Do smokers with chronic obstructive pulmonary disease report their smoking status reliably? A comparison of self-report and bio-chemical validation

Background

Chronic obstructive pulmonary disease (COPD) is predominantly caused by cigarette smoking and is considered a worldwide preventable chronic illness. Smoking cessation is considered the primary intervention for disease management and nurses should play a major role in assisting patients to stop smoking. Currently there is a lack of professional consensus on how cessation interventions should be evaluated. The vast array of biochemical markers reported in the literature can be confusing and can make the comparisons of results difficult.

Objective

To validate self-report data on smoking with exhaled carbon monoxide in patients with chronic obstructive pulmonary disease over twelve months.

Design

We performed a secondary analysis of a previously published randomized controlled trial evaluating nursing interventions to assist respiratory patients to stop smoking.

Setting

Northern Ireland's Regional Respiratory Centre.

Participants

A total of 91 cigarette smokers attending secondary care for the treatment for COPD participated in the study.

Method

Self-reported smoking status and cigarettes smoked per day were compared to exhaled carbon monoxide readings at baseline, 2, 3, 6, 9 and 12 months. The cut-off value of ≤10 ppm was used to identify non-smokers. The p-values are based on Pearson's correlation coefficient and Kappa Coefficient as appropriate.

Results

Findings suggest self-reported smoking status and cigarette consumption amongst patients with chronic obstructive pulmonary disease was highly consistent with exhaled carbon monoxide results (p = 0.001-0.003).

Conclusion

The majority of patients with chronic obstructive pulmonary disease reliably report their cigarette consumption.     

An exploratory analysis of functional staging using an item response theory approach

Tao W, Haley SM, Coster WJ, Ni P, Jette AM. An exploratory analysis of functional staging using an item response theory approach.

Objectives

To develop and explore the feasibility of a functional staging system (defined as the process of assigning subjects, according to predetermined standards, into a set of hierarchic levels with regard to their functioning performance in mobility, daily activities, and cognitive skills) based on item response theory (IRT) methods using short forms of the Activity Measure for Post-Acute Care (AM-PAC) and to compare the criterion validity and sensitivity of the IRT-based staging system to a non-IRT-based staging system developed for the FIM instrument.

Design

Prospective, longitudinal cohort study of patients interviewed at hospital discharge and 1, 6, and 12 months after inpatient rehabilitation.

Setting

Follow-up interviews conducted in patients' homes.

Participants

Convenience sample of 516 patients (47% men; sample mean age, 68.3y) at baseline (retention at the final follow-up, 65%) with neurologic, lower-extremity orthopedic, or complex medical conditions.

Interventions

Not applicable.

Main Outcome Measures

AM-PAC basic mobility, daily activity, and applied cognitive activity stages; FIM executive control, mobility, activities of daily living, and sphincter stages. Stages refer to the hierarchic levels assigned to patients' functioning performances.

Results

We were able to define IRT-based staging definitions and create meaningful cut scores based on the 3 AM-PAC short forms. The IRT stages correlated as well or better to the criterion items than the FIM stages. Both the IRT-based stages and the FIM stages were sensitive to changes throughout the 6-month follow-up period. The FIM stages were more sensitive in detecting changes between baseline and 1-month follow-up visits. The AM-PAC stages were more discriminant in the follow-up visits.

Conclusions

An IRT-based staging approach appeared feasible and effective in classifying patients throughout long-term follow-up. Although these stages were developed from short forms, this staging methodology could also be applied to improve the meaning of scores generated from IRT-based computerized adaptive testing in future work.     

Validation of the Revised Quick Cognitive Screening Test

Mate-Kole CC, Conway J, Catayong K, Bieu R, Sackey NA, Wood R, Fellows R. Validation of the revised Quick Cognitive Screening Test.

Objective

To validate the revised version of the Quick Cognitive Screening Test (QCST).

Design

Cross-sectional.

Setting

Senior homes; hospital; college campus.

Participants

Participants (N=377; 114 men, 263 women) were recruited comprising healthy controls (n=201; 40 men, 161 women), subjects with dementia (n=93; 34 men, 59 women) including Alzheimer disease (n=73) and vascular dementia (n=20); subjects with psychiatric illness (n=35, 15 men, 20 women), specifically schizophrenia or bipolar disorder; and subjects with other neurologic conditions (n=48, 25 men, 23 women) such as traumatic brain injury (n=12) and cerebrovascular disease (n=31). Diagnoses were confirmed by physicians using appropriate criteria. Recruitment was done in the northeastern region.

Interventions

Not applicable.

Main Outcome Measures

In an effort to examine the reliability and validity of the revised QCST, participants were administered the revised QCST with a number of standardized measures (ie, Alzheimer's Disease Assessment Scale-Cognitive, Mini-Mental State Examination, Tests of Oral Fluency, Trail-Making Test, and Functional Activities Questionnaire).

Results

The results revealed that the revised QCST discriminated between healthy controls and the neuropsychiatric participants. Additionally, the revised QCST significantly correlated with other standardized measures, confirming the revised QCST's reliability and validity as a screening instrument for subjects with cognitive deficits.

Conclusions

The revised QCST provides the clinician with a short yet reliable screening instrument in detecting cognitive deficits in subjects with dementia and other neurologic conditions.     

Validation and comparison of two quantitative real-time PCR assays for direct detection of DMD/BMD carriers

Objectives

To develop a robust and reliable assay for direct identification of female carriers of deletions in the dystrophin gene.

Design and methods

We compared two quantitative real-time PCR approaches for the detection of the deletions of exons 4, 17, 47, and 50 in DMD/BMD carriers. One hundred and ten individuals from 26 unrelated families, including 8 large pedigrees characterized by having at least two DMD affected males, were studied. Carrier status of the subjects was also evaluated by MLPA.

Results

The results showed the gene dosage ratio of 0.99 ± 0.14 and 1.09 ± 0.19 for normal individuals and 0.48 ± 0.06 and 0.50 ± 0.10 for carriers in SYBR green and TaqMan probe assays, respectively. Carrier status was accurately attributed in 100% of cases and confirmed by MLPA.

Conclusion

Quantitative real-time PCR can be used as a direct method for carrier detection in female relatives of DMD patients with known deletions. The results are comparable to the MLPA data.     

The effects of mode of exercise instruction on compliance with a home exercise program in older adults with osteoarthritis

Objectives

To explore whether compliance with a prescribed home exercise program in elderly people with knee and/or hip osteoarthritis was influenced by mode of exercise instruction.

Design

Participants were randomised to one of three groups who received different modes of exercise instruction. Exercise performance was assessed at baseline and after 4 weeks and 8 weeks of home exercises.

Setting

Eighteen physiotherapy clinics in rural Victoria, Australia.

Participants

One hundred and fifteen males and females (mean age 70.5 years) with osteoarthritis of the knees and/or hips.

Interventions

Participants were randomised to receive verbal instructions on a home exercise program in addition to: (i) a home exercise brochure; (ii) a brochure together with an audiotape; or (iii) a brochure together with a videotape.

Main outcome measures

The Correctness of Exercise Performance scale and exercise log-sheets.

Results

Compliance with the home exercise program was good for all modes of exercise instruction where between 79% and 91% of exercises were performed correctly. Once provided with verbal instructions together with illustrated brochures, the provision of additional videotapes or audiotapes did not further enhance outcome.

Conclusions

Older people with osteoarthritis who received face-to-face instructions and a brochure on how to perform and comply with an 8-week home exercise program did not show additional benefits from other modes of instruction.

Key messages

•

Brochures can be as effective as additional audiotapes or videotapes to enhance correctness of exercise performance in older people with osteoarthritis of the knees and/or hips when given together with verbal instructions.

•

Audiotapes and videotapes may provide additional cues to maintain correctness of performance of exercises that are difficult to perform.

     

Outcomes after metal-on-metal hip resurfacing: could we achieve better function?

Newman MA, Barker KL, Pandit H, Murray DW. Outcomes after metal-on-metal hip resurfacing: could we achieve better function?

Objective

To report functional outcomes after metal-on-metal (MOM) hip resurfacing.

Design

A cohort of 126 MOM hip resurfacing operations were reviewed 1 year after surgery.

Setting

Hospital trust specializing in orthopedic surgery.

Participants

Sixty-seven right and 59 left hips were reviewed in patients (N=120; 71 men, 49 women; mean age, 56±9y; range, 24-76y).

Interventions

Not applicable.

Main Outcome Measures

Administered once at follow-up. Function was measured using the Oxford Hip Score (OHS), Hip disability and Osteoarthritis Outcome Score, and UCLA Activity Score. Complications, pain, range of motion, Trendelenburg test, strength, walking, single-leg stand, stair climbing, and 10-m walk time were assessed.

Results

Overall examination was satisfactory with few complications. High functional levels were reported. The median OHS was 15 and median UCLA Activity Score 7 (active). For 25%, outcome was poor with persistent pain, reduced hip flexion (mean, 94.46°±12.7°), decreased strength (P<.001), restricted walking, and functional limitations.

Conclusions

Information about outcomes is important for patients undergoing surgery. Hip resurfacing remains an emergent technology, with further follow-up and investigation warranted. One explanation for suboptimal recovery may be current rehabilitation, originally developed after total hip arthroplasty. Rehabilitation tailored to hip resurfacing, paced for this active population and progressed to higher demand activities, may improve outcomes.     

Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson's disease

Ebersbach G, Edler D, Kaufhold O, Wissel J. Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson’s disease.

Objective

To compare the effects of whole body vibration (WBV) and conventional physiotherapy (PT) on levodopa-resistant disturbances of balance and gait in idiopathic Parkinson’s disease (PD).

Design

Randomized controlled rater-blinded trial comparing 2 active interventions, final follow-up assessment 4 weeks after termination of active intervention.

Setting

Specialized referral center, hospitalized care.

Participants

Patients with PD and dopa-resistant imbalance on stable dopamine replacement medication (N=27) were randomized (intent-to-treat population) to receive WBV (n=13) or conventional PT (controls, n=14). Twenty-one patients (per protocol population) completed follow-up (14 men, 7 women; mean age, 73.8y; age range, 62-84y; mean disease duration, 7.2y; mean dopa-equivalent dose, 768mg/d).

Intervention

Subjects were randomized to receive 30 sessions (two 15-min sessions a day, 5 days a week) of either WBV on an oscillating platform or conventional balance training including exercises on a tilt board. Twenty-one subjects (10 with WBV, 11 controls) were available for follow-up 4 weeks after treatment termination.

Main Outcome Measures

The primary measure was Tinetti Balance Scale score. Secondary clinical ratings included stand-walk-sit test, walking velocity, Unified Parkinson’s Disease Rating Scale (section III motor examination) score, performance in the pull test, and dynamic posturography.

Results

The Tinetti score improved from 9.3 to 12.8 points in the WBV group and from 8.3 to 11.7 in the controls. All secondary measures, except posturography, likewise improved at follow-up compared with baseline in both groups. Quantitative dynamic posturography only improved in patients with WBV (1937-1467mm) whereas there was no significant change in controls (1832-2030mm).

Conclusions

Equilibrium and gait improved in patients with PD receiving conventional WBV or conventional PT in the setting of a comprehensive rehabilitation program. There was no conclusive evidence for superior efficacy of WBV compared with conventional balance training.     

Gait Training With Progressive External Auditory Cueing in Persons With Parkinson's Disease

Ford MP, Malone LA, Nyikos I, Yelisetty R, Bickel CS. Gait training with progressive external auditory cueing in persons with Parkinson's disease.

Objective

To investigate the progressively increasing external auditory cues during mobility training with persons with Parkinson's disease (PD).

Design

Experimental.

Setting

General community.

Participants

Convenience sample of persons with PD (N=12) who walked independently.

Interventions

Gait training to external auditory cues was based on a participant's comfortable walking pace. Training external auditory cues rates were increased if patients were able to maintain or increase stride length with increasing external auditory cues rate. Movement synchronization was not monitored during training. Participants trained for 30min/session, 3 sessions/wk, for 8 weeks.

Main Outcome Measures

Walking velocity, stride length, and cadence.

Results

Participants trained at a mean maximal rate of 157bpm. They showed a significant (P<.01) increase in walking velocity, stride length, and cadence after 8 weeks of training.

Conclusions

Walking velocity, stride length, and cadence can significantly improve when community-dwelling persons with PD participate in progressive mobility training.     

Functional Status of Patients With Cerebral Palsy According to the International Classification of Functioning, Disability and Health Model: A 20-Year Follow-Up Study After Selective Dorsal Rhizotomy

Langerak NG, Lamberts RP, Fieggen AG, Peter JC, Peacock WJ, Vaughan CL. Functional status of patients with cerebral palsy according to the International Classification of Functioning, Disability and Health Model: a 20-year follow-up study after selective dorsal rhizotomy.

Objective

To determine functional status of patients with cerebral palsy 20 years after they received selective dorsal rhizotomy (SDR).

Design

A prospective 20-year follow-up study.

Setting

Red Cross Children's Hospital (SDR operation and 1-year follow-up assessment) and at institutional or private locations nearby patients' homes (20-year follow-up assessment).

Participants

Referred sample of 14 patients with spastic diplegia (6 women, 8 men; mean age, 27y; range, 22-33y) who were preoperatively ambulant and fulfilled strict selection criteria for SDR operation in 1985.

Interventions

Patients were assessed before and 1 and 20 years after SDR.

Main Outcome Measures

Standardized assessments of function according to 2 dimensions of the International Classification of Functioning, Disability and Health (ICF) model: (1) body structure and function (muscle tone, joint stiffness, voluntary movement) and (2) activity (rolling, sitting, kneeling, crawling, standing, walking, transitions) were obtained. In addition, based on assessments and questionnaires, Gross Motor Function Classification System (GMFCS) levels were determined before and at 1 year after SDR retrospectively and currently at 20 years after SDR.

Results

One year after SDR, functional outcomes based on the 2 dimensions of the ICF model improved significantly, and these improvements were maintained at 20 years after surgery. Patients showed a shift in their GMFCS levels 1 and 20 years after SDR.

Conclusions

In line with our 20-year follow-up study with gait parameters as outcome measures, patients with spastic diplegia still show improvements in their functional status 20 years after SDR. We acknowledge the presence of possible confounding factors and a small sample size, but we argue that the improvements found in this study were caused mainly by SDR. Finally, changes in GMFCS levels suggest a possible role for this tool to detect changes after an intervention.     

A randomised controlled trial of lay-led self-management for Myocardial Infarction patients who have completed cardiac rehabilitation

Background

There are increasing opportunities for MI patients to attend lay-led, community based generic self-management programmes via self-referral.

Aims

To determine the effectiveness of the Expert Patient Programme (EPP) for MI patients who had completed CR using a randomised controlled, wait-list design, with a nested qualitative study.

Methods

The Intervention Group attends the EPP immediately after completing the baseline assessment; The Control Group had the opportunity to attend the EPP after completion of the 4-month follow-up. 192 MI patients (72% men) completed baseline assessment; 162 responded at follow-up. Telephone interviews were conducted with 10 male and 9 female Intervention group participants.

Results

Intention-to-treat analysis revealed no statistically significant differences between the groups although a pattern of small improvements among the Intervention Group was observed over time. Interviews revealed that Intervention Group participants viewed CR as being more about instruction whereas the EPP was viewed as being more about discussion, mutual support, and goal setting. A gender difference emerged whereby male participants valued information exchange whereas female participants expressed a preference for emotional support and social interaction within the EPP context.

Conclusion

The EPP appears to hold few benefits for MI patients who have attended CR.     

Evaluation of a nurse-led social rehabilitation programme for neurological patients and carers: An action research study

Background

Very few neurological rehabilitation programmes have successfully dealt with patients’ and relatives’ social needs. Furthermore, the nurses’ contribution in those programmes is poor or unclear.

Objectives

To determine the rationale, effectiveness and adequacy of a nurse-led social rehabilitation programme implemented with neurological patients and their carers.

Design

In this action research study Hart and Bond's experimental and professionalizing typologies were applied through Lewinian cycles. A social rehabilitation programme was planned, based on the results of an in-depth baseline assessment of the context and individual needs. The programme focused on increasing the level of acceptance/adaptation of the disease through verbal and written education, easing the discharge planning, and offering social choices based on the social assessment of individual needs and possibilities at home.

Settings

Two neurological wards of a hospital in Spain.

Participants

The programme evaluation included 27 nurses, and two groups of patients and relatives (control group = 18 patients and 19 relatives, intervention group = 17 patients and 16 relatives).

Methods

The two groups of patients and relatives were compared before and after discharge to determine the effectiveness of the programme. Socio-demographic forms, semi-structured interviews, participant observations, and validated scales to measure activities of daily living and social life were used, and data were analysed using content (QSR Nudist Vivo, v.2.0) and statistical (SPSS v. 13.0) analyses.

Results

The new programme resulted in social care being integrated in daily practice and developed knowledge about social rehabilitation. This had a positive impact on nurses’ attitudes. Patients and relatives had more realistic expectations and positive attitudes towards social life, and developed a wider variety of choices for social changes. Better adaptation, and more coping skills and satisfaction were achieved.

Conclusions

This rehabilitation programme was feasible and effective. Patients and relatives benefited from better understanding of the socialisation process, as a result of advancing nurses’ knowledge, experience and role in psychosocial care.     

Effects of Walking With a Shopping Trolley on Spinal Posture and Loading in Subjects With Neurogenic Claudication

Comer CM, White D, Conaghan PG, Bird HA, Redmond AC. Effects of walking with a shopping trolley on spinal posture and loading in subjects with neurogenic claudication.

Objectives

To explore possible mechanisms underpinning symptom relief and improved walking tolerance in patients with neurogenic claudication (NC) when pushing a shopping trolley by evaluating the effects of a shopping trolley on spinal posture and loading patterns.

Design

An exploratory study of kinematic and kinetic changes in walking with and without pushing a shopping trolley in persons with NC symptoms and a comparison with asymptomatic control subjects.

Setting

A primary care-based musculoskeletal service.

Participants

Participants (n=8) with NC symptoms who have anecdotally reported symptomatic improvement when walking with a shopping trolley and a control group of asymptomatic persons (n=8).

Interventions

Shopping trolley.

Main Outcome Measures

Changes in lumbar spinal sagittal posture and ground reaction force.

Results

Subjects with NC and asymptomatic controls walked with significantly more flexed spinal posture (increase in flexion, 3.40°; z=3.516; P<.001) and reduced mean ground reaction forces (−6.9% of body weight; z=−3.46; P=.001) when walking with a shopping trolley. However, at the midstance point of the gait cycle, controls showed minimal reliance on the trolley, whereas, people with NC showed continued offloading.

Conclusions

Both posture and loading are affected by pushing a shopping trolley; however, patients with NC were found to offload the spine throughout the stance phase of gait, whereas asymptomatic controls did not.     

Neuromuscular Electrical Stimulation Training: A Safe and Effective Treatment for Facioscapulohumeral Muscular Dystrophy Patients

Colson SS, Benchortane M, Tanant V, Faghan J-P, Fournier-Mehouas M, Benaïm C, Desnuelle C, Sacconi S. Neuromuscular electrical stimulation training: a safe and effective treatment for facioscapulohumeral muscular dystrophy patients.

Objective

To investigate the feasibility, safety, and effectiveness of neuromuscular electrical stimulation (NMES) strength training in facioscapulohumeral muscular dystrophy (FSHD) patients.

Design

Uncontrolled before-after trial.

Setting

Neuromuscular disease center in a university hospital and a private-practice physical therapy office.

Participants

FSHD patients (N=9; 3 women, 6 men; age 55.2±10.4y) clinically characterized by shoulder girdle and quadriceps femoris muscle weakness.

Interventions

Patients underwent 5 months of strength training with NMES bilaterally applied to the deltoideus, trapezius transversalis, vastus lateralis, and vastus medialis muscles for five 20-minute sessions per week.

Main Outcome Measures

Plasma creatine kinase (CK) activity; scores for pain and fatigue on visual analog scales (VAS), manual muscle testing (MMT), maximal voluntary isometric contraction (MVIC), 6-minute walking tests (6MWT), and self-reported changes in daily living activities.

Results

NMES strength training was well tolerated (CK activity and pain and fatigue scores on VAS were not modified). Most of the muscle functions (shoulder flexion and extension and knee extension) assessed by MMT were significantly increased. MVIC of shoulder flexion and abduction and the 6MWT distance were also improved.

Conclusions

In FSHD, NMES strength training appears to be safe with positive effects on muscle function, strength, and capacity for daily activities.     

One-leg cycling versus arm cranking: which is most appropriate for physical conditioning after knee surgery?

Olivier N, Legrand R, Rogez J, Berthoin S, Prieur F, Weissland T. One-leg cycling versus arm cranking: which is most appropriate for physical conditioning after knee surgery?

Objective

To compare the cardiorespiratory responses, blood lactate concentration and perceived exertion between 1-leg cycling and arm cranking.

Design

Comparison of exercise modalities.

Setting

Hospital.

Participants

Fourteen men who had undergone knee surgery were evaluated during rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

Each patient performed 2 maximal graded tests: 1-leg cycling and arm cranking exercise, with a 7-day interval. Respiratory gas exchange, heart rate, blood lactate concentration, and the ratings of perceived exertion (RPE) were measured.

Results

Peak power output, peak minute ventilation, peak oxygen uptake (Vo₂peak), and peak heart rate did not differ significantly between 1-leg cycling and arm cranking. The first and second ventilatory thresholds occurred at above 40% and 72% of Vo₂peak, respectively, in both tests. The maximal lactate concentrations and the RPE values were significantly higher during arm cranking (+10%, +12%, respectively, P<.05) compared with corresponding 1-leg cycling values.

Conclusions

The maximal cardiorespiratory values were not different between arm cranking and 1-leg cycling. However, the RPE and blood lactate concentration were lower when the exercise was performed with the lower limb. Thus 1-leg cycling may be more easily tolerated than arm cranking by patients participating in aerobic conditioning after knee surgery.     

Community Ambulation in Older Adults: Which Internal Characteristics Are Important?

Lord SE, Weatherall M, Rochester L. Community ambulation in older adults: which internal characteristics are important?

Objective

To examine the internal characteristics of older adults independent in community ambulation to gain further understanding of the skills required for its successful execution.

Design

Exploratory factor analysis.

Setting

General community.

Participants

Healthy, community dwelling older adults (N=113) who were cognitively intact and walked outdoors independently.

Interventions

Not applicable.

Main Outcome Measures

Spatiotemporal gait parameters derived from accelerometry over 6 minutes walking outdoors and a battery of measures for motor, cognitive, executive, and behavioral characteristics.

Results

Mean participant age ± SD was 75.8±7.3 years, with almost a third of the sample over 80 years. Four factors emerged from the Factor Analysis of 23 variables: motor control, self-efficacy, executive function, and cognitive-motor interference, which together explained 61.4% of common variance. Eight variables loaded onto motor control, accounting for 34.5% of common variance; 7 items loaded onto self-efficacy, which explained 12.4% of common variance; 5 variables loaded onto executive function, accounting for 8.4% of common variance; and 3 variables loaded onto cognitive-motor interference, explaining 6% of the variance.

Conclusions

Results of this study indicate that factors beyond motor control contribute to independent community ambulation in older adults, reflecting the multidimensional, complex nature of the task. Self-efficacy was shown to be more relevant than executive function to gait performance, suggesting the need for a broader approach to assessment and intervention strategies.     

The Effects of Scapulothoracic Bursa Injections in Patients With Scapular Pain: A Pilot Study

Chang WH, Im SH, Ryu JA, Lee SC, Kim JS. The effects of scapulothoracic bursa injections in patients with scapular pain: a pilot study.

Objective

To assess the effects of steroid plus hyaluronate injections for scapulothoracic bursitis in patients with scapular pain.

Design

Prospective open-label unicenter trial with a 3-month follow-up.

Setting

University rehabilitation hospital.

Participants

Twenty-two cases of suspected scapulothoracic bursitis.

Intervention

Injections into scapulothoracic bursa were performed with steroid plus hyaluronate. Injections were administered once a week for 3 weeks.

Main Outcome Measures

Visual analog scale (VAS), Rubin scale, adverse events, and injection-associated complications.

Results

Mean outcome scores at 3-month follow-up visits showed significant improvements versus baseline (mean VAS increased from 7.8 to 2.2) (P<.05). Furthermore, mean VAS scores at 1, 2, and 3 weeks after treatment commencement showed significant improvements versus baseline (P<.05). No serious complication occurred during the study.

Conclusions

Scapulothoracic bursitis should be considered when treating patients with perimarginal scapular pain or subscapular pain. Our findings show that steroid plus hyaluronate injections into the scapulothoracic bursa provide an effective means of treating patients with scapulothoracic bursitis.     

Effect of Ankle-Foot Orthosis Alignment and Foot-Plate Length on the Gait of Adults With Poststroke Hemiplegia

Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia.

Objective

To investigate the effect of ankle-foot orthosis (AFO) alignment and foot-plate length on sagittal plane knee kinematics and kinetics during gait in adults with poststroke hemiplegia.

Design

Repeated measures, quasi-experimental study.

Setting

Motion analysis laboratory.

Participants

Volunteer sample of adults with poststroke hemiplegia (n=16) and able-bodied adults (n=12) of similar age.

Interventions

Subjects with hemiplegia were measured walking with standardized footwear in 4 conditions: (1) no AFO (shoes only); (2) articulated AFO with 90° plantar flexion stop and full-length foot-plate-conventionally aligned AFO (CAFO); (3) the same AFO realigned with the tibia vertical in the shoe-heel-height compensated AFO (HHCAFO); and (4) the same AFO (tibia vertical) with ¾ length foot-plate-¾ AFO. Gait of able-bodied control subjects was measured on a single occasion to provide a normal reference.

Main Outcome Measures

Sagittal plane ankle and knee kinematics and kinetics.

Results

In adults with hemiplegia, walking speed was unaffected by the different conditions (P=.095). Compared with the no AFO condition, all AFOs decreased plantar flexion at initial contact and mid-swing (P<.001) and changed the peak knee moment in early stance from flexor to extensor (P<.000). Both AFOs with full-length foot-plates significantly increased the peak stance phase plantar flexor moment compared with no AFO and resulted in a peak knee extensor moment in early stance that was significantly greater than control subjects, whereas the AFO with three-quarter length foot-plate resulted in ankle dorsiflexion during stance and swing that was significantly less than control subjects.

Conclusions

These findings suggest that when an articulated AFO is to be used, a full-length foot-plate in conjunction with a plantar flexion stop may be considered to improve early stance knee moments for people with poststroke hemiplegia.