Ankle positioning and knee perturbation affect temporal recruitment of the vasti muscles in people with patellofemoral pain

Objectives

To compare the temporal recruitment of the vastus medialis obliquus (VMO) and vastus lateralis (VL) during voluntary ankle movements and perturbed standing in people with patellofemoral pain, and to determine the effects of different reflex and voluntary postural exercise tasks on VMO facilitation.

Design

Repeated-measures design.

Participants

Twenty-three subjects with patellofemoral pain.

Interventions

Quadriceps reflex contraction in response to postero-anterior knee perturbations was measured with three crural muscle contraction conditions and three postural exercises (semi-squatting, tip-toeing and heel standing).

Main outcome measures

The electromyographic (EMG) onset time of the VMO and VL during each task was measured and compared across the different tasks.

Results

The mean EMG onset time of the VMO was later than that of the VL in the voluntary tasks such as tip-toeing (VMO 95.3 ms vs VL 36.4 ms, mean difference 58.9 ms, 95% confidence interval −33.7 to 151.5 ms), whereas earlier VMO activation was found in the perturbation tests such as toe standing (VMO 17.6 ms vs VL 22.9 ms, mean difference −5.3 ms, 95% confidence interval −25.3 to 14.7 ms).

Conclusion

These findings suggest the potential benefits of unexpected perturbation activities for facilitating VMO activation. The clinical applications of perturbation tasks in rehabilitation exercise programmes and the underlying mechanisms warrant further investigation.     

Effect of spectators on the performance of a physiotherapy exercise

Objective

To investigate the effect of spectators on the performance of a physiotherapy exercise.

Design

Observational study.

Setting

Research laboratory, Trinity College Dublin.

Participants

Forty adult volunteer subjects (36 females, four males). As there were only four males, these were excluded from the analysis.

Interventions

Subjects were observed and timed while performing single leg stance in two conditions 48 hours apart; once with the investigator present (investigator condition) and once with the investigator and three spectators present (spectator condition).

Main outcome measure

Duration of single leg stance in seconds.

Results

The mean duration of single leg stance, for females, under the investigator condition was 173 seconds [95% confidence interval (CI) 131 to 214], while that of the spectator condition was 168 seconds (95%CI 128 to 208). The mean difference between the two conditions was 5 seconds (95%CI −21 to 31). This was not statistically significant using a paired t-test (P = 0.686).

Conclusions

Female performance of a straightforward exercise such as single leg stance was not affected by the presence of three spectators.     

A prospective randomised controlled trial of spinal manipulation and ultrasound in the treatment of chronic low back pain

Objectives

To assess the short- and long-term effectiveness of spinal manipulation therapy, and to identify the effect of manipulation on lumbar muscle endurance in patients with chronic low back pain (LBP).

Design

A randomised controlled trial comparing manipulation and exercise treatment with ultrasound and exercise treatment.

Setting

An outpatient physiotherapy department.

Participants

One hundred and twenty patients with chronic LBP were allocated at random into the manipulation/exercise group or the ultrasound/exercise group.

Interventions

Both groups were given a programme of exercises. In addition, one group received spinal manipulation therapy and the other group received therapeutic ultrasound.

Main outcome measures

Pain intensity, functional disability, lumbar movements and muscle endurance were measured shortly before treatment, at the end of the treatment programme and 6 months after randomisation using surface electromyography.

Results

Following treatment, the manipulation/exercise group showed a statistically significant improvement (P = 0.001) in pain intensity [mean 16.4 mm, 95% confidence interval (CI) 6.1-26.8], functional disability (mean 8%, 95% CI 2-13) and spinal mobility (flexion: mean 9.4 mm, 95% CI 5.5-13.4; extension: mean 3.4 mm, 95% CI 1.0-5.8). There was no significant difference (P = 0.068) between the two groups in the median frequency of surface electromyography (multifidus: mean 6.8 Hz, 95% CI 1.24-14.91; iliocostalis: mean 2.4 Hz, 95% CI 2.5-7.1), although a significant difference (P = 0.013) was found in the median frequency slope of surface electromyography in favour of spinal manipulation for multifidus alone (mean 0.3, 95% CI 0.1-0.5). A significant difference was also found between the two groups in favour of the manipulation/exercise group at 6-month follow-up.

Conclusions

Although improvements were recorded in both groups, patients receiving manipulation/exercise showed a greater improvement compared with those receiving ultrasound/exercise at both the end of the treatment period and at 6-month follow-up.     

Validity of the 6-minute walk test for assessing heart rate recovery after an exercise-based cardiac rehabilitation programme

Objectives

To compare heart rate responses in the 6-minute walk test and the treadmill exercise test before and after an exercise-based cardiac rehabilitation programme.

Design

Prospective cohort study.

Setting

Hospital-based cardiac rehabilitation programme in Hong Kong.

Participants

Thirty patients (mean age 62.1 ± 8.5 years, 20 males) with stable ischaemic heart disease.

Interventions

Eight-week exercise-based cardiac rehabilitation programme involving upper and lower limb aerobic and resistance training.

Main outcome measures

Six-minute walk test and treadmill exercise test before and after the exercise programme.

Results

Comparing parameters before and after the exercise programme, the peak heart rate in the 6-minute walk test increased (median of 105 beats per minute (bpm), interquartile range 96.8-116.5 versus 110 bpm, interquartile range 100.5-124.5, P = 0.006), while heart rate recovery improved in each 30-second interval of a 2-minute recovery period. The distance covered during the 6-minute walk increased from a mean of 486.3 m (±standard deviation 113.9 m) to 552.5 m (±standard deviation 111.9 m) (P < 0.001). Rating of perceived exertion during the 6-minute walk test decreased from a median of 14 (interquartile range 13-15) to 13 (interquartile range 13-13) (P = 0.001). Heart rate recovery following treadmill exercise testing improved during the 30-second periods from 60 to 90 seconds and from 90 to 120 seconds of recovery. Metabolic equivalents increased during treadmill testing from a median of 7.0 (interquartile range 5.8-8.6) to 8.6 (interquartile range 7-8.6) (P < 0.001).

Conclusions

Both treadmill exercise and 6-minute walk tests demonstrated improvements in heart rate recovery and increases in achieved workload following exercise training. This suggests that the 6-minute walk test is a valid tool to assess heart rate recovery following such a programme.     

Assessment of undergraduate physiotherapist clinical performance: investigation of educator inter-rater reliability

Objectives

To investigate the inter-rater reliability of physiotherapy educators in awarding clinical placement marks to undergraduate students using a standardised clinical placement assessment form.

Design

Inter-rater reliability study performed over five undergraduate physiotherapy clinical placements.

Setting

Five clinical sites associated with a BSc undergraduate physiotherapy programme.

Participants

Second and final year physiotherapy students who were on clinical placements (n = 86 paired assessments). Two physiotherapy educators (a practice tutor and a practice educator), equally involved in supervising the students over the placement period, marked each student blindly at the end of the placement.

Outcome measure

Marking was performed using a standardised clinical placement assessment form and guidelines. This form was developed by physiotherapy educators, and utilised previously published work in the area.

Results

Eighty-six paired assessment marks were analysed. Practice educators and practice tutors agreed on grades on 74% of occasions. The mean difference in marks (maximum of 100) between educators was −0.5 (95% confidence interval −1.1 to 0.2), and using the limits of agreement method, the results suggested that where two raters mark a student at the end of a clinical placement, the raters will be within 6.2 marks of each other on 95% of occasions. The intraclass correlation coefficient (ICC) for the overall mark was 0.84, indicating almost perfect agreement. Subsections of the form also had substantial agreement (patient management ICC, 0.75; professional development ICC, 0.75; organisation and management ICC, 0.81).

Conclusion

Physiotherapy educators demonstrated a high level of reliability in the assessment and marking of undergraduate physiotherapy student performance using a standardised clinical assessment form. This was evident over several sites and specialities.     

Ambulatory oxygen therapy assessment: a comparative study of incremental shuttle and 6-minute walking tests

Background

Walking tests, such as the incremental shuttle walk test (ISWT) and the 6-minute walk test (6MWT), are recommended in the assessment of ambulatory oxygen for patients with chronic obstructive pulmonary disease (COPD). However, there is no evidence that these tests can be used interchangeably.

Objectives

To compare the ISWT and the 6MWT in COPD patients in terms of indication for ambulatory oxygen therapy.

Design

Crossover design.

Setting

Patients attended as outpatients.

Participants

Fifty patients with stable COPD (31 males; age 67 years, range 43 to 83 years); mean forced expiratory volume in 1 second 1.2 l [standard deviation (SD) 0.6 l] and 48.6% predicted (SD 23.4%).

Intervention

Patients performed both the ISWT and the 6MWT whilst breathing air. Breathlessness (Borg scale), percutaneous arterial oxygen saturation (SpO₂) and heart rate were measured before and after both tests.

Main outcome measures

Post-test SpO₂ and change from baseline.

Results

The mean change in saturation was −4.6% (SD 6.2%) and −2.8% (SD 5.3%) after the ISWT and the 6WMT, respectively. Using Bland and Altman plots, the limits of agreement for difference in change in SpO₂ (%) between the two tests were wide (−8.1 to 11.6) and clinically relevant. Sixteen patients (32%) and 13 patients (26%) met the criteria for ambulatory oxygen with the ISWT and the 6MWT, respectively (P = 0.32).

Conclusions

This study found a wide variation between differences in exercise oxygen desaturation after the ISWT compared with the 6MWT, supporting the premise that these tests should not be used interchangeably in the assessment of ambulatory oxygen for COPD patients.     

Inter-rater reliability of McKenzie assessment in patients with neck pain

Objectives

To determine inter-rater agreement on diagnostic category using the Mechanical Diagnosis and Therapy (MDT) classification system for neck pain. If the diagnostic category was derangement syndrome, inter-rater agreement on the subcategory and the directional preference of treatment was also determined.

Design

Clinicians viewed videotaped MDT examinations of 20 patients with neck pain and rated the MDT diagnosis independently for each patient. If the diagnostic category was derangement syndrome, the subcategory and directional preference of treatment were also rated.

Setting

Private physical therapy outpatient clinics and a university clinical laboratory.

Participants

Fifty-four clinicians trained in MDT for neck pain from the USA and Canada, and 20 adult patients with neck pain.

Main outcome measures

Inter-rater agreement for MDT diagnosis, derangement subcategory and directional preference of treatment was determined using Kappa and percentage agreement.

Results

Overall, agreement was of moderate clinical significance for diagnosis [κ = 0.55, P < 0.001, confidence intervals (CI) 0.52 to 0.58, 67%], derangement subcategory (κ = 0.47, CI 0.44 to 0.50, P < 0.001; 63%) and directional preference of treatment (κ = 0.46, CI 0.43 to 0.49, P < 0.05; 70%).

Conclusions

Clinicians trained in MDT for neck pain demonstrate moderate agreement when classifying the diagnostic category and treatment for neck pain.     

Accelerometer monitoring of home- and community-based ambulatory activity after stroke

Haeuber E, Shaughnessy M, Forrester LW, Coleman KL, Macko RF. Accelerometer monitoring of home- and community-based ambulatory activity after stroke. Arch Phys Med Rehabil 2004;85:1997-2001.

Objectives

To investigate the utility of a novel microprocessor-linked Step Watch Activity Monitor (SAM) to quantify ambulatory activity after stroke and to evaluate the validity and reliability of conventional accelerometers to measure free-living physical activity in this population.

Design

Cross-sectional with repeated measures of 2 separate 48-hour recordings in 17 persons wearing an ankle-mounted SAM and Caltrac, a hip-mounted mechanical accelerometer.

Setting

Home and community.

Participants

Seventeen subjects with chronic hemiparetic gait after stroke.

Interventions

Not applicable.

Main outcome measures

The SAM derived stride counts per day and Caltrac estimated the daily caloric expenditure of physical activity.

Results

SAM data revealed that stroke patients had a mean strides per day ± standard deviation of 3035±1944 and demonstrated a broad range of daily activity profiles (400-6472 strides). SAM test-retest reliability was high across separate monitoring periods (r=.96, P<.001). Although Caltrac also revealed a broad range of daily activity calories (346±217kcal/d; range, 83-1222kcal/d), reliability was poor (r=.044, P=not significant) and Caltrac accounted for only 64% of the ambulatory activity quantified by the SAM.

Conclusions

Microprocessor-linked accelerometer monitoring, but not conventional accelerometers, are accurate and highly reliable for quantifying ambulatory activity levels in stroke patients. These findings support the utility of personal status monitoring of ambulatory activity as an outcomes instrument and metric in programs to increase physical activity and cardiovascular health after stroke.     

Objective monitoring of adherence with home exercise training during pulmonary rehabilitation for chronic obstructive pulmonary disease

Objectives

Outpatient pulmonary rehabilitation relies on the patient completing bouts of unsupervised exercise at home. The aim of this study was to monitor adherence with a home walking programme using activity monitors.

Design

The sensitivity and reliability of five activity monitors were initially established at speeds at which patients are advised to walk. Thereafter, 18 patients with established chronic obstructive pulmonary disease attending pulmonary rehabilitation were recruited. All patients were required to wear a small device around their waist for two, 7-day periods during the 7-week course of rehabilitation. During this time, patients also completed a home diary card. Adherence was monitored by frequency, duration and intensity of walks.

Setting

Pulmonary Rehabilitation Department, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.

Results

The activity monitors were able to clearly discriminate varying walking speeds and were reproducible at each pre-selected speed (P < 0.05). However, between-monitor comparison was not reproducible at the pre-determined speeds. Individually prescribed walking speeds for home training ranged from 1.76 to 4.83 km/hour. As a group, only two patients failed to achieve 100% of total adherence. Adherence for the individual components varied widely.

Conclusion

Activity monitor technology appears to be able to discriminate individually prescribed walking speeds that allow home walking programmes to be monitored.     

A multiconvergent approach to the rehabilitation of patients with chronic fatigue syndrome: a comparative study

Objectives

This study investigated the efficacy of a rehabilitation technique for the treatment of chronic fatigue syndrome that was developed by a physiotherapist. Data collected retrospectively from a pilot study indicated that patients benefited from this multiconvergent approach, so further assessments were warranted.

Design

Treatment efficacy was assessed by comparing the primary and secondary outcome measures of patients attending multiconvergent therapy (MCT) with those of patients attending relaxation therapy and a group of non-intervention controls.

Setting

The active treatment took place at a clinic within the physiotherapy outpatient unit. Relaxation therapy and all assessments were conducted at the psychology unit.

Participants

Thirty-five participants, fitting the Centers for Disease Control and Prevention criteria for chronic fatigue syndrome, were recruited from two outpatient clinics and an existing patient panel.

Intervention

Patients were assigned to either MCT (n = 12) or relaxation therapy (n = 14). Nine participants who received general medical care were used as a comparison group.

Main outcome measures

The Karnofsky performance scale was used as the primary outcome measure of function. Secondary outcome measures assessing overall improvement in patient condition, fatigue and disability levels were also administered.

Results

A significant percentage of the patients attending the MCT sessions showed improvement in the primary outcome score used to measure the success of the treatment (MCT = 83%, relaxation = 21%, controls = 0; P < 0.001). A significant percentage of this group also reported improvement in their overall condition (MCT = 92%, relaxation = 64%, controls = 22%; P < 0.001), lower fatigue levels (MCT = 83%, relaxation = 57%, controls = 11%; P < 0.001) and lower levels of disability (MCT = 75%, relaxation = 43%, controls = 11%; P = 0.032) immediately post-therapy. In addition, these improvements were maintained at 6-month follow-up.

Conclusions

Outcomes from this small preliminary study were encouraging. The multiconvergent approach produced significant improvements for standardised primary and secondary outcome measures. Further research is required to examine the efficacy of this approach over time, and its effectiveness on a larger scale within the primary healthcare setting using additional therapists trained in the technique.     

Living with an unfixable heart: A qualitative study exploring the experience of living with advanced heart failure

Background

Nurses working with patients with advanced heart failure need knowledge that will help us to help patients cope with their situations of chronic illness. However, our knowledge bank is deficient due to the scarcity of inquiry that takes the affected person's point of view as its central focus.

Aim

The aim of this study was to describe patients' experiences of living with advanced heart failure.

Methods

The study sample (N = 9) consisted of male (N = 6) and female (N = 3) patients with advanced (NYHA classes III-IV) heart failure. The design was qualitative and open unstructured interviews were audio-taped and transcribed verbatim during 2006.

Results

Four main themes emerged: Living in the Shadow of Fear; Running on Empty; Living a Restricted life; and Battling the System. The experience of living with advanced heart failure was described as a fearful and tired sort of living characterised by escalating impotence and dependence.

Conclusions

The findings suggest that there may be an illogical but enduring ethos of ‘cure’ pervading health care worker's attitudes to advanced heart failure care. This mindset might be working to hinder the application of additional or alternative therapies, which might better palliate the physical and psychosocial distress of patients.     

Self-referral, access and physiotherapy: patients’ knowledge and attitudes—results of a national trial

Objectives

To identify service users’ views and attitudes to access, physiotherapy and patient-autonomous health-seeking behaviours.

Study design

Mixed qualitative and quantitative questionnaire.

Setting

Twenty-six locations representing a range of socio-economic and geographical settings throughout Scotland.

Participants

Three thousand and ten patients over 16 years of age.

Methods

Postal questionnaires containing a mix of open and closed questions, attitude statements and free text for comments were sent to all consenting patients 4 weeks after discharge from physiotherapy. Responses were analysed by referral group: self-referred patients; patients referred by their general practitioner (GP); and patients referred at the suggestion of their GP.

Results

A response rate of 72% (2177/3010) was achieved. Males, females and all age groups were represented. Strong support for the effectiveness of physiotherapy was reported by all groups (>90%). Despite more than 80% of respondents claiming that they were able to confidently predict when they needed physiotherapy, less than 23% reported being knowledgeable or very knowledgeable about physiotherapy, with no significant association between level of knowledge and referral group (P = 0.129). Self-referred patients were more satisfied (P < 0.001), more supportive of being able to self-refer (83% vs 69% of GP-referred patients and 71% of patients referred at the suggestion of their GP), and more supportive of physiotherapists making decisions about their fitness for work or activities (59% vs 53% of GP-referred patients and 53% of patients referred at the suggestion of their GP).

Conclusions

Physiotherapy was regarded positively by all referral groups, particularly by self-referred patients, despite there being a distinct lack of knowledge about the profession. There is a clear need to raise awareness and knowledge of physiotherapy if autonomous health-seeking behaviours are to be encouraged and self-referral schemes progressed appropriately.     

Cold pack/skin interface temperature during ice treatment with various levels of compression

Objective

To compare cold pack/skin interface temperature during a 20-minute ice application with various levels of compression.

Design

Repeated measures.

Setting

Laboratory setting in an educational institution.

Participants

Forty healthy females aged between 20 and 23 years.

Interventions

An ice pack was applied to the right thigh with compression using an elastic bandage. Five different levels of compression were used: 0 (no compression), 14, 24, 34 and 44 mmHg.

Main outcome measure

Cold pack/skin interface temperature was monitored every minute during the 20-minute ice application.

Results

Ice application with compression led to significantly lower cold pack/skin interface temperatures than ice application without compression during the 20-minute application (with compression: mean 6.1 °C, 95% confidence interval 5.9-6.3 °C; without compression: mean 8.1 °C, 95% confidence interval 7.7-8.5 °C) (P < 0.05). The level of compression did not significantly affect the magnitude of the cooling temperature (14 mmHg: mean 6.4 °C, 95% confidence interval 6.0-6.8 °C; 24 mmHg and 34 mmHg: mean 6.1 °C, 95% confidence interval 5.7-6.5 °C; 44 mmHg: mean 5.9 °C, 95% confidence interval 5.5-6.3 °C) (P > 0.05). The minimum temperature reached with ice application with compression of 0, 14, 24, 34 and 44 mmHg was achieved after 9, 7, 6, 6 and 5 minutes of application, respectively (0 mmHg: mean 5.0 °C, 95% confidence interval 4.9-5.1 °C; 14 mmHg: mean 4.2 °C, 95% confidence interval 4.1-4.3 °C; 24 mmHg: mean 4.0 °C, 95% confidence interval 3.9-4.1 °C; 34 mmHg: mean 3.9 °C, 95% confidence interval 3.7-4.0 °C; 44 mmHg: mean 3.7 °C, 95% confidence interval 3.6-3.9 °C) (P < 0.05).

Conclusion

Ice application with adjunctive compression leads to a greater magnitude and rate of cooling compared with ice application without compression. The higher the level of compression, the shorter the time to the minimum recorded temperature. Further research is required to demonstrate the effect of various levels of compression applied over an ice pack in a clinical population.     

Reproducibility and validity of the incremental shuttle walking test in patients following coronary artery bypass surgery

Objective

The incremental shuttle walking test (ISWT) is widely used to assess patients with chronic obstructive pulmonary disease. We hypothesised that it would be an appropriate tool to assess patients with coronary heart disease following coronary artery bypass grafts. We therefore explored the reproducibility, validity and sensitivity of the ISWT following rehabilitation.

Design

Participants completed three ISWTs and an incremental treadmill test over 7 days. Eleven patients repeated the ISWT following rehabilitation.

Setting

Cardiac rehabilitation department.

Participants

Thirty-nine patients, 34 of whom were male, with a mean age of 61.2 years (S.D. 8.5), 6-8 weeks after coronary artery bypass graft surgery.

Main outcome measures

Maximum oxygen uptake (O_2 peak, ml/min/kg) and ISWT.

Results

Mean (S.D.) distances for the three ISWTs were 448 m (137.8), 487 m (147.6) and 481 m (138.2). There was no statistically significant difference between the three ISWTs. The mean difference between Tests 1 and 2 was 42.8 m (95% confidence interval 59.1-26.5 m) compared with 1.7 m (95% confidence interval −1.86-5.29) between Tests 2 and 3. The mean O_2 peak was 21.0 (S.D. 4.5) ml/min/kg. There was a significant relationship between the results for the three ISWTs and O_2 peak (r = 0.79, r = 0.86 and r = 0.87 for Tests 1-3, respectively). Following rehabilitation, there was a significant increase in the distance walked; the mean difference between the second ISWT and the post-rehabilitation ISWT was 81.8 m (95% confidence interval 53.2-110.4, P < 0.001).

Conclusions

The ISWT correlates well with O_2 peak and is a reliable measure of cardiorespiratory fitness in this population after one practice walk.     

Disability in patients with degenerative lumbar spinal stenosis

Lin S-I, Lin R-M, Huang L-W. Disability in patients with degenerative lumbar spinal stenosis.

Objective

To determine factors associated with disability in patients with degenerative lumbar spinal stenosis.

Design

One-group cross-sectional study.

Setting

University hospital.

Participants

One hundred eight patients with degenerative lumbar spinal stenosis.

Interventions

Not applicable.

Main Outcome Measures

Oswestry Disability Index and 4 categories of factors, including patient demographics (age, sex, number of comorbidities, medications), symptom-related factors (intensity, location, onset duration, neurogenic claudication), body structure and function as described in the International Classification of Functioning, Disability and Health model (muscle strength, vibration sense, spine flexibility), and stenotic condition (type and number of spinal segments involved).

Results

Patients with symptoms in both back and leg reported greater disability than those with symptoms only in the leg or back (P=.008). Greater disability correlated significantly with greater symptom intensity (r=.385, P<.001) and higher vibration threshold (r=.236, P=.014). While controlling the variance in patient demographics in the regression analysis, vibration sense and symptom location each added 10% of the variance in disability, and symptom intensity and strength each added 5%, with a total of 44% variance explained (P=.044).

Conclusions

Symptom intensity and location, vibration sense, and muscle strength were identified as significant factors and, together with patient demographics, accounted for 44% of the variance explained in disability. Further investigations are needed to determine if causal relationships exist between these factors and disability.     

A study to compare the effects of massage and static touch on experimentally induced pain in healthy volunteers

Objective

To investigate the hypoalgesic effects of massage on experimental pain.

Design

A cross-over intervention study separated by a 24-hour washout period. During each experiment, participants completed five cold-induced pain tests, two before the intervention and three during the intervention. During each test, participants immersed their hand in iced water and reported the first sensation of pain and pain intensity after a further 30 seconds.

Setting

Laboratory setting.

Participants

A volunteer sample of 30 university staff and students without known pathology, recruited from noticeboard advertisements.

Interventions

Participants received massage in one experiment and static touch in the other experiment. Interventions were administered to the ipsilateral arm for 4 minutes immediately before the hand was immersed in iced water.

Main outcome measures

Time to pain threshold and the odds of a reduction in pain intensity and an increase in pain relief.

Results

A mixed model analysis was used to establish how measures varied, according to baseline, during static touch and during massage. Massage increased the pain threshold by a factor of 1.08 (95% confidence interval 0.99-1.17) compared with static touch, but this failed to reach statistical significance (P = 0.088). Massage was more likely to result in a report of low pain intensity than static touch (odds ratio 0.26, 95% confidence interval 0.10-0.71, P = 0.007). Massage was more likely to result in a state of high pain relief than static touch (odds ratio 7.7, 95% confidence interval 3.0-19.8, P < 0.001).

Conclusion

Massage produced hypoalgesic effects on experimental pain in healthy volunteers.     

Stand up and be counted: measuring time spent upright after hip fracture and comparison with community dwelling older people

Objectives

Following hip fracture, the amount of time an individual spends on their feet (‘uptime’) may be an important marker of recovery. Using an automated device that measured uptime (Uptimer), we aimed to: (1) compare hip fracture patients’ uptime with age- and gender-matched community dwelling older people; (2) identify whether uptime changed during the transition from hospital to home; and (3) examine the relationship between uptime and existing functional measures.

Design

Prospective, observational study.

Setting

Rehabilitation hospital and community.

Participants

Patients undergoing rehabilitation after hip fracture surgery who aimed to return home at the end of rehabilitation, and age- and gender-matched community dwellers.

Interventions

Patients received standard care.

Main outcome measures

Uptime over 24 hours was measured on three occasions in hip fracture patients: 1 week before, 1 day before and 1 week after discharge home. Uptime over 24 hours was measured once in age- and gender-matched community dwelling older people. Functional mobility, self-reported activity, pain, mood and endurance were also assessed.

Results

Thirteen hip fracture patients (mean age 80.4 years) and 13 community dwelling participants completed testing. Once home, hip fracture patients spent 3.4 hours/day (25th, 75th percentiles 2.8, 5.2) upright, while community dwelling healthy older people were upright for 6.5 hours/day (6.1, 8.7). A trend for uptime to increase between hospital and home was observed. Hip fracture uptime at home correlated significantly with self-reported activity, functional mobility and gait endurance (P < 0.05).

Conclusions

This study highlighted uptime limitations of hip fracture patients at home. We discuss possible future directions for research using the Uptimer.     

Apport de l’arthrodistension dans la prise en charge de la capsulite rétractile primitive de l’épaule : étude comparative versus rééducation

Objectives

To describe the epidemiological and clinical features of patients with primitive adhesive capsulitis of the shoulder treated by capsular distension and then rehabilitation; to evaluate the short-, mid- and long-term efficiency of this therapeutic protocol and compare it with rehabilitation alone.

Materials and methods

This was a two-year prospective study. Sixty patients were included and divided into populations P1 (capsular distension and rehabilitation) and P2 (rehabilitation only). Assessment of the treatments’ efficacy was based on the following parameters: pain on a visual analogue scale (VAS), joint motion in several axes, a simplified Constant score (functional ability) and the SF-36 quality of life score.

Results

Thirty patients (mean age: 56) underwent capsular distension. The Constant score was judged to be poor in over half of the patients. All the quality of life parameters were modified. When compared with P2, the P1 group showed a statistically significant improvement in terms of the pain score (p = 0.005), anterior elevation (p = 0.001), lateral elevation (p = 0.005), external rotation (p = 0.006) and the Constant score (p < 0.001) one week after capsular distension. One year after capsular distension, this gain persisted in a statistically significant manner for all functional parameters and all SF-36 dimensions (p < 0.001 for PF, RP, BP, SF and RE; p = 0.01 for GH and VT and p = 0.002 for MH).

Conclusion

Our results show that capsular distension and subsequent intensive rehabilitation have a beneficial effect. This combination enables rapid, significant improvement from the first week onwards. The improvement phase lasts for one month and may hold steady for up to 12 months.     

Cervical erector spinae and upper trapezius muscle activity in children using different information technologies

Objectives

Researchers investigating the effects of computer use and the development of musculoskeletal disorders have mainly focused on the effects of prolonged muscle loading associated with postures assumed during computer use in the adult population. The objective of this study was to investigate the effects of different forms of old and new information technology (IT) on muscle activity levels in a paediatric population.

Design

A 3 × 3 × 2 mixed model design was used for this study.

Participants

Thirty-two schoolchildren aged 4-17 years participated in this study.

Outcome measures

Surface electromyography (EMG) data were collected from the left and right cervical erector spinae and upper trapezius muscles. Participants performed a 5-minutes reading task using the three IT types (book, laptop and desktop computer).

Results

Cervical erector spinae and upper trapezius muscle activity levels were significantly higher when children used the laptop set-up (P < 0.001). The lowest muscle activity levels were found when children used the desktop set-up. Cervical erector spinae and upper trapezius muscle activities were found to be higher on the left side in the book set-up compared with higher right muscle activity levels in the computer set-ups (P = 0.047 and <0.001, respectively).

Conclusions

The three IT types had different effects on cervical erector spinae and upper trapezius muscle activity, suggesting varying risks associated with different IT types. Activity levels were often above 5% maximum EMG (MEMG). As adult studies have linked activity levels greater than 5%MEMG with the development of musculoskeletal disorders, it seems that children are potentially at risk of replicating these adverse health reactions associated with adult IT use.     

The effect of medial patellar taping on pain, strength and neuromuscular recruitment in subjects with and without patellofemoral pain

Objectives

Patellar taping is used by clinicians to reduce pain, increase strength and enhance neuromuscular recruitment in patients with patellofemoral pain. This study explored the effect of medial patellar taping on these parameters in physically active subjects with and without patellofemoral pain.

Study design

A placebo-controlled clinical trial with randomised interventions.

Setting

Sport Science Institute of South Africa.

Participants

Fifteen subjects with patellofemoral pain (experimental group) and 20 subjects without patellofemoral pain (healthy cohort).

Methods

Pain perception, quadriceps force output and electromyographic (EMG) data were collected during maximal quadriceps strength testing and submaximal step testing for each intervention.

Intervention

Subjects were tested during three different knee taping conditions: (1) no tape; (2) placebo tape; and (3) medial tape, in a randomised order.

Main outcome measures

Visual analogue scale (VAS), isokinetic and isometric force output, and EMG analysis.

Results

Medial patellar tape did not result in a significant reduction in pain during the step testing (step-up) in the group with patellofemoral pain (no tape condition: mean VAS 1.0, 95% confidence interval 0.30-1.70; taped condition: mean VAS 1.07, 95% confidence interval 0.22-1.91) or an increase in quadriceps force output. However, there was a significant decrease in EMG activity of the vastus medialis oblique in both groups during the closed chain step test (e.g. group with patellofemoral pain, no tape condition: mean 77%, 95% confidence interval 62-92%; taped condition: mean 64%, 95% confidence interval 53-75%, P < 0.05).

Conclusion

Although taping did not reduce pain in the patellofemoral pain group, it did enhance the efficiency of the vastus medialus oblique. Future studies should determine whether there are clinical benefits to these findings.