcome Measures

Dynamic activity and static activity parameters were recorded by using a portable data logger and classified continuously for 24 hours. Reproducibility was determined by calculating intraclass correlation coefficients (ICCs) for test-retest reliability and by applying the Bland-Altman method for agreement between the 2 measurements. The smallest detectable change (SDC) was calculated based on the standard error of measurement.

Results

Test-retest reliability expressed by the ICC_agreement was .72 for dynamic activity, .74 for transitions, .77 for walking, .71 for static activity, .67 for sitting, .62 for standing, and .55 for lying. Bland and Altman analysis indicated no systematic differences between the first and second assessment for dynamic and static activity. Measurement error expressed by the SDC was 1.23 for dynamic activity, 66 for transitions, .99 for walking, 1.52 for static activity, 4.68 for lying, 3.95 for sitting, and 3.34 for standing.

Conclusions

The current study shows that with 24-hour monitoring, a reproducible estimate of physical activity can be obtained in ambulatory patients with MS.