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1.
AbstractPurpose: To investigate the effects of short stick exercise (SSEs) on fall prevention and improvement of physical function in older adults. Methods: A cluster randomized trial was conducted in five residential care facilities. The intervention group ( n?=?51) practiced SSEs for six months, followed by routine care for six more months. The control group ( n?=?54) received ordinary care for 12 months. The primary outcome measure was the number of fallers, taking into account the time to first fall using the Kaplan–Meier method. The secondary outcome measures were physical and mental functions. Results: The number of fallers was significantly lower in the intervention group ( n?= ?6) than in the control group ( n?=?16) during the 12 months. The adjusted hazard ratio for a first fall in the intervention group compared with the control group was 0.15 (CI, 0.03 to 0.74, p?=?0.02). The fall-free period was significantly longer in the intervention group than in controls (mean?±?SD, 10.1?±?3.0 versus 9.0?±?4.1 months, p?=?0.027). The functional reach and sit and reach tests were significantly improved at three and six months. Conclusion: The SSEs appeared effective for fall prevention and improvement of physical function in older adults. - Implications for Rehabilitation
The newly developed short stick exercises appear an effective means of reducing falls among older adults in residential care facilities. The short stick exercises seem to have an immediate effect on improving physical functions. Effects gained by performing the short stick exercises, such as static balance, flexibility and agility may last for six months. The short stick exercises were found to be easy for older adults to practice continuously in residential care facilities.
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2.
Purpose: To compare the effectiveness of supervised Tai Chi exercises versus the conventional physical therapy exercises in a personalized rehabilitation program in terms of the incidence and severity of falls in a frail older population. Method: The participants were frail older adults living in the community, admitted to the day hospital program in Sherbrooke, Quebec, Canada (n = 152). They were randomized to receive a 15-week intervention, either by supervised Tai Chi exercises (n = 76) or conventional physical therapy (n = 76). Fall incidence and severity were assessed using both the calendar technique and phone interviews once a month during 12 months following the end of the intervention. Other variables were collected at baseline to compare the two groups: age, comorbidity, balance, sensory interaction on balance, and self-rated health. Results: Both interventions demonstrated a protective effect on falls but Tai Chi showed a greater one (RR = 0.74; 95% CI = 0.56–0.98) as compared to conventional physical therapy exercises. Conclusions: Supervised Tai Chi exercises as part of a rehabilitation program seem to be a more effective alternative to the conventional physical therapy exercises for this specific population. Implications for Rehabilitation Seniors who have fallen have a 50% chance of falling again during the following year, leading them to reduce their outings and thus decrease their social activities. Frail older people could benefit more from an individualized intervention than the regular group program generally used in a Tai Chi intervention. Tai Chi exercises seems to be a good alternative to regular physiotherapy exercises as a part of a multidisciplinary intervention in preventing a subsequent fall over a 12-month period.
3.
Purpose: To evaluate the effects of progressive resistance and balance (PRB) exercises on physical and psychological functions of post-stroke individuals. Materials and methods: In a randomized controlled trial with follow-up at 3, 6 and 15 months, 67 community-living individuals (76% male; 65–85 years) with a stroke 1–3 years previously were allocated to an intervention group (IG, n?=?34; PRB exercises combined with motivational group discussions twice weekly for 3 months) or a control group (CG, n?=?33). The primary outcomes were balance (Berg Balance Scale, 0–56 points) and mobility (Short Physical Performance Battery, 0–12 points) at 3 months. The secondary outcomes were 10 m comfortable walking speed, physical activity levels, health-related quality of life, depression and fall-related self-efficacy. Results: At 3 months, the IG exhibited significant improvements in balance (MD 2.5 versus 0 points; effect size [ES], 0.72; p?p?=?0.01) relative to the CG. A faster walking speed persisted at 6 months. No differences were found for the other outcomes. Conclusions: In chronic stroke patients, 3 months of PRB exercises and motivational discussions induced improvements in balance at 3 months and in walking speed at 3 and 6 months. - Implications for Rehabilitation
A progressive resistance and balance exercise program supported by motivational group discussions and one home-based exercise appears to be an effective means of improving the short-term balance and the walking speed in individuals with chronic stroke. People with poor balance and motor function discontinued the study more often and may require additional support. There is a need for powerful and cost-effective strategies that target changes in behavior to obtain long-term changes in physical function after exercising.
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4.
Purpose: To evaluate short- and long-term effects of structured exercise program in euthyroid patients with Graves’ disease. Methods: The study employed a retrospective case-control design. The exercise group (n?=?62) underwent 3 weeks of structured exercise program consisting of daily walking, strengthening, and stretching exercises while the control group (n?=?62) participated in leisure activities. Thyroid profile, aerobic capacity, and perceived fatigue were evaluated on in-patient admission and discharge. Time to discontinuation of anti-thyroid medication after discharge and time to relapse of symptoms were determined. Results: The exercise group increased estimated peak oxygen consumption (significant group-by-time ANOVA interaction, P < 0.001), decreased serum thyroxin (P?=?0.038), increased serum thyrotropin (P?=?0.071), and reported less fatigue (Fisher’s exact test, p < 0.001) from admission to discharge. The anti-thyroid medication was withdrawn within 6 months of discharge in significantly greater proportion of subjects in the exercise than control group (84% vs. 18%). Conversely, the rate of relapse within 12 months of medication withdrawal was smaller in the exercise (29%) than control group (72%). Conclusions: The results suggest that structured exercise program may normalize thyroid profile, improve aerobic capacity, and reduce fatigue on the short-term basis as well as reduce the need for anti-thyroid medication on the long-term basis. Implications for Rehabilitation This retrospective study suggests that the structured exercise program is safe and beneficial for euthyroid Graves’ disease patients. The main benefits include short-term improvements in aerobic capacity and fatigue and long-term reduction in anti-thyroid medication. The prospective randomized control study is warranted to define optimal exercise protocol and validate these preliminary results.
5.
AbstractObjective: To evaluate the efficacy of functional balance exercises on balance impairment, physical activity and quality of life (QOL) in adults with multiple sclerosis (MS). Design: A multiple-baseline time-series design with an uncontrolled intervention. Method: Ten subjects with MS completed assessments twice before and once after a 10-week balance intervention. ANOVA were used to evaluate the effects of testing session on the Brief-BESTest, instrumented stance and gait recordings by inertial motion sensors, lower-limb strength recorded by force transducers, accelerometry-based activity, the 12-item MS Walking Scale (MSWS-12), the Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaire, the Modified Fatigue Impact scale (MFIS) and the Activity-specific Balance Confidence (ABC) scale. Results: The intervention associated with significantly improved scores on the MSQOL-54 mental component, MFIS, MSWS-12 and Brief-BESTest. Sway amplitude significantly decreased and jerk significantly increased during instrumented standing on foam with eyes closed. Instrumented gait recordings of sagittal trunk range of motion also significantly decreased. ABC scores, strength measures and activity measures were not significantly changed. Conclusions: Ten weeks of functional balance exercises provided a feasible intervention for individuals with MS that improved components of balance, mental well-being and perceived fatigue impact and ambulation disability. A future randomized, controlled clinical trial should confirm these preliminary findings. - Implications for Rehabilitation
A balance-specific exercise program is both safe and feasible for individuals with mild-to-moderate MS. Comprehensive exercise interventions that are conceptually driven and employ well-designed progressive exercise across multiple contexts of balance control can facilitate improvements in balance impairments associated with MS. Functional balance exercises can positively impact clinical and objective measures of balance control and favorably influence perceptions of ambulation disability and fatigue as well as perceived quality of life in people with MS.
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6.
Purpose: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients. Method: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age–sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life. Results: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline ( p?p?p?>?0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls ( p?>?0.05). Conclusion: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments. - Implications for Rehabilitation
An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment.
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7.
Purpose: To determine if an intensive wellness program for persons with MS results in improved self-efficacy, quality of life (QOL), or physical activity outcomes. Methods: 129 subjects participated in one of seven 4-day interdisciplinary educational wellness programs throughout the United States. This intervention was based on the philosophy that health management is important to disease management. The program consisted of psychological and physiological evaluations, lectures and workshops. Before the intervention and after at 1, 3 and 6 months, self-efficacy (MS Self-Efficacy Scale, MSSE, control), health related QOL (SF-36) and physical activity (Physical Activity Scale for Persons with Physical Disabilities, PASAID) was assessed. Results: Improvements were noted at 1, 3 and 6 months post-intervention. Those present at 6 months included, MSSE, role physical, vitality and mental health scales of the SF-36. PASAID did not change. Improvements were independent of disability (EDSS). Conclusion: A 4-day multidisciplinary educational wellness program can result in improvement in self-efficacy and health-related QOL in persons with MS and can be stable up to at least 6 months. Improvements do not depend on degree of disability. Implications for Rehabilitation Multiple sclerosis is a neurologic disease that can have a significant negative impact on self-efficacy and quality of life. Some wellness based programs have been shown to be effective in improving self-efficacy and quality of life (QOL) in persons with MS. Distance or time could be barriers to access effective wellness programs. An intensive “traveling” 4-day interdisciplinary educational wellness program can result in improvements in self-efficacy and health-related quality of life in persons with MS. Improvements were not dependent on a person’s level of disability (i.e. EDSS).
8.
AbstractPurpose: This feasibility study sought to determine if compliance and understanding of a home exercise program following a traumatic hand injury is improved when patients are provided with a DVD and a brochure when compared to using brochures only. Method: Patients who presented with a traumatic hand injury and commenced on a hand therapy protocol were randomly assigned into two groups. The control group received brochures while the experimental group were provided with exercise instructions on DVD as well as brochures. Compliance was measured through the use of exercise diaries, clinic attendance, a checklist to measure correctness and understanding of exercises and a follow-up survey. Results: No significant improvement was found in the mean exercise compliance score ( p?=?0.344) between the intervention and control groups. From the survey results almost half of all participants reported that pain interfered in their ability to perform their home exercises and a third acknowledged that time limited their ability to perform their exercises. Conclusion: Findings demonstrate the multidimensional nature of compliance. The provision of DVD technology, while not shown to cause a statistically significant change in overall compliance, did help improve understanding of exercises; as such DVDs could be utilised as part of a program that facilitates the patient--therapist relationship. - Implications for Rehabilitation
Limited time and level of pain are highlighted as reasons for non compliance with exercise and treatment programs. The use of DVDs can improve understanding and execution of exercises and can be part of a treatment program that facilitates increased patient therapist contact for rural and remote clients.
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9.
Purpose: Get in Motion (GIM) is an evidence-based telephone counseling service that promotes leisure-time physical activity (LTPA) among Canadian adults with spinal cord injury (SCI). The first phase of GIM sustained intentions for, and increased participation in, LTPA; however, it is unclear how GIM led to these outcomes. The purpose of this study was to explore the implementation correlates of change in LTPA intentions and behavior in the second phase of GIM. Methods: The frequency, duration, and content of counseling sessions were tailored to meet clients’ ( N?=?46; 50.0% male; 50.0% paraplegia; 51.46 (SD 12.36) years old) needs and preferences. Intervention dose and content were monitored using Counseling Session Checklists. Clients self-reported their intentions for and actual aerobic and strength-training LTPA participation at baseline, 2-, 4-, and 6-months, and their perceptions of service quality at 6-months. Results: The second phase of GIM effectively sustained LTPA intentions and increased time spent on moderate-to-vigorous strength-training and total LTPA. Increases in clients’ moderate-to-vigorous aerobic LTPA were significantly positively related to intervention dose, intervention content (both informational and behavioral strategies), and clients’ perceptions of service credibility. Conclusions: This study identified intervention dose and content as key implementation variables for an LTPA telephone counseling service for adults with SCI. - Implications for Rehabilitation
An evidence- and theory-based telephone counseling service can effectively sustain LTPA intentions and increase LTPA behavior among adults with SCI. The first two months of the service are a critical period for enhancing LTPA participation and for minimizing dropouts. The provision of both informational and behavioral strategies is important for increasing aerobic LTPA levels among adults with SCI.
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10.
Objective: Exercise is associated with improved health in many medical conditions. Little is known about the exercise habits of people with systemic sclerosis (SSc, or scleroderma). This study assessed the proportion of individuals with SSc who exercise and associations of demographic and disease variables with exercise. Additionally, the weekly amount of time spent exercising and the types of exercise performed were assessed among patients exercising. Methods: The sample consisted of adult participants with SSc enrolled in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort who completed baseline questionnaires from March 2014 through August 2015. Baseline questionnaires included questions on exercise habits, physician-reported medical characteristics, self-report demographic characteristics, the Health Assessment Questionnaire-Disability Index, Patient Health Questionnaire-9, and Patient-Reported Outcomes Measurement Information System-29. Results: Of 752 patients, 389 (51.7%) reported presently engaging in exercise, and these patients exercised on average 4.7?h [standard deviation (SD)?=?2.8] per week. Among patients who reported exercising, walking was most commonly reported ( n?=?295, 75.8%). In bivariate analyses, present exercise was associated with more education, lower body mass index, some (versus no) alcohol consumption, non-smoking, limited/sine disease subtype, absence of skin thickening, lower disability, higher physical function, lower symptoms of anxiety and depression, less fatigue, lower sleep disturbance, higher ability to participate in social roles and activities, and less pain. Conclusions: Approximately half of SSc patients reported that they are currently exercising with walking being the most common form of exercise. Understanding exercise patterns and factors associated with exercise will help better inform intervention programs to support exercise for patients with SSc. - Implications for rehabilitation
Systemic sclerosis is a rare autoimmune rheumatic disease associated with great morbidity and highly diverse presentation. Approximately half of people with both limited and diffuse systemic sclerosis report exercising. Most exercisers walk, but patients engage in a wide variety of exercise-related activities. Individually designed exercise programs are most likely to support and encourage exercise in patients with diverse disease manifestations.
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11.
Purpose: To evaluate whether improvements in physical function are related to changes in body composition after a three-month progressive resistance and balance exercise program among individuals approximately one to three years after stroke. Methods: In this randomized controlled trial, 43 community-dwelling subjects (65–85 years, mean age 73?±?5 years, 73% men) were allocated to a progressive resistance and balance exercise program twice weekly for three months (intervention group [IG], n?=?20) or a control group ( n?=?23). The main outcome measures were fat mass (kg) and fat-free mass (kg), as measured by bioelectrical impedance analyses (Tanita ®). Physical function was measured using the six-minute walk test. Results: Complete case analyses revealed reduced fat mass in the IG compared with the control (?1.5 vs. (0).13% of body weight, respectively; effect size?=0.62; p?=?0.048). In contrast, no between-group difference in fat-free mass was observed. The six-minute walk test was improved (25 vs. ?10 m, respectively, effect size =0.69, p?=?0.039) at three months in favor of the IG. The reduced fat mass was associated with an improved six-minute walk test ( r?=?0.48, p?=?0.038) in the IG. Conclusions: Three-month progressive resistance and balance training was associated with reduced fat mass, which was related to improvements in walking capacity in older adults approximately one year after stroke. - Implications for rehabilitation
This three-month PRB group exercise program supported by motivational discussions and daily home-based exercises indicate the following: ??Improved walking capacity was associated with a reduction in fat mass. ??IGF-1 is reduced, possibly indicating improved insulin sensitivity.
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12.
Purpose: A novel physiotherapy intervention for people with intellectual disability (ID) to improve balance was developed and evaluated in a feasibility study which quantitatively assessed potential benefits on measures of balance, gait and activity participation, and qualitatively explored its acceptability, utility and feasibility. Methods: Participants were 27 adults with mild to profound ID (mean age 53 years SD 10.9). We used a mixed methods approach: an uncontrolled before–after study (data analysed with the related samples sign test) and a qualitative interview evaluation (data analysed with the general inductive approach). Balance, gait and participation were assessed at baseline and 6 months after introduction of the physiotherapy intervention with four standardised measures and two questionnaires. Results: Appropriate exercises and a physical activity could be found for all participants, irrespective of the level of ID, although for many this required a high level of assistance from support staff. Only the Balance Scale for ID changed significantly by a median score of 2 (95% CI?=?0.00–2.50, p?=?0.04). No other outcomes changed significantly. Four themes emerged: “Understanding the intervention”; “Routine and reality”; “Remembering what I have to do” and “What happens beyond the study itself”? Conclusions: The findings provide some evidence for the benefit, acceptability, utility and feasibility of the intervention justifying further evaluation. - Implications for Rehabilitation
Falling is a frequent and serious problem for many adults with intellectual disability. Two to three exercises targeted at increasing lower limb strength and challenging balance, performed each day as part of daily routine may help improve balance in adults with intellectual disability. The importance of exercising needs to be stressed to those who support adults with intellectual disability to encourage ongoing adherence.
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13.
AbstractPurpose: The purpose of this study was to examine the effects of 3 months of sitting Tai Chi training on the sitting balance control and eye-hand coordination of older adults subjects. Methods: We randomly assigned 59 older adults from four residential care facilities to either sitting Tai Chi group or mobilizing exercises group as control. The sitting Tai Chi group underwent 3 months of training with a total of 36 sessions (1 hour/session, 3 sessions/week). The outcome measures included sitting balance tests (testing sequential weight shifting and forward reaching in a sitting position) and eye-hand coordination tests (reaction time, movement time and accuracy in finger pointing task). Results: The Tai Chi practitioners showed significant improvement in their sequential weight shifting while sitting (improved by 29.0%, p?≤?0.05) and in their maximum reaching distance from a sitting position (improved by 21.2%, p?≤?0.05). No such improvements were found in the control group. In the eye-hand coordination test, the sitting Tai Chi practitioners had significant improvements in accuracy (improved by 17.3%, p?≤?0.05). Also, no improvement was found in the control group. Conclusions: The results demonstrate 3-months of sitting Tai Chi training can improve sitting balance and accuracy in finger pointing task in the older adults. - Implications for Rehabilitation
Traditional Tai Chi poses difficulties for older adults with poor standing balance. This pilot study showed that a 3 months sitting Tai Chi training can improve sitting balance and accuracy in the finger pointing task in the older adults. Sitting Tai Chi can be a therapy option for older adults with poor standing balance.
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14.
Purpose: Because the oral hygiene is poorly prioritized in the immediate post-stroke period, we implemented an oral hygiene care program (OHCP) for stroke in-patients and evaluated its persistence after discharge. Method: In all, 62 patients with stroke who were admitted to the rehabilitation ward were randomly assigned to two groups: 33 patients to the intervention group and 29 to the control group. The OHCP, including tooth brushing education and professional tooth cleaning, was administered to the intervention group twice a week six times during in-hospital rehabilitation. Oral health status was examined both at baseline and three months after discharge from the hospital. Oral hygiene status was examined at three- to four-day intervals five times during the hospitalization period. Results: After OHCP, oral hygiene status including the plaque index, calculus index, and O’Leary plaque index improved significantly in the intervention group, compared to the control group ( p?p? Conclusions: An OHCP conducted during in-hospital rehabilitation was effective in improving oral health and plaque control performance among patients with stroke, with effects still seen three months after discharge from the hospital. - Implications for Rehabilitation
Initial oral hygiene status and plaque control performance were poor in stroke patients who were in rehabilitation center. An oral hygiene care program during in-hospital rehabilitation was effective in improving oral hygiene status and plaque control performance among stroke patients at three months after discharge. Repeated tooth brushing education and professional tooth cleaning were necessary to improve plaque control performance of stroke patients.
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15.
AbstractPurpose: To determine whether participation in a week-long residential leisure intervention program targeting individuals with an acquired brain injury (ABI) improved the leisure satisfaction, self-esteem and quality of life (QOL) of participants. The program included leisure awareness, leisure resources, social interaction skills and leisure activity skills. Method: Using a pre- and post-intervention design leisure satisfaction, self-esteem and QOL were assessed prior to, immediately following and at three months post program. Data were analyzed using Wilcoxon signed-rank tests. Results: Participants were eight men and four women aged between 19 and 49 years who were recent clients of a rural Brain Injury Rehabilitation Service. The majority (7/12) had acquired their ABI more than two years previously, and for most (10/12) the cause was trauma. Program participants showed clinically important and statistically significant improvements in leisure satisfaction ( p?=?0.002), self-esteem ( p?=?0.03) and QOL ( p?=?0.02 to 0.008 for four domains of the World Health Organisation Quality of Life – Bref scale) three months post program. Conclusion: Adults with an ABI participating in leisure education programs can experience improvements in leisure satisfaction, self-esteem and QOL following the program. The findings suggest that active leisure intervention programs should be included in the ongoing rehabilitative care of adults with an ABI. - Implications for Rehabilitation
Leisure participation, leisure satisfaction and social integration can be seriously compromised following an acquired brain injury (ABI). Engagement in leisure activities has positive effects on physical and mental health and is increasingly recognised as an important determinant of quality of life (QOL) for people with ABI. Participation in a short-term intensive leisure intervention program can improve leisure satisfaction, self-esteem and QOL. Active leisure intervention programs should be included in the ongoing rehabilitation and reintegration of adults with ABI.
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16.
Purpose: To test the feasibility of a handwriting retraining program with adults after stroke; specifically the feasibility of: (i) recruiting people with stroke to the study, (ii) delivering the handwriting retraining program and (iii) outcome measures of handwriting performance. Method: A quasi-experimental pre-test post-test design was used. A four-week, home-based handwriting retraining program was delivered by an occupational therapist using task-specific practice. Legibility, speed, pen control and self-perception of handwriting were measured at baseline and completion of the program. Legibility was scored by a blinded rater. Results: Seven adults with stroke were recruited (eligibility fraction 43% of those screened, and enrolment fraction 78% of those eligible). There were no dropouts. Although, recruitment was slow the intervention was feasible and acceptable to adults with stroke. No statistically or clinically significant changes in legibility were reported in this small sample, but a ceiling effect was evident for some outcome measures. The study was not powered to determine efficacy. Conclusions: Delivery of a four-week handwriting intervention with eight supervised sessions in the community was feasible; however, recruitment of an adequate sample size would require greater investment than the single site used in this pilot. - Implications for Rehabilitation
Handwriting difficulty is common following hemiparesis after stroke, however research addressing handwriting retraining for adults with stroke is lacking. A four-week home-based handwriting program using task-specific practice and feedback was feasible to deliver and appropriate for adults with stroke. Improving handwriting legibility and neatness across a range of tasks were important goals for adults with handwriting impairment.
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17.
Purpose: Little is known of Motion-Controlled Video Games (MCVGs) as an intervention for people with chronic pain. The aim of this study was to explore the experience women with fibromyalgia syndrome (FMS) had, using commercially available MCVGs; and to investigate indicators of symptom severity and performance of activities of daily living (ADL). Method: Of 15 female participants diagnosed with FMS, 7 completed a program of five sessions with Nintendo Wii (Wii), five sessions with PlayStation 3 Move (PS3 Move) and five sessions with Microsoft Xbox Kinect (Xbox Kinect). Interviews were conducted at baseline and post-intervention and were supported by data from observation and self-reported assessment. Results: Participants experienced play with MCVGs as a way to get distraction from pain symptoms while doing fun and manageable exercise. They enjoyed the slow pace and familiarity of Wii, while some considered PS3 Move to be too fast paced. Xbox Kinect was reported as the best console for exercise. There were no indication of general improvement in symptom severity or performance of ADL. Conclusion: This study demonstrated MCVG as an effective healthcare intervention for the women with FMS who completed the program, with regards to temporary pain relief and enjoyable low impact exercise. - Implications for Rehabilitation
Exercise is recommended in the management of fibromyalgia syndrome (FMS). People with FMS often find it counterintuitive to exercise because of pain exacerbation, which may influence adherence to an exercise program. Motion-controlled video games may offer temporary pain relief and fun low impact exercise for women with FMS.
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19.
Purpose: Because wheelchair users are unable to use standard fitness equipment such as treadmills and bikes, we developed an upper body rowing ergometer (UBRE) that can be retrofitted onto a standard stationary cycle and used to perform a rowing exercise. We validated a graded exercise testing protocol utilizing the UBRE and completed a 12-week pilot intervention to compare the training effects of the UBRE to a standard arm cycle ergometer (ACE) in manual wheelchair users. Methods: Repeat graded exercise tests were compared on the two pieces of equipment. Twenty-seven manual wheelchair users participated in the intervention. Outcomes included pre- versus post-test change in shoulder pain, strength and cardiorespiratory fitness measures. Results: Testing results obtained with the UBRE were comparable to those on the ACE. In the exercise intervention, most outcome measures did not change significantly, but individuals assigned to the UBRE were able to increase their peak exercise test power by 31?W and duration by 3.6?min. Conclusion: There is biomechanical reason to believe that rowing exercises may improve shoulder muscle balance in this population, which could reduce the risk of impingement. This may be of benefit to manual wheelchair users, who are at high risk for shoulder injury. - Implications for Rehabilitation
Regular exercise improves cardiorespiratory fitness and did not exacerbate shoulder pain in this group of manual wheelchair users. Exercises that target posterior shoulder muscle groups, such as rowing, may improve muscle balance and reduce the risk of shoulder impingement. Participation in exercise is hindered in this population by a high rate of secondary health conditions and difficulty accessing facilities and equipment.
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20.
Purpose: The aim of this cohort study was to identify early predictive factors for a poor outcome of disability and pain 12- and 36-months after an intervention in patients with recurrent low-back pain, currently at work. Method: Seventy-one patients with recurrent low-back pain, all at work, seeking care in a primary health care setting were included. Predictive indicators including demographic data and health-related variables were derived from questionnaires pre- and post intervention over eight weeks. The dependent outcome variables were perceived disability and present pain at 12- and 36-months. Results: Multivariate regression analyses show that early data on poor self-efficacy for physical activity, greater disability, and higher level of pain-ratings emerged as independent predictors of a poor outcome of disability at 12 and 36 months. Higher ratings of pain and poor self-efficacy appeared again as independent predictors of a poor outcome of pain at the 12-month follow-up. Pain frequency ratings predicted a poor outcome of pain at 36 months. Conclusions: Our results suggest that ratings of poor self-efficacy for physical activity, greater disability, and pain-ratings, are the most consistent independent predictors of long-term poor outcome of disability and pain. This indicates the importance of screening for such factors to optimize the management of low-back pain. However, larger studies in similar patient populations are needed to confirm these results. Implications for Rehabilitation Patients ratings of self-efficacy for physical activities, disability and pain predict long-term poor outcome of perceived disability and pain in subjects with recurrent low-back pain. Prognostic information about self-efficacy for physical activity may be used to tailor intervention to prevent future disablement resulting from further episodes of recurrent low-back pain. It is important to implement knowledge of predictive factors in the clinical work.
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