静态直立时足位对眩晕患者姿势平衡的影响

目的：分析不同足位对眩晕患者静态直立时的姿势平衡影响。探讨足位在平衡控制和姿势描记中的作用。方法：眩晕组79例患者和正常组92例健康者进行如下静态直立试验：①标准Romberg试验，双足并拢站立；②双脚分开平行直立试验；③强化Romberg试验（踵趾位站立）；④单足直立试验。每种测试条件下分别睁眼和闭眼站立，用秒表记录①-④试验中维持平衡的时间，同时用SPG记录①、②条件下的人体足底压力中心的晃动速度（sway velocitv，SV）。结果：①维持平衡时间：眩晕组采取踵趾位和单足站立时，维持平衡时间较正常组降低．差异均有极显著性意义（P〈0．001）；②SV：采用标准Romberg位和双脚分开站立，眩晕组和正常组相比，睁眼时两组SV差异无显著性意义（P〉0．05）。而闭眼时，两组间差异均有显著性意义（P〈0．001）；③对于眩晕组和正常组，无论睁眼或闭眼，采用双脚分开站立时，SV较标准Romberg位时降低。差异有极显著性意义（P〈0．001）：④除眩晕组闭眼踵趾位下计时平衡试验结果与其睁眼时标准Romberg足位下的SV呈负相关性外（r=-0．244，P=-0．03），其他计时平衡测试结果与各足位下的SV均未发现有相关性。结论：静态直立时不同足位可影响人体平衡控制能力，踵趾位和单足直立测试是对姿势描记的补充．可结合应用于临床评价眩晕患者的平衡功能。     

Repeatability of the measurement of augmentation index in the clinical assessment of arterial stiffness using radial applanation tonometry

Objective. Aortic augmentation index (AIx) measured using applanation tonometry is a non‐invasive indicator of arterial stiffness. The objective of this study was to assess its repeatability when used by nurses with limited experience of the technique. Material and methods. Blood pressure/augmentation index (BP/AIx) was measured 4 times in 20 consecutive ambulant patients (16 male) after they rested supine for 15?min. Two nurses independently and alternately measured BP/AIx using the same equipment (Omron HEM‐757; SphygmoCor with Millar hand‐held tonometer). Nurses were blinded to patient medical records and their colleague's AIx/BP. ‘Within’ and ‘between’ observer differences were assessed using intra‐class correlation coefficients (rI) and 95 % limits of agreement (95 % LoA) derived from Bland‐Altman plots. Results. Mean age was 56 (mean BP 136/79; mean pulse 64). Mean AIx was 24.1 (range 2.8 to 41.0). Both ‘between’ and ‘within’ observer repeatability was very high, with intra‐class correlation coefficients ranging from 0.92 to 0.98. Mean AIx readings ‘between’ observers differed by only 0.68 (95 % CI ?0.24 to 1.59) with a high rI (0.98; 95 % CI 0.95 to 0.99) and a narrow 95 % LoA (?3.22 to 4.57). The 95 % LoA for ‘within’ observer repeatability was ?6.75 to 7.95. Differences in AIx measurement did not vary over time or with increasing levels of AIx. Conclusions. Even when undertaken by relatively inexperienced operators, both ‘within’ and ‘between’ observer repeatability of AIx measurement is very high. Such non‐invasive assessment of arterial stiffness has the potential to be included in the clinical assessment of ambulant patients.     

Reliability and validity of perceived self-efficacy in wheeled mobility scale among elite wheelchair-dependent athletes with a spinal cord injury

Purpose: To study the reliability and validity of the perceived self-efficacy in wheeled mobility scale among elite athletes with a spinal cord injury (SCI). Method: During the Beijing Paralympics, 79 participants with SCI completed the SCI Exercise Self-Efficacy Scale (ESES), the revised Self-Efficacy in Wheeled Mobility scale (SEWM) and the perceived wheeled mobility (WM) at present Visual Analog Scale (VAS). Sample included athletes from 18 countries and subcategorized by gender, lesion level/completeness and type of sports. Reliability and concurrent validity were determined. Results: SEWM Cronbach’s α was 0.905. High internal consistency was confirmed in Split-half correlation coefficient (r = 0.87). Validity was supported by significant correlations between SWEM and ESES total scores (r = 0.64, p < 0.05), and between SEWM and WM VAS scores (r = 0.60; p < 0.001). Subgroups analyses showed that athletes with tetraplegia showed significantly lower WM self-efficacy levels than those with paraplegia. There was a significant difference in perceived WM self-efficacy between athletes who participated in dynamic wheelchair sports and those who participated in non-wheelchair sports (p < 0.03). Conclusions: The SEWM is a reliable and valid scale among Paralympic athletes with SCI. Findings confirmed a significantly higher perception of self-efficacy in WM among athletes who participated in dynamic wheelchair sports.

Implications for Rehabilitation

• Increased self-efficacy in wheeled mobility (WM) may encourage wheelchair users with spinal cord injury (SCI) to approach, persist, and persevere at WM related tasks that were previously avoided.

• The perceived self-efficacy in WM scale (SEWM), which is available on-line in five different languages, may find clinical applications for people with SCI in different countries.

• The SEWM can be applied to the assessment of progress in WM levels during the acute rehabilitation phase, and also in structured WM workshops conducted after discharge from the hospital.

     

Reliability and sources of variation of the ABILHAND-Kids questionnaire in children with cerebral palsy

Purpose: To determine reliability of the ABILHAND-Kids, explore sources of variation associated with these measurement results, and generate repeatability coefficients.

Method: A reliability study with a repeated measures design was performed in an ambulatory rehabilitation care department from a rehabilitation center, and a center for special education. A physician, an occupational therapist, and parents of 27 children with spastic cerebral palsy independently rated the children’s manual capacity when performing 21 standardized tasks of the ABILHAND-Kids from video recordings twice with a three week time interval (27 first-, and 25?second video recordings available). Parents additionally rated their children’s performance based on their own perception of their child's ability to perform manual activities in everyday life, resulting in eight ratings per child.

Results: ABILHAND-Kids ratings were systematically different between observers, sessions, and rating method. Participant?×?observer interaction (66%) and residual variance (20%) contributed the most to error variance (9%). Test–retest reliability was 0.92. Repeatability coefficients (between 0.81 and 1.82 logit points) were largest for the parents’ performance-based ratings.

Conclusion: ABILHAND-Kids scores can be reliably used as a performance- and capacity-based rating method across different raters. Parents’ performance-based ratings are less reliable than their capacity-based ratings. Resulting repeatability coefficients can be used to interpret ABILHAND-Kids ratings with more confidence.

• Implications for Rehabilitation

• The ABILHAND-Kids is a valuable tool to assess a child's unimanual and bimanual upper limb activities.

• The reliability of the ABILHANDS-Kids is good across different observers as a performance- and capacity-based rating method.

• Parents' performance-based ratings are less reliable than their capacity-based ones.

• This study has generated repeatability coefficients for clinical decision making.

     

Heart rate variability in elite sprinters: effects of gender and body position

To describe the heart rate variability (HRV) of high‐level sprinters in both the supine and standing positions, the HRV of 7 male (24 ± 6 years; 80 ± 8 kg and 182 ± 7 cm) and 11 female (27 ± 5 years; 61 ± 4 kg; 167 ± 5 cm) high‐level Brazilian sprinters was measured in the standing and supine body positions in both the time and frequency domains. The heart rate (HR) and the time (SDNN, RMSSD) and frequency (LF; HF and LF:HF) domains of the HRV were assessed. Natural log‐transformations (ln) of all HRV indices were log‐transformed prior to analysis to reduce bias arising from non‐uniformity of error. The Cohen's effect size and magnitude‐based inference (MBI) were obtained for comparisons. The results suggest higher cardiac autonomic stress in the standing position than in the supine for both genders. With the exception of the lnSDNN that showed possibly MBI in female athletes, all other HRV indices presented a likely or almost certainly MBI. Male athletes demonstrated a higher lnSDNN in the supine body position (very likely MBI) and a higher HR in the standing position (very likely MBI) than females. In conclusion, elite sprinters (independent of the gender) present lower HRV in the standing position than in the supine position, but males present a more notable change in cardiac autonomic stress than female athletes.     

Reliability and validity of shoulder function outcome measures in people with a proximal humeral fracture

Abstract

Purpose: Investigate test--retest reliability and validity of five shoulder outcome measures in people during their active rehabilitation after a shoulder fracture. Method: This prospective longitudinal study assessed shoulder function in 20 people (16 women, mean age 68.1 years) with surgical or conservative management at 6, 12 and 13 weeks post proximal humeral fracture using three patient-reported (Disabilities of Arm, Shoulder and Hand; Oxford Shoulder Score; Subjective Shoulder Value) and two clinician-administered (Constant Score; UCLA Shoulder score) outcome measures. Results: Content analysis categorised items into multiple domains of functioning for each outcome measure. Construct validity testing between measures found moderate to strong correlations (r?=?0.43–0.92). Longitudinal validity (responsiveness), represented by correlations between change scores, was moderate to strong (r?=?0.44–0.83). Although ICCs_2,1 for test–retest reliability ranged from 0.75 to 0.93, Limits of Agreement between measurements were relatively wide (10–23% of available range of scores). Minimal clinically important difference estimates varied between anchor- and distribution-based methods. Conclusions: The five outcome measures assessing shoulder function provided values for reliability and validity that meet measurement requirements for use in groups of people after a proximal humeral fracture. However, the use of these outcome measures might be limited by low absolute agreement between measurements and their content covering multiple domains of functioning.

• Implications for Rehabilitation

• Linking the International Classification of Functioning, Disability and Health (ICF) to the content of common shoulder function outcome measures showed that multiple domains of functioning are combined into a single score. This might not be preferred for measurement of the single construct of “shoulder function”.

• Currently available shoulder function outcome measures may not be sufficiently reliable to monitor change in an individual after a proximal humeral fracture during the rehabilitation phase.

     

Response measures in the acute treatment of migraine

Pain ratings from 268 migraine patients have been used to compare the visual analogue scale (VAS) and a four-point verbal rating scale. All patients completed pain ratings on both scales at the beginning of a migraine attack and 4 h after starting treatment with sumatriptan or placebo. The VAS scores showed large variability within each category on the verbal rating scale. A common way of analysing pain in migraine studies is to classify patient response as a success or failure based on the score on the four-point verbal rating scale. In this study, the statistical power of analysing response either as "success or failure" or by means of the VAS score has been investigated by stochastic simulation. The simulations showed that the two response measures resulted in approximately equal power.     

肝硬化患者合并感染性心内膜炎8例临床分析并文献复习

目的探讨肝硬化患者并发感染性心内膜炎的临床特点,以提高临床医生对其的认识。方法回顾性分析本院确诊的8例肝硬化患者并发感染性心内膜炎的临床资料。结果 8例患者中,男4例,病程为1周至24个月。主要临床表现为发热（8/8）、栓塞（4/8）。随访的5例患者1年内病死率为80%（4/5）,死亡的原因是急性心功能衰竭、肺栓塞、肝功能衰竭、呼吸衰竭。1例患者接受了手术治疗,术后感染性心内膜炎复发后死亡。结论肝硬化患者并发感染性心内膜炎临床表现具有起病隐匿、病程长等特点,早期诊断及内外科联合治疗有利于改善预后。     

平衡反馈训练仪用于脑损伤偏瘫患者静态平衡测试的信度与效度研究

目的:探讨Pro-Kine Line平衡反馈仪测试静态平衡的信度和效度,为临床应用提供客观依据。方法:24名健康人和24例脑损伤偏瘫患者,每位受试者分别在前后两天的同一时间使用Pro-Kine Line平衡反馈仪进行坐位和站立位平衡测试,检测压力中心前后及左右方向的摆动幅度标准差和摆动速度,以及压力中心的摆动长度和摆动面积。结果:①信度检验:坐位下,除压力中心前后方向摆动幅度标准差外,其他5个参数重测信度均较高(ICC=0.66—0.92);站立位下6个参数的重测信度也均较高(ICC=0.57—0.93)。②区分效度检验:偏瘫组与对照组比较,各个测试指标的差异均有显著性意义(P<0.01)。③标准效度检验:站立位下各测试指标与Berg量表之间呈良好的负相关(-0.41—-0.64)。结论:Pro-Kine Line平衡反馈训练仪在静态平衡功能的评定中具有较高的信度和效度。     

大肠癌幸存者体力活动相关临床实践指南推荐意见的内容分析

目的对国内外大肠癌幸存者体力活动相关临床实践指南的推荐意见进行内容分析,为临床制定规范、个性化的大肠癌幸存者体力活动指导方案提供参考依据。方法计算机检索国内外中英文数据库、指南网站及专业学会网站内与大肠癌幸存者体力活动相关的临床实践指南,检索时限为2009年1月1日—2019年7月1日。对指南中的推荐意见进行提取、翻译、归类整理后,采用内容分析法对指南中的推荐意见进行文献内容分析。结果共纳入7篇临床实践指南,共提取出26条大肠癌幸存者体力活动相关推荐意见,析出体力活动的安全性和益处,体力活动前评估,体力活动总量,体力活动方式,体力活动强度、频率及持续时间,体力活动注意事项,体力活动禁忌证,增加体力活动的策略共8项体力活动相关内容。结论涉及体力活动方式、总量、频率、强度、注意事项方面的推荐意见较多,推荐意见的提及频次与临床重要性之间存在不一致性,指南的部分推荐意见与国内实践内容一致,但内容较国内实践内容更多样化。应对国外的高质量指南进行本土化实践,挖掘适合我国大肠癌幸存者体力活动的证据。