Unintentional Fall Injuries Associated with Walkers and Canes in Older Adults Treated in U.S. Emergency Departments

OBJECTIVES: To characterize nonfatal, unintentional, fall-related injuries associated with walkers and canes in older adults.
DESIGN: Surveillance data of injuries treated in hospital emergency departments (EDs), January 1, 2001, to December 31, 2006.
SETTING: The National Electronic Injury Surveillance System All Injury Program, which collects data from a nationally representative stratified probability sample of 66 U.S. hospital EDs.
PARTICIPANTS: People aged 65 and older treated in EDs for 3,932 nonfatal unintentional fall injuries and whose records indicated that a cane or a walker was involved in the fall.
MEASUREMENTS: Sex, age, whether the fall involved a cane or walker, primary diagnosis, part of the body injured, disposition, and location and circumstances of the fall.
RESULTS: An estimated 47,312 older adult fall injuries associated with walking aids were treated annually in U.S. EDs: 87.3% with walkers, 12.3% with canes, and 0.4% with both. Walkers were associated with seven times as many injuries as canes. Women's injury rates exceeded those for men (rate ratios=2.6 for walkers, 1.4 for canes.) The most prevalent injuries were fractures and contusions or abrasions. Approximately one-third of subjects were hospitalized for their injuries.
CONCLUSION: Injuries and hospital admissions for falls associated with walking aids were frequent in this highly vulnerable population. The results suggest that more research is needed to improve the design of walking aids. More information also is needed about the circumstances preceding falls, both to better understand the contributing fall risk factors and to develop specific and effective fall prevention strategies.     

Foot Medial Longitudinal-Arch Deformation During Quiet Standing and Gait in Subjects with Medial Tibial Stress Syndrome

The objective of this study was to investigate (1) if subjects with medial tibial stress syndrome demonstrate increased navicular drop and medial longitudinal-arch deformation during quiet standing and gait compared with healthy subjects, and (2) the relationship between medial longitudinal-arch deformation during quiet standing and gait. Thirty subjects aged 20 to 32 years were included (15 with medial tibial stress syndrome and 15 controls). Navicular drop and medial longitudinal-arch deformation were measured during quiet standing with neutral and loaded foot using a ruler and digital photography. Medial longitudinal-arch deformation was measured during walking gait using 3-dimensional gait analysis. Subjects with medial tibial stress syndrome demonstrated a significantly larger navicular drop (mean +/- 1 SD, 7.7 +/- 3.1 mm) and medial longitudinal-arch deformation (5.9 +/- 3.2 degrees) during quiet standing compared with controls (5.0 +/- 2.2 mm and 3.5 +/- 2.6 degrees, P < .05). Subjects with medial tibial stress syndrome also demonstrated significantly larger medial longitudinal-arch deformation (8.8 +/- 1.8 degrees) during gait compared with controls (7.1 +/- 1.7 degrees, P = .015). There was no correlation between medial longitudinal-arch deformation during quiet standing and gait in either of the 2 groups (r < 0.127, P > .653). The subjects with medial tibial stress syndrome in this study demonstrated increased navicular drop and medial longitudinal-arch deformation during quiet standing and increased medial longitudinal-arch deformation during gait compared to healthy subjects. Medial longitudinal-arch deformation during quiet standing did not correlate with medial longitudinal-arch deformation during gait in either of the 2 groups. ACFAS Level of Clinical Evidence: 5.     

Aerobic capacity in patients with rheumatoid arthritis: A comparison of two submaximal test methods

Background: In a clinical setting it is important to evaluate aerobic capacity in individuals with rheumatoid arthritis (RA) and to have a choice between tests, owing to disability of varying severity. Two submaximal tests, a bicycle ergometer test and a treadmill walking test, are commonly used. Despite expected differences in the results, these tests have been used interchangeably. The aim of the current study was to compare the results of the two tests, the size of the difference and factors expected to influence the results. Methods: Fifty‐two outpatients with RA performed the two tests. Agreement and correlations between the results of the tests were calculated. Multivariate analysis was used to study the relationships between gender, weight, health assessment questionnaire, global health assessment and the difference between the tests. Results: Sixty per cent of the subjects exhibited a higher estimated value of maximum oxygen uptake (V?O_2max) in the treadmill test. The limits of agreement for the estimated V?O_2max values between the two methods ranged from ?13.4 to +18.4 ml × min^?1 × kg^?1, and the intraclass correlation coefficient (ICC_{Two‐way mixed}) was 0.34 (95% confidence interval [CI] 0.07, 0.56). Body weight was independently associated with the difference between the two tests (regression coefficient 0.3; 95% CI 0.14, 0.42). A higher body weight had a greater impact on the results of the bicycle test (R² = 0.28; regression coefficient ?0.3; 95% CI ?0.47, ?0.17) than on the treadmill walking test (R² = 0.02; regression coefficient ?0.06; 95% CI ?0.14, 0.03). Conclusions: It is not advisable to use the two submaximal methods interchangeably. Weight influenced the difference between the two tests, and to a higher degree in the bicycle test than the treadmill walking test. Copyright © 2008 John Wiley & Sons, Ltd.     

Physiotherapie im Wandel

This article is intended to give a review for dentists and dentofacial orthopedists of the slowly emerging profession of physiotherapy. Within the framework of the Bologna process Bachelor and Master Degrees are now possible and technicians for scientific work will be procured from this professional group. This basic scientific training is the foundation for a system by which those who finally carry out the forms of therapy on patients are actually those who can now develop and carry out effective and validated study designs. These studies will ensure an improved estimation of therapy success and patients will also receive the optimal evidence-based treatment corresponding to the scientific state-of-the art. Physiotherapists will have an improved planning capability for physiotherapeutic treatment options due to new guidelines for the treatment of craniomandibular dysfunction (CMD) which have yet to be established. Dentists transferring patients can in the future prescribe physiotherapeutic treatment with a clear conscience in the knowledge that this treatment has been scientifically tested and validated. The inclusion of physiotherapists is alone scientifically profitable due to the improved safety of treatment and economically for those responsible for finance due to proven or non-proven validation of the tested forms of therapy. Physiotherapists have then the possibility to test forms of therapy for which results are still lacking and to evaluate them in a valid way using scientifically correct study designs.     

Electromyographic analysis of the deltoid and rot tor cuff muscles in persons with subacromial impingement

The purpose of this study was to compare subjects with subacromial impingement and subjects with normal shoulders with respect to muscle activity. Fifteen subjects in each group were studied by means of fine-wire electromyography. The middle deltoid and rotator cuff muscles were evaluated during isotonic scaption from 30 to 120 degrees. Overall, the impingement group demonstrated decreased mean muscle activity in comparison with the group of normal subjects. The magnitude of diminished activity was statistically significantly different (P < .05) during the 30- to 60-degrees arc for the infraspinatus, subscapularis, and middle deltoid muscles; in addition, the infraspinatus muscle demonstrated significantly depressed activity during the 60- to 90-degrees arc. In the impingement group, the supraspinatus and teres minor revealed a diminution of muscle function in comparison with shoulders in the normal group; the difference was not significant. This study demonstrates that muscle activity in subjects with impingement is most notably decreased in the first arc of motion. Also of clinical relevance is the fact that the inferior force vector (from the infraspinatus and subscapularis) is less functional in subjects with impingement than is the superior compressive vector (from the supraspinatus). Thus, humeral head depression during the critical first portion of elevation may be insufficient in people with subacromial impingement. (J Shoulder Elbow Surg 2000;9:519-23.)