Effect of isometric upper-extremity exercises on the activation of core stabilizing muscles

Tarnanen SP, Ylinen JJ, Siekkinen KM, Mälkiä EA, Kautiainen HJ, Häkkinen AH. Effect of isometric upper-extremity exercises on the activation of core stabilizing muscles.

Objective

To evaluate whether isometric exercises for the upper extremities could sufficiently activate core stabilizing muscles to increase muscle strength.

Design

Cross-sectional study.

Setting

Department of physical medicine and rehabilitation at a Finnish hospital.

Participants

Healthy adult women (N=20).

Interventions

Not applicable.

Main Outcome Measures

Peak isometric strength of the back and abdominal muscles was measured and relative loading in 5 test exercises was evaluated by surface electromyography.

Results

The rectus abdominis and obliquus externus abdominis were activated to the greatest degree in a bilateral shoulder extension exercise and the average surface electromyographic activity was 114% and 101% compared with the amplitude elicited during the maximal isometric trunk flexion exercise. Horizontal shoulder extension elicited the greatest activation of the longissimus and multifidus muscles. In this exercise, the activity levels of the left side multifidus and longissimus muscles were 84% and 69%, respectively, compared with the level of activity elicited during trunk extension.

Conclusions

Of all the exercises studied, bilaterally performed isometric shoulder extension and unilaterally performed horizontal shoulder extension elicited the greatest levels of activation of the trunk musculature. Thus, it can be assumed that these exercises elicit sufficient levels of contraction of the trunk muscles for the development of their endurance and strength characteristics in rehabilitation.     

Patient-centredness in physiotherapy from the perspective of the chronic low back pain patient

Objective

To define patient-centredness from the patient's perspective in the context of physiotherapy for chronic low back pain (CLBP).

Design

Qualitative study using semi-structured interviews to explore perceptions of various aspects of physiotherapy management of CLBP.

Setting

Physiotherapy departments in one geographical area of the UK National Health Service.

Participants

Twenty-five individuals who had received physiotherapy for CLBP within the previous 6 months.

Results

Six key themes emerged as the dimensions that the participants perceived to be important for patient-centred physiotherapy: communication; individual care; decision-making; information; the physiotherapist; and organisation of care. Communication was the most important dimension, underpinning the five other dimensions as well as being a distinct dimension of patient-centred physiotherapy.

Conclusions

Physiotherapists should have an understanding of the six dimensions of patient-centred physiotherapy for CLBP. Improving physiotherapists’ communication skills may better facilitate patient-centred physiotherapy, and therefore enhance the experience of physiotherapy for this client group.     

Is the Fear Avoidance Model Associated With the Reduced Level of Aerobic Fitness in Patients With Chronic Low Back Pain?

Smeets RJ, van Geel KD, Verbunt JA. Is the fear avoidance model associated with the reduced level of aerobic fitness in patients with chronic low back pain?

Objectives

To compare aerobic fitness of patients with chronic low back pain (CLBP) against healthy controls and to assess whether variables of the fear avoidance model are associated with loss of aerobic fitness.

Design

A case-comparison study.

Setting

Rehabilitation centers.

Participants

Patients with CLBP (n=223), and normative data from healthy subjects (n=18,082).

Interventions

Not applicable.

Main Outcome Measures

Maximal oxygen uptake (V?o₂max) was estimated on the basis of a modified submaximal Åstrand bicycle test performed by patients with CLBP (observed level of aerobic fitness) and compared with the normative data of healthy controls matched for age, sex, and level of sport activity (expected level of aerobic fitness). Pain (visual analog scale); disability (Roland Disability Questionnaire); pain-related fear (Tampa Scale for Kinesiophobia); depression (Beck Depression Inventory); catastrophizing (Pain Catastrophizing Scale); and the level of activity during sport, work/household, and leisure time (Baecke Physical Activity Questionnaire) were assessed. Multiple linear regression analysis was performed with the difference of the observed and expected level of aerobic fitness as dependent variable and putative influential factors including those of the fear avoidance model as independent variables.

Results

V?o₂max could be calculated in 175 (78%) of the patients. Both men and women with CLBP had significant lower V?o₂max than expected (10.3mL/kg lean body mass (LBM)×min⁻¹ and 6.5mL/kg LBM×min⁻¹, respectively; P<.001). The levels of activity during leisure time and work/household were significantly associated with this reduced level of aerobic fitness. However, the variables of the fear avoidance model were not.

Conclusions

Most patients with CLBP-associated disability have a lower level of aerobic fitness, but this is not associated with fear avoidance.     

Immediate Effects of 2 Different Whole-Body Vibration Frequencies on Muscle Peak Torque and Stiffness

Siu PM, Tam BT, Chow DH, Guo J-Y, Huang Y-P, Zheng Y-P, Wong SH. Immediate effects of 2 different whole-body vibration frequencies on muscle peak torque and stiffness.

Objective

To examine the immediate effects of 2 vibration protocols with different vibration frequencies that yielded the same maximum acceleration (106.75ms⁻²) on muscle peak torque and stiffness of knee extensor and flexor.

Design

Randomized crossover study with repeated measures.

Setting

Laboratory setting.

Participants

Recreationally active male adults (N=10).

Intervention

Participants performed 10 bouts of 60-second static half squats intermitted with a 60-second rest period between bouts on a platform with no vibration (control) and a vibration frequency of 26Hz or 40Hz.

Main Outcome Measures

Concentric and eccentric peak torques of knee extensor and flexor were examined within 5 minutes before and after vibration by isokinetic test. Young's modulus as an index of tissue stiffness was determined at quadriceps and hamstring pre- and postvibration by using an ultrasound indentation method.

Results

The 2-way repeated-measures analysis of variance indicated a significant interaction effect between vibration and vibration frequency for knee extensor concentric peak torque (P=.003). The vibration-induced changes of knee extensor concentric peak torque in vibration frequency of 26Hz (14.5Nm) and 40Hz (12.0Nm) were found to be significantly greater than that in controls (−29.4Nm) (P<.05). The change in eccentric peak torque of knee flexor after vibration tended to be greater in 26Hz of vibration frequency when compared with controls (26Hz of vibration frequency vs controls: 13.9±7.1 vs −11.4±5.3Nm, P=.08). No statistically significant differences were obtained in tissue stiffness in the quadriceps and hamstring with any of the conditions.

Conclusions

Our data suggest that whole-body vibration at a frequency of 26Hz and 40Hz preclude the decline in concentric peak torque of knee extensor observed after 10 bouts of 60 seconds of static half squats. A change in muscle mechanical stiffness property as induced by whole-body vibration is not supported by our data.     

Effects of ankle joint mobilizations in adults poststroke: a pilot study

Kluding PM, Santos M. Effects of ankle joint mobilizations in adults poststroke: a pilot study.

Objective

To compare the effect of 2 interventions on ankle mobility, ankle kinematics, and weight-bearing symmetry during functional activities in subjects with hemiparesis after a stroke.

Design

Randomized trial.

Setting

Academic medical center.

Participants

A convenience sample of 16 subjects with hemiparesis after stroke (mean age, 55.2y; mean time since stroke, 21.4mo).

Intervention

Subjects received 8 sessions over 4 weeks of either functional task practice combined with ankle joint mobilizations, or functional task practice only.

Main Outcome Measures

Changes in ankle range of motion (ROM) (not blinded), ankle kinematics during sit-to-stand (STS) and gait, and lower-extremity weight-bearing symmetry during STS and static standing.

Results

The combined intervention group gained 5.7°±3.1° in passive ankle ROM compared with 0.2°±2.6° in the functional practice only group (95% confidence interval [CI], 2.5-8.6; P<.01). No significant changes in ankle kinematics or weight bearing during static standing were noted in either group. The functional practice group decreased differences in weight bearing during STS by 9.5%±6.47%, whereas the combined intervention group increased this difference by 3.37%±5.29% (95% CI, 3.26-19.46; P=.01).

Conclusions

The increase in ankle motion did not improve joint kinematics and may have prevented improvement in weight-bearing symmetry.     

The influence of psychologic factors on diskography in patients with chronic axial low back pain

Derby R, Lee S-H, Chen Y, Kim B-J, Lee C-H, Hong Y-K, Lee J-E, Seo K-S. The influence of psychologic factors on diskography in patients with chronic axial low back pain.

Objective

To determine whether a patient's presenting psychometric scores affect the findings of a pressure and injection speed-controlled manometric lumbar diskography in patients with chronic low back pain (CLBP).

Design

A prospective, correlation-based, investigative study.

Setting

Free-standing ambulatory spine surgery center.

Participants

Two hundred sixty-three disks from 81 patients (54 men, 27 women).

Intervention

Diskography was performed using pressure and injection speed-controlled techniques. The patients were divided into psychometric subgroups (normal, at risk, abnormal) according to the Distress and Risk Assessment Method (DRAM).

Main Outcome Measures

The diskography findings on each psychometric DRAM subgroup were evaluated.

Results

Across the individual psychometric categories, the positive rates of diskography in the normal, at-risk, and abnormal subgroups were 75.0% (9/12), 59.5% (25/42), and 70.4% (19/27), respectively (P>.05). The mean numeric rating scores of pain at 15 and 50psi above the opening pressure were similar in the 3 psychometric subgroups. There was no correlation between the diskography results and the psychometric subgroupings.

Conclusions

In patients with CLBP, there is no correlation between the presenting psychometric DRAM score and the findings from pressure and injection speed-controlled manometric lumbar diskography.     

Test position and hip strength in healthy adults and people with chronic stroke

Barbic S, Brouwer B. Test position and hip strength in healthy adults and people with chronic stroke.

Objective

To determine if peak torques generated by the hip flexors and extensors are dependent on test position in healthy adults and in people with chronic stroke.

Design

Cross-sectional study.

Setting

Motor performance laboratory.

Participants

Volunteers were 10 young (20.7±1.5y), 10 older adults (62.1±7y), and 10 stroke survivors (60.6±10y) who were an average of 5 years poststroke.

Interventions

Not applicable.

Main Outcome Measures

Isokinetic (60°/s) peak concentric hip flexor and extensor torques (in Nm/kg) generated in supine and standing positions.

Results

Peak flexor torques measured in standing were generally higher than in supine (P=.018); a pattern evident in all groups, but significant only in stroke. An interaction between test position and group for hip extensor strength (P=.016) reflected 2 distinct patterns in which torques were highest in standing among the young subjects and highest in supine after stroke.

Conclusions

Isokinetic hip flexor and extensor strength measured in standing and supine are comparable in young and older healthy people. In chronic stroke, the test position may over or underestimate maximum peak torque depending on the muscle group tested, particularly on the side ipsilateral to the lesion. These findings may have implications for predicting functional ability from strength measurements.     

Reliability of the assessment of lumbar range of motion and maximal isometric strength in patients with chronic low back pain

Roussel NA, Truijen S, De Kerf I, Lambeets D, Nijs J, Stassijns G. Reliability of the assessment of lumbar range of motion and maximal isometric strength in patients with chronic low back pain.

Objective

To examine the interobserver reliability of the assessment of lumbar range of motion (ROM) and maximal isometric strength in patients with chronic low back pain (CLBP) using commercially available equipment.

Design

A prospective repeated-measures design.

Setting

Ambulatory care in a university hospital.

Participants

Twelve patients (5 men, 7 women; age range, 20−52y) with CLBP, with a mean visual analog scale score of 31.5±25.8mm, volunteered for the study. The duration of their symptoms was 63±115 months and the mean Oswestry Disability Index score was 31%.

Interventions

Not applicable.

Main Outcome Measures

Movements of the lumbar spine were assessed with commercially available equipment. Both the range of motion (ROM) and the maximal isometric strength for flexion, extension, lateroflexion, and rotation of the lumbar spine were evaluated twice to analyze the interobserver reliability. The same test procedure was performed on 2 separate days by 2 investigators who were blinded to the outcome of the assessment of their colleague. The order of investigator was balanced, so that each investigator tested the same number of patients as first investigator.

Results

The intraclass correlation coefficient varied between .91 and .98 for the measurements of the lumbar ROM and was between .93 and .97 for all the strength measurements. Post hoc power analysis confirmed previous power analysis, that is, despite the small sample size, an excellent power was found for the observed interobserver reliability coefficients (power range, 0.93−1.00). No learning effect was found when comparing the results of the second measurement with the first measurement (P>.05).

Conclusions

The interobserver reliability is excellent for the measurement of the ROM of the lumbar spine and for the maximal isometric strength using specific devices in patients with CLBP.     

Craniocervical Orientation Affects Muscle Activation When Exercising the Cervical Extensors in Healthy Subjects

Elliott JM, O'Leary SP, Cagnie B, Durbridge G, Danneels L, Jull G. Craniocervical orientation affects muscle activation when exercising the cervical extensors in healthy subjects.

Objective

To evaluate the activity of neck extensor muscles during different extension exercises with muscle functional magnetic resonance imaging (mfMRI).

Design

Cross-sectional.

Setting

University laboratory.

Participants

Healthy subjects (N=11; 7 men, mean age ± SD, 34±5.6y; 4 women, mean age ± SD, 23.3±5.2y; group mean age ± SD, 30.1±7.5y).

Intervention

Not applicable.

Main Outcome Measures

mfMRI measures of T2 relaxation were made for the multifidus (Mul), the semispinalis cervicis (SCe), the semispinalis capitis (SCa), and the splenius capitis (SpC) at C2-3, C5-6, and C7-T1 in response to 2 head/neck orientations: craniocervical neutral (CCN) and craniocervical extension (CCE). Subjects performed three 1-minute repetitions of each condition at 20% maximum voluntary contraction.

Results

Significant shifts were observed in all muscle groups at the C5-6 and C7-T1 levels after both conditions (P=.04) except the SpC muscle at C5-6 with CCN (P=.17). T2 shifts in the SCa were significantly greater in response to CCE than CCN at C2-3 (P=.03) and C5-6 (P=.02). Similarly, CCE resulted in larger shifts than CCN in the Mul/SCe at C7-T1 (P=.003). No segmental differences were observed between exercises for SpC (P=.25).

Conclusions

The results of this study provide some preliminary insight into the impact of craniocervical orientation on the differential response of the deep and superficial cervical extensor muscles during the performance of cervical extensor exercises.     

Scapular Muscle Activity in Overhead Athletes With Symptoms of Secondary Shoulder Impingement During Closed Chain Exercises

Tucker WS, Armstrong CW, Gribble PA, Timmons MK, Yeasting RA. Scapular muscle activity in overhead athletes with symptoms of secondary shoulder impingement during closed chain exercises.

Objective

To determine the amount of muscle activation in 4 scapular muscles in overhead athletes with and without a history of secondary shoulder impingement, during 3 upper extremity closed chain exercises.

Design

One-between (group), one-within (exercise) repeated measures.

Setting

Controlled laboratory study.

Participants

Overhead athletes (n=15; mean age ± SD, 21.0±2.5y; mean height ± SD, 176.0±7.8cm; mean weight ± SD, 76.1±13.4kg) demonstrating with symptoms of shoulder impingement and overhead athletes (n=15; mean age ± SD, 20.4±3.8y; mean height ± SD, 174.1±9.7cm; mean weight ± SD, 73.3±11.7kg) with no shoulder pathologies.

Interventions

Subjects completed 5 individual trials of a standard push-up, a push-up on an unstable surface, and a revolution on a shoulder rehabilitation device while electromyography (EMG) recorded muscle activity of the serratus anterior, upper trapezius, middle trapezius, and lower trapezius.

Main Outcome Measures

The mean EMG data for the 4 muscles from the standard push-up, push-up on an unstable surface, and shoulder rehabilitation device trials were normalized as a percentage of a maximum voluntary isometric contraction for each muscle.

Results

There was a statistically significant interaction for the middle trapezius (F_2,56=3.856; P=.027). The shoulder impingement push-up on an unstable surface (33.76%±26.45%) had significantly greater activation compared with the shoulder impingement standard push-up (25.88%±13.76%), the shoulder impingement shoulder rehabilitation device (9.40%±5.86%), and the nonpathology push-up on an unstable surface (19.49%±7.73%). The shoulder impingement standard push-up had significantly greater activation compared with the shoulder impingement shoulder rehabilitation device and nonpathology standard push-up (17.99%±7.31%). The nonpathology standard push-up and nonpathology push-up on an unstable surface had significantly greater activation compared with the nonpathology shoulder rehabilitation device (7.95%±4.30%).

Conclusions

These results suggest that the muscle activation of the middle trapezius differs in overhead athletes with a history of secondary shoulder impingement compared with those who lack this history during closed chain exercise, as well as within the 3 closed chain exercises. The levels of muscle activation of the serratus anterior and upper trapezius during these closed chain exercises were similar between the 2 groups. These results support the use of closed chain exercises in the rehabilitation process of overhead athletes with secondary shoulder impingement. However, clinicians should consider the muscle(s) of interest when selecting an exercise.     

Comparison of Trunk Proprioception Between Patients With Low Back Pain and Healthy Controls

Lee AS, Cholewicki J, Reeves NP, Zazulak BT, Mysliwiec LW. Comparison of trunk proprioception between patients with low back pain and healthy controls.

Objective

To determine whether proprioceptive impairments exist in patients with low back pain (LBP). We hypothesized that patients with LBP would exhibit larger trunk proprioception errors than healthy controls.

Design

Case-control study.

Setting

University laboratory.

Participants

24 patients with nonspecific LBP and 24 age-matched healthy controls.

Interventions

Not applicable.

Main Outcome Measures

We measured trunk proprioception in all 3 anatomical planes using motion perception threshold, active repositioning, and passive repositioning tests.

Results

LBP patients had significantly greater motion perception threshold than controls (P<.001) (1.3±0.9° vs 0.8±0.6°). Furthermore, all subjects had the largest motion perception threshold in the transverse plane (P<.001) (1.2±0.7° vs 1.0±0.8° for all other planes averaged). There was no significant difference between LBP and healthy control groups in the repositioning tasks. Errors in the active repositioning test were significantly smaller than in the passive repositioning test (P=.032) (1.9±1.2° vs 2.3±1.4°).

Conclusions

These findings suggest that impairments in proprioception may be detected in patients with LBP when assessed with a motion perception threshold measure.     

Patient experience of neurologic rehabilitation: a qualitative investigation

Wain HR, Kneebone II, Billings J. Patient experience of neurologic rehabilitation: a qualitative investigation.

Objective

To understand the experiences of patients who had undergone neurologic rehabilitation.

Design

An interpretative phenomenological analysis of semistructured interviews.

Setting

Neurologic rehabilitation unit.

Participants

A purposive convenience sample of 8 past patients.

Interventions

Not applicable.

Main Outcome Measure

Participants' reports of neurologic rehabilitation obtained via in-depth semistructured interviews.

Results

Participants predominantly described positive experiences of rehabilitation. The superordinate theme person-centeredness was developed, which included 4 key themes: ownership, personal value, holistic approach, and therapeutic atmosphere. These reflected patients' perceptions of choice and control and feelings of personal respect and self-worth. These appeared to be promoted through the multidimensional benefits of the unit (eg, the understanding and friendly nature of staff and other patients, physical improvements, psychologic gains) as well as the unit's informal, relaxed environment. When present, these factors created a positive rehabilitation experience; when absent, a negative experience.

Conclusions

These findings support those from other literature, which has identified person-centered care as a core element of successful rehabilitation and linked its absence to dissatisfaction with health care. This research has increased our understanding of patients' experience of neurologic rehabilitation, and could inform the development of a patient-centered assessment instrument for neurologic rehabilitation.     

Quality of Life of Persons With Lower-Limb Amputation During Rehabilitation and at 3-Month Follow-Up

Zidarov D, Swaine B, Gauthier-Gagnon C. Quality of life of persons with lower-limb amputation during rehabilitation and at 3-month follow-up.

Objective

To describe and compare the quality of life (QOL) of persons with lower-limb amputation (LLA) at admission (T1), discharge (T2), and 3 months after rehabilitation discharge (T3) and to explore the relationships between QOL and demographic and clinical variables including body image.

Design

Longitudinal case series.

Setting

Inpatient rehabilitation facility.

Participants

Consecutive sample of 19 unilateral persons with LLA (14 men, mean age, 53.4±14.6y).

Intervention

Interdisciplinary rehabilitation.

Main Outcome Measures

Generic and specific QOL measures and perception of body image at T1, T2, and T3.

Results

Subjective QOL was relatively high at T1, T2, and T3 (0.87/2, 1.1/2, and 1.0/2, respectively) except for items related to physical functioning. There was no significant change over time for all but 1 QOL satisfaction measure (ability to go outside, P=.024). Prosthesis-related QOL was high at discharge and follow-up. Body-image disturbances were absent over the study period. QOL satisfaction and prosthesis satisfaction were strongly related to lower-limb pain and psychosocial factors (eg, body image).

Conclusions

QOL of persons with LLA was high and remained relatively stable during inpatient rehabilitation and 3 months after discharge.     

Comparing performance of manual wheelchair skills using new and conventional rear anti-tip devices: randomized controlled trial

Kirby RL, Corkum CG, Smith C, Rushton P, MacLeod DA, Webber A. Comparing performance of manual wheelchair skills using new and conventional rear anti-tip devices: randomized controlled trial.

Objective

To test the hypotheses that, compared with participants using manual wheelchairs equipped with conventional rear anti-tip devices (C-RADs), those using a new RAD design that deploys through an arc (Arc-RAD) perform RAD-relevant wheelchair skills better and as safely.

Design

A randomized controlled study.

Setting

A rehabilitation center.

Participants

Participants (N=30) including 16 able-bodied and 14 wheelchair users.

Intervention

Participants were provided with wheelchair skills training (up to 2.4h).

Main Outcome Measures

Total percentage score on a set of 23 RAD-relevant skills of the Wheelchair Skills Test (WST, version 3.2) administered a minimum of 3 days after training.

Results

For the C-RAD and Arc-RAD groups, the mean ± standard deviation RAD-relevant WST scores were 32.3%±8.5% and 85.1%±18.9% (Kruskal-Wallis, P<.001). Of the 23 RAD-relevant individual skills, the success rates for the Arc-RAD group were at least 20% higher (the criterion we set for clinical significance) in 17 (74%). For the C-RAD group, the success rate was 0% for the 12 wheelie-dependent skills, the 13-cm-high obstacle, and the 15-cm level change ascent. There were no serious adverse effects in either group.

Conclusions

The new RAD design allows much better performance on relevant wheelchair skills than the conventional design without compromising safety.     

The Impact of Age and Comorbidity on the Progression of Disability in Late-Onset Sequelae of Poliomyelitis

Stolwijk-Swüste JM, Tersteeg I, Beelen A, Lankhorst GJ, Nollet F, on behalf of the CARPA Study Group. The impact of age and comorbidity on the progression of disability in late-onset sequelae of poliomyelitis.

Objectives

To describe the functional course over 5 years in patients aged 45 to 85 years with late-onset sequelae of poliomyelitis (LOSP) and to explore the impact of age and comorbidity.

Design

Prospective cohort study with 5 measurements over 5 years.

Setting

University hospital.

Participants

Subjects with LOSP (N=168).

Interventions

Not applicable.

Main Outcome Measures

FIM, Medical Outcomes Study 36-Item Short Form health survey for physical functioning subscale (SF-36-PF), walking test, isokinetic quadriceps strength, and cumulative illness rating scale (CIRS) for comorbidity.

Results

The FIM score (mean baseline ± SD, 121±4) and SF-36-PF (mean baseline ± SD, 39.5±24) decreased 2.2 and 3.7 points, respectively, over 5 years independent of age. The distance walked in 2 minutes (mean baseline ± SD, 126.2±34m) decreased 4.5m, quadriceps strength (mean baseline ± SD, 88.0±42.2Nm) declined 7Nm (8%), and CIRS (median baseline=6; range, 0-21) increased 1.5 points. A higher CIRS score was correlated with a lower FIM score and faster decrease in the FIM. A longitudinal model of factors associated with the FIM included sex, age, leg strength sum-score, arm strength sum-score, and CIRS score. The interaction of CIRS and leg strength sum-score with follow-up time was significant. A model of factors associated with SF-36-PF included sex, age, leg strength sum-score, and CIRS score.

Conclusions

Despite a reduction in muscle strength, disability increased little in patients with LOSP. Increased age and comorbidity has a negative effect on disability. Comorbidity and the severity of leg paresis affected the course of functional independence but not the course of perceived physical functioning.     

Improvement in aerobic fitness during rehabilitation after hip fracture

Mendelsohn ME, Overend TJ, Connelly DM, Petrella RJ. Improvement in aerobic fitness during rehabilitation after hip fracture.

Objective

To evaluate the effect of an upper-body exercise program on cardiorespiratory fitness in older adults with hip fracture during inpatient rehabilitation.

Design

Randomized controlled trial using a convenience sample.

Setting

An inpatient rehabilitation unit.

Participants

Twenty older patients (age, 81.3±7.2y; 14 women).

Intervention

Patients were randomly assigned to a control group (n=10) or a training group (n=10). Both groups attended physical and occupational therapy sessions 5 times a week during rehabilitation (mean length of stay, 32.9±5.3d). Patients in the training program used an arm crank ergometer 3 times a week for 4 weeks.

Main Outcome Measure

Peak oxygen consumption (Vo₂peak).

Results

Vo₂peak increased significantly in the training group (8.9±1.4 to 10.8±1.7mL·kg⁻¹·min⁻¹) and did not change in the control group (8.9±1.2 to 8.8±1.6mL·kg⁻¹·min⁻¹). At discharge, both groups were significantly improved in all functional outcome measures (Timed Up & Go [TUG] test, Berg Balance Scale [BBS], FIM instrument, two-minute walk test [2MWT], and ten-minute walk test [10MWT]). The training group performed significantly better in mobility (TUG, 2MWT, 10MWT) and balance (BBS) compared with the control group. There was a significant correlation between Vo₂peak and the 2MWT (r=.81) and 10MWT (r=.85) in the training group at discharge.

Conclusions

The upper-body exercise program had a significant effect on aerobic power. Our results suggest that aerobic endurance exercise should be integrated into standard rehabilitation to enhance patients’ aerobic fitness and mobility after hip fracture surgery.     

Motivating patients with shoulder and back pain to self-care: can a videotape of exercise support physiotherapy?

Objectives

The National Health Service is developing an ethos of self-care. Patients are being encouraged to become proficient in helping themselves. This has long been a philosophy of the physiotherapy profession, where self-care between consultations has been an integral part of the treatment process through encouraging the uptake of self-care skills training. This study explored how patients with shoulder and back pain perceived videotaped exercises and instructions to support their routine physiotherapy, and how the videotape was used.

Design

A videotape, developed by physiotherapists for patients with musculoskeletal problems, of exercises to view at home was given to patients by their physiotherapists to support their routine physiotherapy consultations. A qualitative methodology was used to examine how patients responded to being given a videotape of exercises and instructions between consultations. Data were collected through semi-structured interviews.

Setting

The study was based in 26 general practices that had access to practice-based physiotherapists in two primary care trusts in the north-west of England.

Participants

Thirty-three patients with shoulder and back pain who received a videotape of exercises and advice were interviewed.

Results

Three themes emerged from the data: finding space for exercise; remembering and doing exercises; and supporting the physiotherapy-patient relationship. Patients discussed aspects of motivation, and described how a videotape of exercises might support or inhibit the performance of exercises prescribed by physiotherapists. Patients identified a range of different ways in which they derived support from the videotape.

Conclusions

The videotape supported patients with a variety of different needs as it enhanced their ability to complete exercises correctly. Videotapes (or DVDs) are useful for patients and could be adopted as a tool to support treatment.