Validation of the cancer needs questionnaire (CNQ) short-form version in an ambulatory cancer setting

The short-form Cancer Needs Questionnaire (CNQ) is a self-administered cancer-specific questionnaire designed to assess patients' needs across several domains. The purpose of this study is to further evaluate its internal consistency and construct validity, in a group of ambulatory patients with cancer. Four hundred and fifty patients with a variety of cancer types participated. Factor analysis reproduced five domains: psychological; health information; physical and daily living; patient care and support; and interpersonal communication needs. Cronbach's alpha coefficients ranged from 0.94 to 0.77, indicating substantial consistency across items grouped in the five domains. A priori predictions regarding convergent and contrasting groups construct validity were explored using bivariate relationships between domains of the short-form CNQ, the EORTC QLQC-30 and Beck Depression Inventory (short-form), with support provided for most of the predictions. The current study provides supportive evidence that the short-form CNQ is a reliable and valid instrument for assessing the needs of patients with cancer in an ambulatory care setting.     

Relationship between vastus lateralis muscle ultrasound echography,knee extensors rate of torque development,and jump height in professional soccer athletes

Purpose

This study aimed to investigate the relationship between knee extensors maximum voluntary contraction (MVC) torque and rate of torque development (RTD) with jump performance and with echography intensity (EI) from the vastus lateralis muscle (VL).

Methods

We assessed the MVC torque and RTD from knee extensors by a standard isokinetic device from 16 male professional soccer players (25.5?±?3.9 years). Counter-movement jump (CMJ) and squat jump (SJ) height were calculated from their flight times. EI was determined from VL ultrasound images’ grayscale histogram acquired in the middle of the tight. Correlation between variables was investigated by the Pearson correlation coefficient.

Results

We observed a VL EI of 26.4?±?7.8 a.u., and the SJ and CMJ heights were 36.0?±?3.0 and 36.2?±?4.1 cm, respectively. There was a significant correlation between the MVC torque and absolute late-phase RTD (r?=?0.67 and 0.76—RTD₂₀₀ and RTD₂₅₀, respectively), between the CMJ height and absolute RTD₅₀ (r?=?0.50), and between the normalized early-phase RTD and SJ height (r?=?0.53–0.60—RTD₅₀ and RTD₁₅₀). Additionally, normalized RTD₂₀₀ (r?=?? 0.51) and RTD₂₅₀ (r?=?? 0.56) were negatively correlated with EI.

Conclusions

Such results suggest that athletes with the ability to produce torque explosively in the very beginning (between 50 and 150 ms) of knee extension can jump higher. Also, the muscle quality assessed by the VL IE seems to be more important to maximum strength and later periods of torque rise (>?200 ms).

     

Effects of peak torque angle on the bilateral deficit of knee extensors and flexors at two velocities of contraction

Purpose

To examine effects of the peak torque angle (PTA) on the bilateral deficit (BD) index at two low velocities of contraction.

Methods

Twenty young men performed right and left knee concentric extension–flexion (1 set, 5 repetitions) unilaterally and bilaterally in an isokinetic dynamometer at 30°/s and 60°/s. The peak torque (PT) from right, left and bilateral tests and their respective PTA were registered. Two BD indexes were determined as the bilateral PT divided by the summation of right and left PT (BDI₁) and by the summation of left and right torque values found at the bilateral PTA (BDI₂). Additionally, the mean of the absolute differences (MAD) between bilateral and unilateral PTAs was calculated as the mean of the modulus of the difference between bilateral minus right and bilateral minus left values divided.

Results

The knee extensors showed difference between bilateral and unilateral PTA (p?<?0.01) and effect of velocity on bilateral PTA (p?<?0.05). MAD was not influenced by the direction of movement (p?=?0.673), whereas on knee flexors it depended on velocity (p?=?0.01). Knee extensors and flexors presented higher BDI₁ than BDI₂ at both velocities (p?<?0.001). The difference between BDI₁ and BDI₂ was strongly correlated with MAD (p?<?0.01).

Conclusion

The BD is generally attributed to neural mechanisms, whereas the BD index was influenced by the PTA. Hence, it is suggested that the angle–torque relationship plays a role on the BD reported because it may enhance the BD index.

     

Uptake of psychosocial referrals in an outpatient cancer setting: improving service accessibility via the referral process

The object of this study was to identify factors which influence the uptake of psychosocial services in an ambulatory cancer setting and to identify potential barriers to the access of support services in the referral process. To this end, 202 individuals attending outpatient clinics of a cancer hospital were randomised to the intervention arm of a study to assess the impact of providing co-ordinated, targeted psychosocial referrals and interventions. Qualitative and quantitative analysis of the reasons for failure to offer services and for nonacceptance of services was undertaken. Individuals accepted 22% of offered services, refused 38% of offered services, indicated that services were in place in 31% of cases, and were not offered 9% of identified services. The major response from patients refusing services was "not now". Female patients ( P < 0.01), and individuals with a moderate to high level of depression ( P = 0.02), were more likely to accept services. A variety of factors impact on decisions on utilisation of support services. Recommendations on how individuals' access to these services might be improved are offered, based on an analysis of the reasons given by patients for refusal.     

Strength Training and Shoulder Proprioception

Context:

Proprioception is essential to motor control and joint stability during daily and sport activities. Recent studies demonstrated that athletes have better joint position sense (JPS) when compared with controls matched for age, suggesting that physical training could have an effect on proprioception.

Objective:

To evaluate the result of an 8-week strength-training program on shoulder JPS and to verify whether using training intensities that are the same or divergent for the shoulder''s dynamic-stabilizer muscles promote different effects on JPS.

Design:

Randomized controlled clinical trial.

Setting:

We evaluated JPS in a research laboratory and conducted training in a gymnasium.

Patients or Other Participants:

A total of 90 men, right handed and asymptomatic, with no history of any type of injury or shoulder instability.

Intervention(s):

For 8 weeks, the participants performed the strength-training program 3 sessions per week. We used 4 exercises (bench press, lat pull down, shoulder press, and seated row), with 2 sets each.

Main Outcome Measure(s):

We measured shoulder JPS acuity by calculating the absolute error.

Results:

We found an interaction between group and time. To examine the interaction, we conducted two 1-way analyses of variance comparing groups at each time. The groups did not differ at pretraining; however, a difference among groups was noted posttraining.

Conclusions:

Strength training using exercises at the same intensity produced an improvement in JPS compared with exercises of varying intensity, suggesting that the former resulted in improvements in the sensitivity of muscle spindles and, hence, better neuromuscular control in the shoulder.Key Words: joint position sense, neuromuscular control, muscle spindles

Key Points

• Improvements in joint position sense can be attained via standard strength-training exercises.
• Performing resistance exercises at consistent intensity rather than varying intensity resulted in better proprioception performance.

Improving muscle strength for joint stability is a goal of physical training for the shoulder.^1–3 According to Myers and Lephart,⁴ the rotator cuff, deltoid, biceps, teres major, latissimus dorsi, and pectoralis major muscles are responsible for providing shoulder stabilization. Inman et al⁵ were the first to state that the coactivation force of the shoulder''s dynamic stabilizers provides the joint stability. However, joint mechanics and stability may be compromised if such forces are not equalized. Therefore, in order to achieve joint stability, training must be directed at attaining proportional strength around the joint. Two main aspects should be taken into account during strength training: a specific muscle-force level and the force balance among muscles that act on the same joint.^3,6Shoulder-joint stability is the result of passive and dynamic components.⁷ The bone geometry, relative intra-articular pressure, glenohumeral labrum, and capsuloligamentous structures are passive components,⁴ whereas dynamic components are provided by contractile muscle activity coordinated around the joint and modulated by the neuromuscular system.⁸ The basis of passive and dynamic interactions is the proprioceptive information emerging from mechanoreceptors in muscles, tendons, joint-capsule ligaments, and skin, which are centrally integrated.^7,9 In this context, kinesthesia, joint position, and force sense are described as proprioception submodalities.^4,10–12Proprioception is essential to motor control and joint stability during daily activities and sports practice.^10,11 Thus, proprioception can be defined as the ability to recognize and to locate the body in relation to its position and orientation in space.^13,14 Allegrucci et al¹⁵ identified kinesthetic deficits in the dominant shoulder of throwing athletes as a mechanism for shoulder instability. The same result was found by Safran et al.¹⁶ Conversely, a recent study¹⁷ demonstrated that athletes have better joint position sense (JPS) than controls matched for age, suggesting that sport activity could have an effect on proprioception. Despite this result, the effect of strength training on proprioception remains unclear, although some authors^17–20 have described the effects of muscle strengthening on proprioception. These researchers hypothesized that strength training directly affects the functional capacity of the dynamic stabilizers. For this reason, it is important to understand the effects of this training on proprioception so that we can improve the strength-training protocols to increase joint stability.However, the effects of different strength-training programs on the JPS of healthy individuals remain debatable. Therefore, the focus of our study was to (1) evaluate the effect of 8 weeks of strength training on shoulder JPS and (2) verify whether using the same or divergent training intensities for the shoulder muscles'' stability produced any significant effects on JPS. We hypothesized that the JPS would be improved by strength training and that different strategies to control training intensity would promote different responses with regard to shoulder proprioception.