Reliability of occupational therapists in determining safe, maximal lifting capacity

Determination of an individual's lifting capacity is an important component in Functional Capacity Evaluation, which is widely used to delineate potential for work. Despite a recent surge in the number and types of Functional Capacity Evaluations, and therefore in approaches to determining lifting capacity, there has been limited research to support the reliability and validity of their use. This study evaluated the inter-rater reliability of five occupational therapists in determining safe maximal lifting capacity using a biomechanical approach. In addition, the use of an operational definition of a safe lift was examined to determine its effect on therapists' decision-making process and therefore the reliability of their ratings. The use of an operational definition was found to significantly affect therapists' decision-making process in differentiating safe from unsafe lifts, with all raters showing highly significant improvements in their ability to determine the safety of lifts from pre- to postdefinition ratings, according to McNemar's χ ² statistic. The provision of a definition also enhanced therapists' reliability of ratings, with kappa values that ranged from 0.47 to 0.74 predefinition changing to 0.56–0.82 postdefinition. Possible explanations for the change in decision-making are discussed and the need for ongoing evaluation of procedures used in Functional Capacity Evaluation, particularly with regard to the determination of lifting capacity, are highlighted.     

Predicint lifting capacity

As science and technology become more sophisticated and with the rapid computation capabilities of the modern computer available, it becomes both possible and economically feasible to scientifically study man and his interaction with his working environment. It is now possible for a person seeking employment to expect and obtain a position which will not be unnecessarily hazardous to his immediate health or have detrimental effects over the long run. Manual materials handling is the contributor of over 400,000 back injuries suffered in the U.S. each year. This research is directed at determining the appropriate operator variables to measure for predicting the permissible weight of lift for three ranges of lift: floor to knuckle height, knuckle height to shoulder height, and shoulder height to reach height. A modified psychophysical procedure was used during which the subjects were instructed to adjust the weight in a tote box to the maximum weight they could lift repetitively without excessive strain or fatique. The task consisted of lifting loads under different conditions of task variables, namely, height of lift, frequency of lift, and load size. Industrial workers as well as students of both sexes were used as subjects. Based on the data obtained, the lifting capacity of the worker was determined for the different ranges of lift. In addition, predictive models were developed based on the operator variables and the task variables investigated.     

Effects of eight weeks of exercise training and orlistat therapy on body composition and maximal exercise capacity in obese females

A comparative assessment was made of the short-term effects of orlistat therapy and exercise training on body composition and aerobic fitness in obese females. A total of 24 obese patients were enrolled in to the study; 12 received orlistat therapy (DO) and 12 participated in a regular aerobic exercise-training programme (DE). All patients were on hypocaloric diets. Each patient performed three incremental ramp exercise tests (one at Week 0, one at the end of Week 4 and one at the end of Week 8) to exhaustion using an electromagnetically braked cycle ergometer to determine their anaerobic threshold and maximal exercise (Wmax) capacity. Patients in the DE group performed continuous exercise at a work rate that corresponded to the anaerobic threshold. Weight loss and loss of fat mass after 8 weeks were -6.4% (P=0.002) and -13.4% (DE) vs -5.8% (P=0.002) and -6.4% (P=0.008) (DO), respectively. Wmax capacity was 90.8+/-5 W (basal) vs 92.9+/-5 W (Week 4, P=0.1) and 100.4+/-6 W (Week 8, 10.5%, P=0.04) in the DO group, and 96.2+/-6 W (basal) vs 129.1+/-4 W (Week 4, 34.1%, P=0.002) and 137.5+/-5 W(Week 8, 42.9%, P=0.002) in the DE group. Despite similar decreases in body weight in both groups, patients in the DE group achieved a markedly higher level of Wmax, reflecting a better improvement in cardiopulmonary fitness, compared with patients in the DO group. Considering the improvement of aerobic fitness in the short term, an aerobic exercise-training programme should be considered for sedentary obese patients to improve their aerobic fitness and thereby reduce the negative outcomes of obesity.     

Effects of lifting frequency and technique on physical fatigue with special reference to psychophysical methodology and metabolic rate

A laboratory study was conducted (1) to evaluate the effects of lifting frequency and technique on maximum acceptable work loads using psychophysical measurement technique, and (2) to compare the physiological fatigue criteria of 5 Kcal/min with the psychophysical fatigue criteria by measuring the metabolic rates at maximum acceptable work loads determined by subjective estimates of physical fatigue. Six male college students were required to lift from the floor to a 0.5 m height for 40 minutes. Four levels of lifting frequency (3, 6, 9 and 12 lifts/min) and three different lifting techniques (free sytle, stooped back and straight-back, bent-knee) were employed. Oxygen consumption rates were measured at maximum acceptable work loads (and were reduced to STPD). Statistical analysis showed that the maximum work loads acceptable to the workers were significantly affected by both lifting frequency and technique. Maximum acceptable work loads increased with an increase in lifting frequency. Both the subjective estimates of physical fatigue and the metabolic energy expenditure rate favored the free style lifting technique. The measured metabolic rates were in agreement with the physiological fatigue criteria of 5 Kcal/min only for six of the twelve combinations of lifting frequency and technique. Use of the physiological fatigue criteria will result in more liberal standards of work load at low work paces, especially for the stooped back and the free style lifting techniques.     

重复性搬举作业所致背部肌肉疲劳的表面肌电信号分析

目的　应用表面肌电信号 (SEMG)技术对重复性搬举所致的竖脊肌疲劳进行评价。方法　通过对 13名自愿者 10 0次搬举 8kg负荷至腰部高度的EMG波幅分析和搬举前后 2次静态实验EMG信号快速傅立叶转换 (FFT)后的频谱变化分析对竖脊肌疲劳进行评估。结果　 10 0次动态搬举过程中 ,随着时间的延长 ,EMG平均波幅逐渐上升 ,T10右竖脊肌和L3左竖脊肌平均波幅的差异有显著性 (P <0 .0 5、P <0 .0 1) ;而T10左竖脊肌和L3右竖脊肌的差异无显著性 (P >0 .0 5 )。中频截距在T10右竖脊肌、T10左竖脊肌、L3右竖脊肌、L3左竖脊肌均有下降。T10右竖脊肌中频截距下降了2 .0 % ,与搬举前的差异无显著性 (P >0 .0 5 ) ,T10左竖脊肌、L3右竖脊肌和L3左竖脊肌分别下降了10 .9%、2 9.9%、2 7.9% ,与搬举前的差异均有显著性 (P <0 .0 5、P <0 .0 1)。 10 0次搬举后平均功率频率截距在L3左竖脊肌下降了 9% ,与搬举前比较 ,差异有显著性 (P <0 .0 5 ) ,其他部位下降不明显。结论　重复性的搬举可导致竖脊肌疲劳 ,L3部位比T10部位更容易疲劳 ;用中频截距的下降评价肌肉疲劳比用平均功率频率截距下降更敏感。     

低氧训练对肥胖大学生体成分和有氧耐力的影响

探讨8周低氧训练对肥胖大学生体成分和有氧耐力相关指标的影响,为改善肥胖大学体成分以及有氧耐力提供参考.方法 选取山东科技大学自愿参与研究的肥胖大学生18名,其中对照组和试验组各9名,对照组进行每日60 min,每周5次,持续8周的功率自行车训练干预,运动强度为65%~ 75%最大摄氧量,试验组在低氧环境(氧浓度为14.7%)下进行相同条件的干预.结果 经8周训练干预后,试验组体重、体脂、肌肉质量分别为96.62 kg,54.81%,26.89%,较干预前差异均有统计学意义(P值均<0.05),对照组变化不明显(P值均>0.05);试验组红细胞计数、血红蛋白含量分别为5.80× 108个/L、147g/L,均高于干预前(t值分别为,P值均<0.05),对照组红细胞计数、血红蛋白含量较干预前差异均无统计学意义(P值均>0.05);实验组最大摄氧量水平和3000m跑成绩分别为54.83 mL/(kg〈min-1),858.33 s,较干预前均提高(t值分别为,P值均<0.05),而对照组差异无统计学意义(P值均>0.05).结论 相比于常氧环境下的训练干预,每日60 min,每周5日,持续8周的65%~75%最大摄氧量强度的低氧训练干预更有利于降低肥胖大学生的体重、体脂,增加肌肉质量,提高有氧耐力水平.     

Comparison of physiological work capacity in lifting and carrying the loads

Comparative data on the physiologic value of carrying over (along the horizontal surface with the rate of walking of 4.5 km/hr) and load lifting from the floor up to 0.7 m with the rate of 6, 10, 16 per min are given, the magnitude of external load with the weight of 4-300 H being different. Physiologic values of the completed work have been compared because of the significant difference in the work load when lifting and carrying over some objects. It is demonstrated that external load magnitude and physiologic value of muscular work are directly correlated. Physiologic work value during load lifting per work unit is higher than that during its carrying over. The ratio of physiologic value of load carrying over and lifting is different under various magnitudes of external load.     

Research capacity development and training

The HSRC was awarded a large core grant specifically for research capacity development and training, with the aim of facilitating future high quality HSR in the UK. This was used to pursue three main areas of activity. First, the provision of small grants to facilitate the development of new work, help create new, multidisciplinary groupings and support junior researchers. Of the various schemes discussed, the research initiation grants (max pound6000) and workshop awards (max pound3000) appear to have been particularly valuable. Second, appoint cohorts of PhD students to pursue four-year training programmes (rather than the traditional three years), during which they received individualized research training and development opportunities with an emphasis on both multidisciplinary HSR training and generic skills training, as well as pursuing their own research projects. Third, improving research training opportunities by developing networks for research staff at various stages in their careers and organizing workshops and courses in specialist HSR subjects, and for generic skills training. The premature closure of the HSRC prevented us from fully evaluating these initiatives and, arguably, their real value will not be apparent for some years. However, we believe that the programme was successful and that it went some way to helping us break out from the traditional, entrenched approaches to research training, and to helping us think of research capacity development as being as important as doing the research itself. But much more remains to be done.     

The reliability and validity of two new tests of maximum lifting capacity

This study investigated the test-retest reliability and validity of the isokinetic and gravity/inertia modes of the Lido Lift ^TM and the Progressive Lifting Capacity II test (PLC II). Maximum lifting capacity tests were performed in the isokinetic and gravity/inertia modes on the Lido Lift and with the PLC II with 29 healthy male subjects. Pearson product-moment correlations were calculated to determine the test-retest reliabilities and to compare PLC II test values with isokinetic and gravity/inertia test values. The correlations for the isokinetic, gravity inertia, and the PLC II werer=.90, .82, and .91, respectively. The correlations between the isokinetic and gravity/inertia tests and the PLC II werer=.64 and .74 during the test andr=.72 and .81 during the retest. The results of this study support the reliability of both Lido Lift ^TM tests and of the PLC II, and the validity of the isokinetic and gravity/inertia tests when compared to the PLC II.     

Effect of aerobic training status on both maximal lactate steady state and critical power

This study aimed at assessing the sensitivity of both maximal lactate steady state (MLSS) and critical power (CP) in populations of different aerobic training status to ascertain whether CP is as sensitive as MLSS to a change in aerobic fitness. Seven untrained subjects (UT) (maximal oxygen uptake = 37.4 ± 6.5 mL·kg(-1)·min(-1)) and 7 endurance cyclists (T) (maximal oxygen uptake = 62.4 ± 5.2 mL·kg(-1)·min(-1)) performed an incremental test for maximal oxygen uptake estimation and several constant work rate tests for MLSS and CP determination. MLSS, whether expressed in mL·kg(-1)·min(-1) (T: 51.8 ± 5.7 vs. UT: 29.0 ± 6.1) or % maximal oxygen uptake (T: 83.1 ± 6.8 vs. UT: 77.1 ± 4.5), was significantly higher in the T group. CP expressed in mL·kg(-1)·min(-1) (T: 56.8 ± 5.1 vs. UT: 33.1 ± 6.3) was significantly higher in the T group as well but no difference was found when expressed in % maximal oxygen uptake (T: 91.1 ± 4.8 vs. UT: 88.3 ± 3.6). Whether expressed in absolute or relative values, MLSS is sensitive to aerobic training status and a good measure of aerobic endurance. Conversely, the improvement in CP with years of training is proportional to those of maximal oxygen uptake. Thus, CP might be less sensitive than MLSS for depicting an enhancement in aerobic fitness.     

Test-retest reliability of lifting and carrying in a 2-day functional capacity evaluation

The objectives of this study were to establish test-retest reliability of lifting and carrying of a functional capacity evaluation (FCE) on two consecutive days and to verify the need for a 2-day protocol. A cohort of 50 patients (39 men, 11 women) with nonspecific low back pain were evaluated using a 2-day FCE protocol. Intraclass correlation coefficients (ICC) were calculated for weight lifted and carried. Predictive relationschips between test and retest were explored by means of a regression analysis. The results of ICC were lifting low 0.87, lifting overhead 0.87, and carrying 0.77. Performances on day 2 were on an average 6–9% higher. Other than the amount of weight handled on day 1, no variable was found to predict performance on day 2. It was concluded that test-retest reliability of lifting and carrying was good, and the need for a 2-day protocol could not be confirmed.     

Effects of calcium pyruvate supplementation during training on body composition, exercise capacity, and metabolic responses to exercise

OBJECTIVE: We evaluated the effects of calcium pyruvate supplementation during training on body composition and metabolic responses to exercise. METHODS: Twenty-three untrained females were matched and assigned to ingest in a double blind and randomized manner either 5 g of calcium pyruvate (PYR) or a placebo (PL) twice daily for 30 d while participating in a supervised exercise program. Prior to and following supplementation, subjects had body composition determined via hydrodensiometry; performed a maximal cardiopulmonary exercise test; and performed a 45-min walk test at 70% of pre-training VO2 max in which fasting pre- and post exercise blood samples determined. RESULTS: No significant differences were observed between groups in energy intake or training volume. Univariate repeated measures ANOVA revealed that subjects in the PYR group gained less weight (PL 1.2 +/- 0.3, PYR 0.3 +/- 0.3 kg, P = 0.04), lost more fat (PL 1.1 +/- 0.5; PYR -0.4 +/- 0.5 kg, P = 0.03), and tended to lose a greater percentage of body fat (PL 1.0 +/- 0.7; PYR -0.65 +/- 0.6%, P = 0.07), with no differences observed in fat-free mass (PL 0.1 +/- 0.5; PYR 0.7 +/- 0.3 kg, P = 0.29). However, these changes were not significant when body composition data were analyzed by MANOVA (P = 0.16). There was some evidence that PYR may negate some of the beneficial effects of exercise on HDL values. No significant differences were observed between groups in maximal exercise responses or metabolic responses to submaximal walking. CONCLUSIONS: Results indicate that PYR supplementation during training does not significantly affect body composition or exercise performance and may negatively affect some blood lipid levels.     

Effects of a new industrial lifting belt on back muscular activity, hand force, and body stability during symmetric lifting

This work investigated how wearing a new design of back belt affects erector spinae activity, hand force, and body stability. The belt was first tested with static holding tasks and found to significantly decrease the back muscle activity. Actual lifting tasks were further carried out to test the effect of the belt. Ten male subjects performed a symmetric lifting task of low-lying loads (11 and 16 kg) at natural toting velocity, using either a squat or stoop lifting posture, both with and without a belt. The study measured various independent variables using electromyography (EMG), load cells, and motion capture device. The results demonstrated that the belt reduced the load on the erector spinae, as well as the triceps brachii and biceps brachii. The overall mean values of the peak (hand) force did not appear significantly affected while wearing the belt, but the force peaks appeared postponed. The belt did not alter body stability while lifting. From the present findings, the belt effectively changed the force distribution during lifting, at least reducing the muscle load on the back. The belt may be a potentially useful device for symmetric industrial lifting tasks.     

重复经颅磁刺激联合康复训练对语言发育障碍患儿的影响

目的 观察重复经颅磁刺激联合康复训练对语言发育障碍患儿的影响。方法 选取2017年2月—2018年2月间在河南省儿童医院康复中心住院的患儿86例,按随机数字表法随机分为观察组和对照组各43例。选用中国康复研究中心研制的汉语版S-S语言发育迟缓评价法,分别对不同组别患儿在治疗前后进行理解能力、表达能力、基本操作能力、交流态度、发育商和语言发育商对比评定。结果 治疗后,观察组疗效(95.35%)明显优于对照组(79.07%),差异有统计学意义(χ²=5.108,P＜0.05);与治疗前相比,治疗后两组患儿发育商、语言发育商均显著升高,且两组之间差异有统计学意义(t=4.827,5.009,P＜0.05)。结论 重复经颅磁刺激作为一种早期干预语言发育障碍的新型电生理技术,联合康复训练对语言发育能力改善有较好的效果。     

双侧重复经颅磁刺激联合常规康复训练治疗脑卒中后吞咽障碍效果观察

目的 观察双侧重复经颅磁刺激(rTMS)在单侧脑卒中后吞咽障碍患者康复治疗中的效果.方法 前瞻性选取2018年8月～2019年11月于四川大学华西医院住院的单侧脑卒中后吞咽障碍患者90例,用随机数表法将患者分为双侧rTMS组、单侧rTMS组、假刺激组,每组各30例.各组均接受常规康复训练,rTMS频率为3 Hz,刺激强...     

Effects of training on hearing protector attenuation

The effect of training instruction, whether presented as the manufacturer's printed instructions, a short video training session specific to the product, or as a one-on-one training session was evaluated using four hearing protection devices with eight groups of subjects. Na?ve subjects were recruited and tested using three different forms of training: written, video, and individual training. The group averages for A-weighted attenuation were not statistically significant when compared between the video or the written instruction conditions, regardless of presentation order. The experimenter-trained A-weighted attenuations were significantly greater than the written and video instruction for most of the protectors and groups. For each earplug, the noise reduction statistic for A-weighting (NRS A ) and the associated confidence intervals were calculated for the 80 th and 20 th percentiles of protection. Across subject groups for each protector, the differences between NRS A ratings were found to be not statistically significant. Several comparisons evaluating the order of testing, the type of testing, and statistical tests of the performance across the groups are presented.     

Developing public health management training capacity in Nicaragua

The Cooperative for Assistance and Relief Everywhere (CARE) and Centers for Disease Control and Prevention (CDC) Health Initiative in Nicaragua is distinctive in its focus on developing a cadre of in-country trainers whose aim is to equip frontline public health managers with widely applicable tools and techniques to assist them in identifying and solving implementation problems. Since 1999, 137 trainees--37% more than originally planned--have demonstrated competence by completing and presenting applied management projects. Nineteen professors from the preventive medicine faculty at the Autonomous University of Nicaragua also have been trained. The country office now has a cadre of seasoned trainers who can meet the ongoing management training needs of CARE staff and their counterparts in the Ministry of Health and in other nongovernmental organizations.     

医学研究生临床实践能力的培养策略研究

医学是一门实践性很强的学科,要求医学教育不仅要重视基础理论教育,更要重视临床实践能力的培养。目前,我国医学院校对医学研究生培养存在着“重智轻能”的问题,尚需深化改革。文章试图探索建立一个能够提高医学研究生临床实践能力的新策略,使之适应现代医学模式,能够面向未来,为社会培养急需的高级医务人才。