Level of agreement between physical activity levels measured by ActiHeart and the International Physical Activity Questionnaire in persons with intellectual disability

Purpose: The purpose of this study was to determine the level of agreement between objective physical activity (PA) (ActiHeart^®) and subjective proxy-respondent International Physical Activity Questionnaire-short version (IPAQ-S) data in adults with intellectual disabilities (IDs).

Method: Fifty-eight participants wore ActiHeart^® monitors for seven consecutive days. Caregivers of each participant completed the IPAQ-S on behalf of the participant. Total PA, time spent in light, moderate, and vigorous activity as well as time spent being sedentary were assessed by the IPAQ-S and the ActiHeart^®. Results were compared by means of correlation analyses. The level of agreement was presented with Bland–Altman plots.

Results: Objective PA (ActiHeart^®) was higher (225.57?±?91.96?min/week) than IPAQ-S PA reported by care-givers (177.06?±?309.17?min/week). Weak significant correlations were observed between the ActiHeart^® and IPAQ-S instruments for sedentary behavior (r?=?0.31; p?=?0.04); no significant correlations for light (r=??0.04; p?=?0.8), moderate (r=??0.07; p?=?0.63), or vigorous PA (r=??0.2; p?=?0.18) were found. Limited agreement between objectively determine PA (ActiHeart^®) and IPAQ-S was found.

Conclusion: IPAQ-S is inaccurate when determining PA in persons with ID as it significantly underestimates the true levels of PA in this cohort.

• Implications for Rehabilitation

• Persons with intellectual disability (ID) report insufficient physical activity for health benefits.

• Physical activity is often determined by means of subjective proxy reporting.

• Objective physical activity measurements by means of combined heart rate and accelerometer are necessary to determine accurate levels of physical activity in persons with ID.

• Exercise interventions should be based on objective physical activity measurements.

     

Neuromuscular taping versus sham therapy on muscular strength and motor performance in multiple sclerosis patients

Purpose: Purpose of this study is to evaluate differences in leg muscles strength and motor performance between neuromuscular taping (NT) and sham tape groups. Method: Relapsing-remitting (RR) multiple sclerosis (MS) patients were recruited and randomly assigned to NT or sham tape groups. All patients underwent the treatment 5 times at 5-d intervals. They were submitted to a 6-minute walk test and isokinetic test (peak torque) at the beginning (T0), at the end (T1) and 2 months after the end of the treatment (T2). Results: Forty MS patients (38?F; 2?M; mean age 45.5?±?6.5 years) were assigned to NT group (n?=?20) and to sham tape group (n?=?20). Delta Peak Torque T1–T0 and T2–T0 between two groups were statistically significant in quadriceps (p?=?0.007; 0.000) and hamstrings (p?=?0.011; 0.007). The difference between the two groups according to 6-minute walk test was not statistically significant but in NT group it was noticed an increasing trend about the distance run. Conclusions: In this single-blind randomized controlled trial, NT seemed to increase strength in leg muscles, compared to a sham device, in RR MS patients. Further studies are needed to consider this therapy as a complement to classic physical therapy.

• Implications for Rehabilitation

• Neuromuscular taping (NT) in multiple sclerosis:

• NT is well tolerated by multiple sclerosis patients and should be a complement to classic physical therapy.

• This technique normalizes muscular function, strengthens weakened muscles and assists the postural alignment.

     

A simple test of choice stepping reaction time for assessing fall risk in people with multiple sclerosis

Purpose To determine (a) the discriminant validity for established fall risk factors and (b) the predictive validity for falls of a simple test of choice stepping reaction time (CSRT) in people with multiple sclerosis (MS). Method People with MS (n?=?210, 21–74y) performed the CSRT, sensorimotor, balance and neuropsychological tests in a single session. They were then followed up for falls using monthly fall diaries for 6 months. Results The CSRT test had excellent discriminant validity with respect to established fall risk factors. Frequent fallers (≥3 falls) performed significantly worse in the CSRT test than non-frequent fallers (0–2 falls). With the odds of suffering frequent falls increasing 69% with each SD increase in CSRT (OR?=?1.69, 95% CI: 1.27–2.26, p?=?<0.001). In regression analysis, CSRT was best explained by sway, time to complete the 9-Hole Peg test, knee extension strength of the weaker leg, proprioception and the time to complete the Trails B test (multiple R² = ^?0.449, p?Conclusions A simple low tech CSRT test has excellent discriminative and predictive validity in relation to falls in people with MS. This test may prove useful in documenting longitudinal changes in fall risk in relation to MS disease progression and effects of interventions.

• Implications for rehabilitation

• Good choice stepping reaction time (CSRT) is required for maintaining balance.

• A simple low-tech CSRT test has excellent discriminative and predictive validity in relation to falls in people with MS.

• This test may prove useful documenting longitudinal changes in fall risk in relation to MS disease progression and effects of interventions

     

Degenerative lumbar spinal stenosis and physical functioning: an exploration of associations between self-reported measures and physical performance tests

Background: Degenerative spinal stenosis is a common lumbar condition in the elderly population. Clinical decision-making in the physiotherapy settings is based on assessments of the patients physical status. The purpose of this study was to examine how self-reported measures on symptoms and physical function relate to responses on physical performance tests.

Methods: A total of 103 patients with LSS completed a comprehensive questionnaire and physical performance tests (functional leg-strength and dynamic balance). Associations between the subscales Symptom Severity (SYMP) and Physical Function (FUNC) from the Spinal Stenosis Questionnaire, and the performance tests were examined. Univariate correlation and multivariable linear regression analyses were applied.

Results: The associations between SYMP or FUNC and the performance tests were moderate (?0.3?p?p?R²?=?0.31 and R²?=?0.38).

Conclusions: The present study indicates that both self-reported symptoms and walking limitation are associated with leg strength, while only symptoms are associated with balance. The results suggest that a combination of simple performance tests will add information needed to map the patients disability and guide interventions.

• Implications for Rehabilitation

• One-leg-standing, 30-s sit-to-stand and stair climb test are easy to use and applicable for examining physical function in patients with lumbar spinal stenosis (LSS).

• Simple performance tests add information needed to map the patients’ disability and guide interventions.

• Leg strength is a key factor for both symptoms and walking ability. Also, balance is of importance for the symptoms in LSS patients.

     

Measures of respiratory function correlate with fatigue in ambulatory persons with multiple sclerosis

Abstract

Purpose: This article examines the association between measures of respiratory muscle function and fatigue in individuals with mild-to-moderate disability multiple sclerosis (MS). Methods: This was a cross-sectional study of 37 ambulatory volunteers with MS (28 F/9?M, 52.7?±?10.2 years, Expanded Disability Status Scale [EDSS]?=?3.5?±?1.9). No patients withdrew from the study. Primary outcome variables included measures of respiratory function: maximal inspiratory (MIP) and expiratory pressures (MEP), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), maximal voluntary ventilation (MVV₁₂); and a self-reported measure of fatigue: the Modified Fatigue Impact Scale (MFIS). Secondary measures included 6-min walking test (6MWT), a timed stair climb, the Short Form (SF)-36, the Epworth Sleepiness Scale and the Physical Activity and Disability Scale (PADS). Results: Significant correlations were shown between expiratory muscle strength (MEP) and the MFIS total (p?<?0.03, r?=?–0.362) and between MEP and physical fatigue scores (p?<?0.03, r?=?–0.360), as well as between MVV₁₂ percent predicted (respiratory muscle endurance) and both the 6MWT (p?=?0.045, r?=?0.346) and the Epworth Sleepiness Scale (p?=?0.006, r?=?0.447). Conclusions: Respiratory muscle performance is correlated with perceived fatigue (MFIS), whereas respiratory endurance correlated to reductions in physical function and sleep quality among individuals with mild-to-moderate severity MS.

• Implications for Rehabilitation

• Multiple sclerosis (MS) results in peripheral and respiratory muscle weakness and affected individuals report fatigue as one of their most disabling symptoms.

• Expiratory muscle strength was correlated with self-reported physical fatigue, while respiratory muscle endurance was correlated with functional performance and sleepiness.

• Respiratory muscle strength was not correlated with lung spirometry testing.

• These findings highlight the importance of considering the effects of respiratory muscle weakness when evaluating causes of fatigue among individuals with mild-to-moderate MS.

     

Reliability and validity of the Finnish version of the Lower Extremity Functional Scale (LEFS)

Purpose: The present study aimed to assess the psychometric properties of the Finnish version of the Lower Extremity Functional Scale (LEFS) among foot and ankle patients.

Methods: The LEFS was translated and cross-culturally adapted to Finnish. We assessed the test–retest reliability, internal consistency, floor-ceiling effect, construct validity and criterion validity in patients who underwent surgery due to musculoskeletal pathology of the foot and ankle (N?=?166).

Results: The test–retest reliability was high (ICC = 0.93, 95% CI: 0.91–0.95). The standard error of measurement was 4.1 points. The Finnish LEFS showed high internal consistency (Cronbach’s α?=?0.96). A slight ceiling effect occurred as 17% achieved the maximum score. The LEFS correlation was strong with the 15D Mobility dimension (r?=?0.74) and overall HRQoL (r?=?0.66), pain during foot and ankle activity (r=??0.69) and stiffness (r=??0.62). LEFS correlated moderately with foot and ankle pain at rest (r=??0.50) and with physical activity (r?=?0.46).

Conclusions: The Finnish version of the LEFS showed reliability and validity comparable to those of the original version. This study indicates that the Finnish version of the LEFS serves both clinical and scientific purposes in assessing lower-limb function.

• Implications for Rehabilitation

• The Finnish version of the Lower Extremity Functional Scale (LEFS) is a reliable and valid tool for assessing lower-extremity musculoskeletal disability in Finnish-speaking population.

• Investigation of the psychometric properties of the Finnish version of the LEFS showed validity and reliability comparable to those of the original English version.

• The Finnish LEFS is easy to complete and suitable for clinical, rehabilitation and research purposes.

     

Physical activity motivation and benefits in people with multiple sclerosis

Purpose: Multiple sclerosis is a degenerative neurological disease that affects 2.1 million people worldwide. There is no cure, but an expanding body of research supports the positive impact of physical activity and suggests physical activity has benefits for the individual’s psychological and physical well-being.

Material and methods: Using Self-Determination Theory as a framework, mixed methods with a focus on qualitative interviews were used to explore physical activity motivation and benefits with a sample of highly active people with multiple sclerosis (n?=?15). Disability level ranged from not disabled to wheelchair bound with the majority of participants reporting minimal impact from multiple sclerosis. Survey data were collected using a number of open-ended questions along with measures of self-efficacy, self-determined motivation, physical activity, and quality of life. Additionally, eight individuals participated in semistructured telephone interviews focused on (a) motivation and strategies used to maintain physical activity and (b) the benefits and impact of physical activity in their lives.

Results: The main findings were consistent with Self-Determination Theory; participants described feelings of accomplishment and competence in both their physical activity and daily life, as well as a sense of independence and autonomy. Similarly, all participants cited benefits, and the main themes were enhanced satisfaction with life and an overall positive outlook on life.

Conclusion: Results provide insight into the role of physical activity in a highly active sample and have implications for professionals working in physical activity settings with the multiple sclerosis population. Interventions aimed at increasing long-term physical activity adherence should focus on increasing autonomy and competence for physical activity in the individual and promoting potential increased quality of life outcomes from physical activity participation.

• Implications for Rehabilitation

• Multiple sclerosis is a chronic degenerative neurological disease that the individual lives with for a majority of the lifespan.

• Physical activity is one means that has been shown to aid is the control of multiple sclerosis symptoms.

• Increasing patient understanding of the benefits of using physical activity as a means to control multiple sclerosis symptoms may result in long-term physical activity adherence.

• Physical activity interventions that develop feelings of competence and independent choice in the patient may be more successful for long-term participation.

     

Measurement properties of the Wheelchair Skills Test for scooters among experienced users

Purpose: To investigate the score distribution, reliability, and validity of the objective Wheelchair Skills Test (WST) for scooter users.

Method: A study using a test–retest design was conducted with 20 people who had mobility limitations that prevented them from ambulating more than one city block without a mobility aid, and who had owned a scooter for ≥3 months. Objective scooter skills, confidence, and physical accessibility were measured at both time points, while anxiety, depression, visual attention and task switching, functional independence, and visual acuity were measured only at baseline.

Results: The mean total WST scores at Time 1 and Time 2 were 86.3% and 87.5%. The WST ICC was 0.889. The WST had a SEM of 2.50 and a Cronbach’s alpha of 0.74. The total WST scores were significantly correlated with total subjective WST-Q scores (r?=?0.547, p?=?0.013), scooter confidence (r?=?0.466, p?=?0.038), and were affected by gender (p?=?0.005).

Conclusion: The WST for scooters has good test–retest reliability and generally varies as anticipated with other measures. Although further study is needed, the WST for scooters appears to have promise for use in research and clinical practice.

• Implications for Rehabilitation

• It is important to understand the measurement properties of the tools we use in rehabilitation so the results can be interpreted correctly.

• As scooter use increases, better measurement of skills is required.

     

Targeted upper-limb Wii-based Movement Therapy also improves lower-limb muscle activation and functional movement in chronic stroke

Purpose: Post-stroke hemiparesis may manifest as asymmetric gait, poor balance, and inefficient movement patterns. We investigated improvements in lower-limb muscle activation and function during Wii-based Movement Therapy (WMT), a rehabilitation program specifically targeting upper-limb motor-function.

Methods: Electromyography (EMG) was recorded bilaterally from tibialis anterior (TA) in 20 stroke patients during a 14-day WMT program. EMG amplitude and burst duration were analyzed during stereotypical movement sequences of WMT activities. Functional movement ability was assessed pre- and post-therapy including 6-min walk test (6MWT), stair-climbing speed, and Wolf Motor Function Test timed-tasks.

Results: TA EMG burst duration during Wii-golf increased by 30% on the more-affected side (p?=?0.04) and decreased by 28% on the less-affected side. Patients who did not step during Wii-tennis had a 16% decrease in more-affected TA burst sum (p?=?0.047) resulting in more symmetrical activation ratio at late-therapy, with the ratio changing from 3.24?±?2.25 to 0.99?±?0.11 (p?=?0.047). Six-minute walk and stair-climbing speed improved (p?=?0.005 and 0.03, respectively), as did upper-limb movement (p?≤?0.001).

Conclusion: This study provides physiological evidence for lower-limb improvements with WMT. Different patterns of muscle activation changes were evident across the WMT activities. Despite the relatively good pre-therapy lower-limb function, muscle activation and symmetry improved significantly with upper-limb WMT.

• Implications for rehabilitation

• WMT is an upper-limb neurorehabilitation program that also improves lower-limb motor-function.

• We report a shift towards more symmetrical muscle activation of tibialis anterior on the more- and less-affected sides that were reflected in increased distance walked during the 6MWT.

• The use of standing during therapy not only improves lower-limb function but also permits larger and more powerful upper-limb movements.

• Targeted upper-limb rehabilitation can also significantly improve mobility and balance, whether dynamic or static, that should reduce the risk of falls post-stroke.

     

Performance and capacity-based measures of locomotion,compared to impairment-based measures,best predicted participation in individuals with hemiparesis due to stroke

Purpose: To determine the potential predictors of participation of individuals with post-stroke hemiparesis, taking into account modifiable variables of impairments, activity limitations, and environmental factors.

Methods: One hundred and nine individuals (58?±?12 years; 64 men) participated in this study. Outcomes included measures of impairments (depressive symptoms: Geriatric Depression Scale and motor-based impairments: finger-to-nose test, lower extremity (LE) motor coordination test, and handgrip strength, isometric strength of the LE muscles), activity (capacity: 10-meter walking speed test and Test d'Évaluation des Membres Supérieurs de Personnes Agées; performance: locomotion and manual abilities; environmental factors (Measure of the Quality of the Environment); and participation: Assessment of Life Habits (LIFE-H 3.1 Brazil)).

Results: Regression analyses revealed that the explanatory variables accounted for 59% and 49% of the variance in the LIFE-H 3.1 Brazil daily activity and social role sub-scales, respectively. Locomotion performance (R²?=?39%; p?R²?=?32%; p?Conclusions: Performance and capacity-based measures of locomotion showed to be the best predictors of participation. Additionally, depressive symptoms should not be underlooked.

• Implications for Rehabilitation

• Activity-related measures of locomotion showed to be the main predictors of participation in individuals with post-stroke hemiparesis, as assessed by the daily activity and social role sub-scales of the LIFE-H 3.1.

• The daily activity model was best predicted by measures of performance, whereas the social role sub-scale, by measures of capacity.

• Although small, the impact of depressive symptoms on participation should not be underlooked.

• Locomotion appeared to be essential for participation and increases in walking speed and locomotion ability should be the main goals for both professionals and individuals, when the aim is to increase participation.

     

If a joint is hot it’s not the time: health professionals’ views on developing an intervention to promote physical activity in rheumatoid arthritis

Purpose: The study aimed to explore the views of health professionals on (i) physical activity in people who have rheumatoid arthritis (RA) and (ii) the design of an intervention to promote physical activity in this population.

Method: We used a qualitative methodology and conducted 14 interviews (rheumatologists n?=?7, physiotherapist n?=?4, clinical nurse specialists n?=?3). Interviews were transcribed verbatim and analyzed using thematic analysis.

Results: Three key themes were generated: “Personal opinions”, “Supporting physical activity” and “An ideal world”. Although health professionals viewed physical activity as important, recommending it to people who have RA was largely based on persons’ disease status rather than empirical evidence. Resources were highlight as a key challenge to interventions in clinical practice. Supporting physical activity through provision of information, goal setting and monitoring was also discussed.

Conclusion: Health professionals believe physical activity is important for people who have RA, although there is uncertainty regarding physical activity recommendations for this population. Thus, there is scope to increase health professionals’ knowledge of recent evidence. Views varied on how an intervention to promote physical activity should be delivered, but consideration of barriers to delivery in clinical practice is important.

• Implications for Rehabilitation

• Physical activity is an important aspect of disease management for people who have rheumatoid arthritis.

• Health professionals need to acknowledge the “mixed messages” received by people who have RA about being physically active thus further education for health professionals is suggested to standardize physical activity advice in clinical practice.

• Health professionals may benefit from education about behavior change theory and techniques.

• When designing future physical activity interventions consideration of the practical challenges of implementing research in a clinical setting is necessary.

     

An innovative training program based on virtual reality and treadmill: effects on gait of persons with multiple sclerosis

Aim: In this single blind randomized controlled trial, we examined the effect of a virtual reality-based training on gait of people with multiple sclerosis.

Methods: Twenty-five individuals with multiple sclerosis with mild to moderate disability were randomly assigned to either the control group (n?=?11) or the experimental group (n?=?14). The subjects in the control group received treadmill training. Subjects in the experimental group received virtual reality based treadmill training. Clinical measures and gait parameters were evaluated.

Result: Subjects in both the groups significantly improved the walking endurance and speed, cadence and stride length, lower limb joint ranges of motion and powers, during single and dual task gait. Moreover, subjects in the experimental group also improved balance, as indicated by the results of the clinical motor tests (p?Conclusion: Our results support the perceived benefits of training programs that incorporate virtual reality to improve gait measures in individuals with multiple sclerosis.

• Implication of rehabilitation

• Gait deficits are common in multiple sclerosis (85%) and worsen during dual task activities.

• Intensive and progressive treadmill training, with and without virtual reality, is effective on dual task gait in persons with multiple sclerosis.

• Virtual reality-based treadmill training requiring obstacle negotiation increases the range of motion and the power generated at the hip, consequently allowing longer stride length and, consequently, higher gait speed.

     

The effects of progressive resistance training on daily physical activity in young people with cerebral palsy: a randomised controlled trial

Purpose: To examine if individualised resistance training increases the daily physical activity of adolescents and young adults with bilateral spastic cerebral palsy (CP). Method: Young people with bilateral spastic CP were randomly assigned to intervention or to usual care. The intervention group completed an individualised lower limb progressive resistance training programme twice a week for 12?weeks in community gymnasiums. The primary outcome was daily physical activity (number of steps, and time sitting and lying). Secondary outcomes included muscle strength measured with a one-repetition maximum (1RM) leg press and reverse leg press. Outcomes were measured at baseline, 12?weeks and 24?weeks. Results: From the 36 participants with complete data at 12?weeks, there were no between-group differences for any measure of daily physical activity. There was a likely increase in leg press strength in favour of the intervention group (mean difference 11.8?kg; 95% CI ?1.4 to 25.0). No significant adverse events occurred during training. Conclusions: A short-term resistance training programme that may increase leg muscle strength was not effective in increasing daily physical activity. Other strategies are needed to address the low-daily physical activity levels of young people with bilateral spastic CP.

• Implications for Rehabilitation

• Progressive resistance training may increase muscle strength but does not lead to increases in daily physical activity of young people with bilateral spastic cerebral palsy (CP) and mild to moderate walking disabilities.

• Other strategies apart from or in addition to resistance training are needed to address the low daily physical activity levels of young people with bilateral spastic CP and mild to moderate walking disabilities.

     

Self-reported use of the upper limbs related to clinical tests in persons with multiple sclerosis

Abstract

Purpose: This study investigated the relationship between self-reported use of the upper limbs and clinical tests in persons with multiple sclerosis (pwMS). Methods: This cross-sectional study involved 25?pwMS with upper limb dysfunction. The Motor Activity Log (MAL) was bilaterally applied to investigate the self-reported use of both upper limbs. Clinical tests on function level were the Motricity Index (MI) and the Brunnström–Fugl–Meyer (BFM). On activity level, the Action Research Arm test (ARAt) was conducted. To identify the relationship between the self-reported use and the clinical tests, Spearman correlation coefficients were calculated. Subgroups of dominant and non-dominant arms were differentiated, and compared with the Wilcoxon Signed rank test. Results: The highest correlations were found between the MAL and function level tests: MI (r?=?0.83, p?<?0.01) and BFM (r?=?0.75, p?<?0.01). A lower correlation was found between the MAL and the ARAt (r?=?0.49, p?<?0.01). For all outcome measures, the absolute scores were higher for the dominant hand. Higher correlations were found for the non-dominant compared to the dominant hand. Conclusion: The self-reported use of the upper limbs was highly associated with measures on function level. The association with activity level was, however, less pronounced. Magnitudes of relationships were influenced by hand dominance.

• Implications for Rehabilitation

• Self-reported use of the upper limbs in persons with MS, measured by the MAL, is highly associated with muscle strength and movement control.

• The ARAt (activity level of the ICF) is less associated with self-reported use compared to outcome measures at function level.

• The ARAt seems to be less sensitive to mild arm dysfunction.

• This study indicates that it is feasible and clinically relevant to apply the MAL as a self-reported outcome measure of upper limb use in MS.

     

Muscle power is an important measure to detect deficits in muscle function in hip osteoarthritis: a cross-sectional study

Purpose: To investigate between-leg differences in hip and thigh muscle strength and leg extensor power in patients with unilateral hip osteoarthritis. Further, to compare between-leg differences in knee extensor strength and leg extensor power between patients and healthy peers.

Methods: Seventy-two patients (60–87 years) with radiographic and symptomatic hip osteoarthritis not awaiting hip replacement and 35 healthy peers (63–82 years) were included. Hip and thigh muscle strength and leg extensor power were measured in patients and knee extensor strength and leg extensor power in healthy.

Results: The symptomatic extremity in patients was significantly (p?t-test) weaker compared with the non-symptomatic extremity for five hip muscles (8–17%), knee extensors (11%) and leg extensor power (19%). Healthy older adults had asymmetry in knee extensor strength (6%, p?Conclusions: Patients had generalized weakening of the affected lower extremity and numerically the largest asymmetry was evident for leg extensor power. In contrast, healthy peers had no asymmetry in leg extensor power. These results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with hip osteoarthritis.

• Implications for Rehabilitation

• Even in patients with mild symptoms not awaiting hip replacement a generalized muscle weakening of the symptomatic lower extremity seems to be present.

• Between-leg differences in leg extensor power (force?×?velocity) appears to be relatively large (19%) in patients with unilateral hip osteoarthritis in contrast to healthy peers who show no asymmetry.

• Compared to muscle strength the relationship between functional performance and leg extensor power seems to be stronger, and more strongly related to power of the symptomatic lower extremity.

• Our results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with mild symptoms not awaiting hip replacement.