bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of standardized mobilization on the posteroanterior stiffness of the lumbar spine in asymptomatic subjects
Authors: Allison Garry , Edmonston Stephen , Kiviniemi Kari , Lanigan Helen , Simonsen Anine Vibe , Walcher Susanne
Published: March 2006

Background and Purpose

Spinal mobilization is commonly used to relieve pain and assist recovery of mobility in individuals with low back pain. Fundamental to this concept is the belief that spinal mobilization will influence the mechanical properties of the symptomatic motion segment. The objective of the present study was to examine the segmental effects of a standardized mobilization procedure on the posteroanterior (PA) stiffness of the lumbar spine.

Method

Audio and visual feedback was used to train a physiotherapist to perform PA mobilization at a consistent load and frequency. After training, twenty‐four subjects without low back pain were recruited for the intervention phase of the study. The spinal posteroanterior mobilization (SPAM) apparatus was used to measure the PA stiffness of the lumbar spine at three measurement sites (L1, L3 and L5). The trained physiotherapist then applied the standardized PA mobilization technique via the L3 spinous process for two minutes. Following mobilization, PA stiffness was measured three times at the three locations.

Results

The physiotherapist was able to apply a standardized mobilization with a mean force of 146 N (standard deviation (SD) 8 N) at a frequency of 1.5 Hz. The first trial on each assessment demonstrated a pre‐condition effect. Two minutes' PA mobilization resulted in no significant change in the PA stiffness of the lumbar spine at the level to which the mobilization was applied, or at the L1 and L5 segments. The 95% confidence intervals (CI) of the difference in PA stiffness before and after testing included zero at each measurement site.

Conclusions

Clinicians should pre‐condition the spine when assessing PA stiffness both before and after interventions. A standardized mobilization of 150 N at 1.5 Hz for two minutes had no segmental effect on spinal PA stiffness. Subsequent studies need to consider other mechanisms that may contribute to the changes that occur after PA spinal mobilization. Copyright © 2001 Whurr Publishers Ltd.
Journal provision and the prevalence of journal clubs: a survey of physiotherapy departments in England and Australia
Authors: Turner Patricia , Mjolne Ingvild
Published: March 2006

Background and Purpose

Evidence‐based journal clubs can promote evidence‐based practice and continuing professional development (CPD). Although studies have evaluated the impact of journal clubs in medical and nursing departments, there is little information concerning journal clubs or journal provision in physiotherapy departments. The present survey was conducted to address this deficit.

Method

A postal questionnaire, designed to ascertain the type and extent of journal provision, and prevalence and attributes of journal clubs in physiotherapy departments, was distributed to physiotherapy managers in 150 facilities in England and in south‐east Australia. Sixty‐two per cent of facilities approached in England and 55% of those approached in Australia responded to the survey.

Results

The provision of journals in physiotherapy departments was limited, and alternative access to physiotherapy journals was generally poor. Certain facilities were innovative in providing additional journal literature for physiotherapy staff. Physiotherapy journal clubs existed in 42% of responding facilities in England and 18% of those surveyed in Australia. Several facilities provided alternative forms of journal review as part of in‐service training. Relatively few journal clubs utilized a ‘problem‐based’ format, which fosters the teaching of critical appraisal skills. Evidence of enthusiasm emerged in some facilities, but in contrast, barriers and a degree of apathy were also revealed in others.

Conclusions

Physiotherapy managers, hospital administrators and academic institutions should jointly agree a strategy to both promote evidence‐based journal clubs and to facilitate journal provision within physiotherapy departments. Copyright © 2001 Whurr Publishers Ltd.
Sagittal plane head stabilization during level walking and ambulation on stairs
Authors: Cromwell Ronita , Wellmon Robert
Published: March 2006

Background and Purpose

Head stabilization in space provides a stable reference frame for visual and vestibular systems during locomotor tasks. The purpose of the present study was to examine upper body movement patterns used to maintain head stability in response to the increased challenge of stair ambulation.

Method

A repeated‐measures study design was used and the order of conditions was randomized for each subject. Eight healthy, non‐disabled, young adults walked 10 metres on a level surface, ascended and descended four steps. Head, neck and trunk angular positions in space were obtained for three trials of each condition. Significant differences in mean head, neck and trunk angular orientation in space and segment excursions were determined. Cross‐correlation analyses between head and neck, neck and trunk, and head and trunk determined movement patterns used for maintaining head stability. The chi‐square test examined the homogeneity of movement pattern distributions for each segment pair across conditions.

Results

Head in space flexion orientation and angular excursions were greater during stair ascent and greater still during stair descent as compared to level walking. This indicates a progressively significant increase in the challenge to head stability. Neck flexion orientation in space and angular excursion were greater during stair descent as compared to level walking. Movement patterns between segment pairs demonstrated phase leads and lags between segments when threats to head stability were minimal. With increased challenge to head stability, segments moved synchronously in opposite directions to maintain balance. With further challenges to head stability, segments moved synchronously in the same direction to maintain body segment alignment.

Conclusions

Head stabilization was significantly challenged when ascending stairs and is further challenged while descending stairs. Movement patterns reflected changes associated with challenges to head stability. Increased head excursion during stair ambulation may reflect the need to orient vision for foot placement. Results suggest that individuals with visual or vestibular deficits may be at risk for falls during stair ambulation. Copyright © 2001 Whurr Publishers Ltd.
Balance assessment in patients with peripheral arthritis: applicability and reliability of some clinical assessments
Authors: Norén Anne Marie , Bogren Ulrika , Bolin Jenny , Stenström Christina
Published: March 2006

Background and Purpose

Many individuals with peripheral arthritis blame decreased balance as a reason for limiting their physical activity. It is therefore important to assess and improve their balance. The purpose of the present study was to evaluate the applicability and the reliability of some clinical balance assessment methods for people with arthritis and various degrees of disability.

Method

To examine the applicability and reliability of balance tests, 65, 19 and 22 patients, respectively, with peripheral arthritis participated in sub‐studies investigating the applicability, inter‐rater reliability and test–retest stability of the following methods: walking on a soft surface, walking backwards, walking in a figure‐of‐eight, the balance sub‐scale of the Index of Muscle Function (IMF), the Timed Up and Go (TUG) test and the Berg balance scale.

Results

For patients with moderate disability walking in a figure‐of‐eight was found to be the most discriminative test, whereas ceiling effects were found for the Berg balance scale. Patients with severe disability were generally able to perform the TUG test and the Berg Balance Scale without ceiling effects. Inter‐rater reliability was moderate to high and test–retest stability was satisfactory for all methods assessed.

Conclusions

Applicable and reliable assessment methods of clinical balance were identified for individuals with moderate and severe disability, whereas more discriminative tests need to be developed for those with limited disability. Copyright © 2001 Whurr Publishers Ltd.
A randomized controlled trial comparing periodic mask CPAP with physiotherapy after abdominal surgery
Authors: Denehy Linda , Carroll Sara , Ntoumenopoulos George , Jenkins Susan
Published: March 2006

Background and Purpose

Physiotherapists use a variety of techniques aimed at improving lung volumes and secretion clearance in patients after surgery. Periodic continuous positive airway pressure (PCPAP) is used to treat patients following elective upper abdominal surgery. However, the optimal method of application has not been identified, more specifically, the dosage of application of PCPAP. The present randomized controlled trial compared the effects of two dosages of PCPAP application and ‘traditional’ physiotherapy upon functional residual capacity (FRC), vital capacity (VC), oxyhaemoglobin saturation (SpO2), incidence of post‐operative pulmonary complications and length of stay with a control group receiving ‘traditional’ physiotherapy only.

Method

Fifty‐seven subjects were randomly allocated to one of three groups. All groups received ‘traditional’ physiotherapy twice daily for a minimum of three post‐operative days. In addition, two groups received PCPAP for 15 or 30 minutes, four times per day, for three days.

Results

Fifty subjects (39 male; 11 female) completed the study. There were no significant differences in any variables between the three groups. The overall incidence of post‐operative pulmonary complications was 22% in the control group, 11% and 6% in the PCPAP 15‐minute and PCPAP 30‐minute groups, respectively. Length of hospital stay was not significantly different between the groups but for subjects who developed post‐operative pulmonary complications, the length of stay was significantly greater (Z = −2.32; p = 0.021).

Conclusions

The addition of PCPAP to a traditional physiotherapy post‐operative treatment regimen after upper abdominal surgery did not significantly affect physiological or clinical outcomes. Copyright © 2001 Whurr Publishers Ltd.
Relationship between change in balance and self‐reported handicap after vestibular rehabilitation therapy
Authors: Murray Kate , Carroll Sara , Hill Keith
Published: March 2006

Background and Purpose

Dizziness and balance problems are two commonly reported symptoms of vestibular system disease, with subsequent alterations in lifestyle and reports of physical, functional and emotional handicap. Vestibular rehabilitation therapy (VRT) was developed to improve the functional status of patients with vestibular dysfunction. The aim of the present study was to investigate the relationship between change in balance performance and change in self‐rated handicap after a four‐week home exercise programme in 16 subjects with chronic vestibular disease.

Method

Before and after the treatment intervention, balance was tested by use of a Smart Balance Master (SBM) system (Neurocom® International, Clackamas, OR, USA) and self‐rated handicap was measured by use of the Dizziness Handicap Inventory (DHI).

Results

Significant improvement was observed in both the SBM (p<0.001) and DHI (p = 0.003) scores over the testing period. A moderately strong negative correlation existed between change in SBM and DHI scores (Spearman's r = −0.6). Further analysis using the DHI subscales indicated, however, that the emotional component showed no significant change over time, and a poor correlation with change in balance scores (Spearman's r = −0.39).

Conclusions

These results indicate that a home‐based exercise programme can significantly improve balance abilities in people with chronic vestibular dysfunction, but that outcomes may be enhanced by addressing the emotional issues associated with their disability. Copyright © 2001 Whurr Publishers Ltd.
Reliability of lower extremity girth measurements after anterior cruciate ligament reconstruction
Authors: Soderberg Gary L. , Ballantyne Byron T. , Kestel Lisabeth L.
Published: March 2006

The purpose of this study was to determine the intra‐ and inter‐rater reliability of lower extremity girth measurements in patients recovering from anterior cruciate ligament (ACL) reconstructive surgery. Nine subjects, within several months of their surgery, volunteered. Circumferential measurements were taken of the involved and uninvolved legs at the following locations: 15 cm inferior to the joint line; 5, 10 and 15 cm superior to the joint line; at the joint line; and at mid‐thigh. All subjects were supine with the knee in extension whilst a specially designed device, formulated to make circumferential measurements at locations around the knee, was applied to the extremity. Three physical therapists each repeated all measurements on two occasions, in random order, during the same test session. Intra‐tester intraclass correlation (ICCs) calculated showed high coefficients (0.82–1.0) for both the involved and uninvolved sides for all locations of the measurement. Inter‐tester ICCs ranged from 0.72 to 0.97. The measurements established sufficiently high reliability to justify their use both within and between examiners for subjects recovering from surgery of the ACL. Copyright © 1996 Whurr Publishers Ltd.
Disability and health: perceptions of a sample of elderly people
Authors: Partridge Cecily , Johnston Marie , Morris Lorna
Published: March 2006

The background to this work was the expected increase in the proportion of elderly people in the population, giving rise to a greater demand for services at a time of scarcity of healthcare resources. The aims of the study were to investigate disability and health in a sample of elderly people living at home in the community. We wished to obtain detailed information about physical disability and health then to explore individual perceptions of health and disability and, finally, to examine relationships between the objective assessments and individual, subjective perceptions. The results reported here represent only part of the work of a larger study which also investigated the use of health and social services in this sample of elderly people. In‐depth interviews were undertaken with a random stratified population sample of 200 elderly people living at home. Analysis of interview data showed that, by use of a multidimensional scale of disability, just over one‐third of the sample could be classified as ‘disabled’. The mobility status of the sample was, in general, good with only small numbers spending most of their time in a wheelchair. The total sample scored highly on activities of daily living, though those classified as disabled were significantly less independent. The mean number of reported health conditions was less than might have been expected in an elderly population. One‐third of the subjects in the sample showed discrepancies between their own assessment of their disability and objective assessments. These discrepancies could partly be explained by a combination of individuals' assessment of their own abilities and their beliefs about factors influencing disability. Measures of disability, or activity associated with daily living, were related to perceptions of health, whereas the number of current health problems was not. The factors which determined perceptions of health or disability were: walking unaided and general levels of activity. Health was perceived in terms of what one could do rather than the presence of current diseases or conditions. The results suggested that when planning treatment for elderly people, physiotherapists and others should consider individual variability in perceptions of disability and health, as well as objective assessments. The importance of locomotion in the value systems of elderly people emphasises the high profile of physiotherapy in the care of elderly people. Copyright © 1996 Whurr Publishers Ltd.
Evaluation of the relationship between laboratory and clinical tests of transversus abdominis function
Authors: Hodges Paul , Richardson Carolyn , Jull Gwendolen
Published: March 2006

A clinical test of the function of the deep abdominal muscles was compared to a laboratory electromyographic (EMG) investigation of the contribution of transversus abdo‐minis (TrA) to stability of the lumbar spine during limb movement. The two different functions of TrA were evaluated in 15 subjects. The subject group included six subjects with chronic low back pain and nine subjects with no history of low back pain so that the resultant recordings were spread over a wide range for each test. The clinical test involved quantification of the ability of the subjects to specifically displace the anterior abdominal wall in a way consistent with the function of the muscle. This was evaluated by use of a device designed to measure pressure reduction as the abdomen lifted off a transducer in the prone position. The laboratory test involved determination of the onset of contraction of TrA associated with rapid upper limb movement, measured using fine‐wire EMG electrodes. The parameter evaluated was the latency between the contraction of TrA and the prime mover of the limb. Data were analysed both as absolute values and as ordinal data of a three‐rating scale derived from criteria based on current knowledge of the response to both tests. No significant correlation was found between the absolute magnitudes of the pressure and timing data, however, comparison of the rating scale data indicated a significant relationship between the tests and associated high level of agreement between the two measures. The results of the study indicate that a reduction in the ability to draw in the abdominal wall is related to changes in the coordination of TrA, although the magnitude of the changes were not correlated. The degree of causality between these co‐varying but independent manifestations of the function of TrA is uncertain. Copyright © 1996 Whurr Publishers Ltd.
Evaluation of the reliability of reflective marker placements
Authors: Marks Ray , Karkouti Ellie
Published: March 2006

This study determined the reliability of recording knee angle coordinates in the sagittal plane during erect stance by use of skin reflective markers. To this end, 32 healthy male and female subjects participated in three standardised test sessions of 1 hour duration spaced at 1‐ and 4‐week intervals. At each session, markers were placed on three bony landmarks of the leg and their coordinates were photographed with the leg in extension and semi‐flexion. The resultant knee angles, calculated from lines drawn on the photographs marking the coordinate sites, were subjected to separate repeated measures analysis of variance statistical procedures. The results showed that both sets of measurements could be carried out reliably when repeated within a single test session (R = 0.87). However, when repeated over time, neither measurement reached the criterion for acceptable reliability (set at R ≥ 0.80). The magnitude of the method error was also higher between test sessions for both angles than it was for tests repeated within the sessions. These data suggest that whereas knee coordinates recorded on a single day can be reproduced reliably, they may be less useful for evaluating knee angle changes over time. Copyright © 1996 Whurr Publishers Ltd.
Measurements of scapular position and rotation: a reliability study
Authors: T'Jonck Leen , Lysens Roeland , Grasse Gunther
Published: March 2006

Smooth motion of the scapula and humerus with respect to the thorax is essential for shoulder function and abnormalities may indicate clinical entities. Recent studies have made an attempt to devise simple, practical means of quantifying scapular position. The aim of this study was to examine the intra‐tester and inter‐tester reliability of two methods and to determine if significant differences existed between the dominant versus non‐dominant extremity. Seventeen healthy volunteers (4 M; 13 F) were examined by two testers. The tape measurements consisted of the classic methods of Kibler and DiVeta in three sitting postures, expanded by the measurement of the linear distance from the medial border to the thoracic mid‐line, and the scapular size measure. The SAS software package was used for data analysis. The Intraclass Correlation Coefficient (ICC) intra‐tester reliability ranged between 0.96–0.8 for both methods without significant differences, whereas the ICC for inter‐tester reliability ranged between 0.42–0.9 with higher values (moderate and good) for the Kibler technique. In the additional tests high values were also obtained for ICC intra‐tester, except for the measurements of the linear distance of the medial border of the scapula to the thoracic mid‐line and the distance of the inferior process of the acromion to the third vertebra, both in 90° abduction and internal rotation. The ICC for inter‐tester was only acceptable for the DiVeta measurement on 45° abduction. Significant differences were noted between both testers on the following measures: Kibler in 45° abduction, DiVeta in 45° abduction and 90° abduction and the scapular size measure. The comparison of dominant versus non‐dominant extremity revealed larger but not significantly different means for the dominant extremity in the classic methods. Significant differences occurred for Tester 1 in the measurement of the distance of the medial border to the thoracic mid‐line and Tester 2 in DiVita in 45° abduction. The SEM values never exceeded 1 cm. We believe that the Kibler technique holds promise for further studies, has the advantage of measuring in three positions and with some familiarisation can be reliable. Further research is necessary in patients with pathological conditions. Copyright © 1996 Whurr Publishers Ltd.
Physical therapists' perceptions of family involvement in the rehabilitation process
Authors: Ryan Nancy Powell , Wade Janet Crew , Nice Amy , Shenefelt Heidi , Shepard Katherine
Published: March 2006

The purpose of this qualitative study was to describe how physical therapists working in rehabilitation settings involved families in the patient's rehabilitation program and what factors facilitated or impeded this involvement. Forty physical therapists practicing in the eastern United States were individually interviewed on their involvement of families in a patient's rehabilitation. The interview data were transcribed, coded, and analyzed for main themes. Family involvement was found to be a significant aspect of a patient's rehabilitation. Factors pertaining to the family, the patient, the healthcare organization and the physical therapist were identified. Factors, such as the family's knowledge, attitudes and skills of the family, their relationship with the patient prior to the injury or disability, the availability and opportunity of family members to be involved, and their physical capabilities, all influenced the degree to which the family participated. Therapists also perceived the cognitive status of the patient as a factor which dictated the proper amount of family participation. The health‐care organization was an important factor which needed to encourage and support the family participation. With decreased lengths of stay there is less time for families to be independent in caring for their loved one. The organization of the department could be instrumental in this by providing multiple formal and informal avenues for family training, such as support groups, home visits, ‘open door’ policy visiting hours, and scheduling changes. Finally, the physical therapists might have been the single most significant factor in facilitating family involvement. It was important for them to establish open and honest communication and be pro‐activists for their patients and their families. The findings were consistent with the existing literature base in relation to the patient and family. Additional findings present physical therapists and healthcare organizations with suggestions for improving family education. Copyright © 1996 Whurr Publishers Ltd.
Responsiveness and reliability of a pediatric strategy score for balance
Authors: Di Fabio Richard P. , Foudriat Beth A.
Published: March 2006

Various motor patterns or ‘strategies’ can be used to maintain balance. The purpose of this study was to determine the responsiveness of a pediatric strategy score (PED‐SS) compared to a standard strategy score (SS) as a measure of age‐related changes in the force patterns used to maintain stance. Eighty‐one healthy children between 3–6 years of age were tested during stance on a force platform while facing a visual surround. The platform, visual surround (or both) moved simultaneously with the child's body sway. Four sensory conditions that altered visual and somatosensory (support surface) inputs were presented. The PED‐SS was found to be more responsive to age‐related changes in balance behavior compared to the SS. The oldest children (aged 5 and 6 years) showed the greatest ability to utilize horizontal A/P shear force to maintain stance and this finding was reflected only in the PED‐SS. The implications of evaluating force strategy as one component of balance in healthy children is discussed with respect to the early developmental assessment of vestibular and developmental coordination disorders. Copyright © 1996 Whurr Publishers Ltd.
Concentric and eccentric force–velocity relationships during electrically induced submaximal contractions
Authors: Kues Janet M. , Mayhew Thomas P.
Published: March 2006

The purpose of this investigation was to examine the force–velocity relationship during electrically induced, submaximal concentric and eccentric contractions of the quadriceps femoris muscle. Thirty female subjects with no history of knee pathology participated in the study. Force was measured on an isokinetic dynamometer and the quadriceps femoris muscle was electrically stimulated by use of a medium frequency current generator. Subjects were stimulated at 30% of their maximum voluntary isometric force. Four velocities were tested (30°, 90°, 120° and 180°/sec) during both concentric and eccentric contractions. The relationship between force and velocity was examined with an analysis of covariance. The regression model describing the force–velocity relationship for concentric contractions was significant (p<0.0001) with an R2 of 0.96 and a slope of ‐0.76 (p<0.0001). The regression model describing the force–velocity relationship for eccentric contractions was significant (p<0.0001) with an R2 of 0.91 and a slope of 0.4 (p<0.0001). The relationship between force and velocity during electrically induced, sub‐maximal concentric and eccentric contractions were similar to in vitro studies that have examined this relationship during shortening and lengthening contractions. Copyright © 1996 Whurr Publishers Ltd.
The use and interpretation of the Friedman test in the analysis of ordinal‐scale data in repeated measures designs
Authors: Sheldon Michael R. , Fillyaw Michael J. , Thompson W. Douglas
Published: March 2006

The purpose of this paper is to review the use and interpretation of the Friedman two‐way analysis of variance by ranks test for ordinal‐level data in repeated measurement designs. Physical therapists frequently make three or more repeated measurements of the same individual to compare different treatments, or to assess the effect of a single treatment over time. When the measurements are ordinal‐scaled, such as some ratings of functional status and muscle strength, statistical significance may be determined by the Friedman test. We illustrate the use of the Friedman test and a post hoc multiple comparison test with data from 27 subjects whose performance on a lifting task was rated on three occasions by use of an ordinal scale. We discuss the interpretation of ordinal‐level data and recommend that therapists understand the limitations a measurement scale imposes on the inferences that can be made from these tests. Copyright © 1996 Whurr Publishers Ltd.
Changes in voluntary motor control induced by intrathecal baclofen in patients with spasticity of different etiology
Authors: Latash Mark L. , Penn Richard D.
Published: March 2006

We studied the effects of intrathecal baclofen upon voluntary movements. Eleven patients with spasticity of different etiology and one patient with idiopathic dystonia were studied. Six patients participated in a double‐blind trial. Kinematic/dynamic and electromyographic (EMG) patterns were recorded during attempts at single‐joint elbow or ankle voluntary movements and isometric contractions. Reflex responses were also recorded. Baclofen suppressed spastic signs in 10 patients: it eliminated clonus and decreased the co‐contraction of antagonist and distant muscle groups. Baclofen could induce weakness, particularly in patients with cerebral palsy (CP). Patients with hemi‐syndromes did not notice any effects of baclofen in their ‘unaffected’ limbs. Intrathecal baclofen could improve voluntary movements in some patients with spasticity resulting in better walking and usage of arms. We hypothesize that spasticity induces an adaptive reaction at a segmental level that includes an increase in the number and/or affinity of GABA‐sensitive receptors. Copyright © 1996 Whurr Publishers Ltd.
The job satisfaction of physical therapists
Authors: Speakman Haddon G. B. , Pleasant Jon Mark , Sutton Grant B.
Published: March 2006

Ten statements were created for the purpose of measuring job satisfaction in the practise of physiotherapy. The subjects consisted of 96 of the 106 (90%) of the physical therapists licensed with the Texas State Board of Physical Therapy Examiners, and listed as residing in El Paso, Texas, USA. To indicate their job satisfaction, subjects indicated on a seven‐point scale their level of agreement or disagreement with each statement. They then indicated on a different seven‐point scale how important they thought each statement was to their job satisfaction. The results indicated that subjects thought that their jobs were challenging in a positive sense; enabled them to use their abilities; and were interesting. They also thought that they had sufficient independence in decision‐making; were learning and improving in their work; and were given significant autonomy. The most dissatisfying aspect of their work was the amount of paperwork. In addition, the results suggest that some subjects may feel overworked, and think their jobs may be too physically demanding and mentally stressful. The subjects felt that all the statements had validity and measured important aspects of job satisfaction in physical therapy. Copyright © 1996 Whurr Publishers Ltd.
The exercise capacity of three socio‐economic groups of elderly hypertensive patients
Authors: Eales C. J. , Stewart A. V.
Published: March 2006

A third of all persons over the age of 65 suffer from hypertension. The incidence in South African blacks is particularly high. Exercise, although effective in lowering blood pressure, has not gained acceptance for its antihypertensive benefits. It would certainly be an inexpensive management option in community‐based clinics in South Africa. In this paper, the exercise profiles of a group of elderly hypertensive patients are examined in three different socio‐economic settings: a tertiary care hospital (Group 1); an urban community‐based clinic (Group 2); and a rural clinic (Group 3). All the patients completed the six‐minute walking test and the Duke Activity Status Index (Hlatky et al., 1984). All test values were expressed as means and standard deviations. A p value of <0.05 was considered significant. Both resting and exercise pulse rates were higher at the urban clinic (p=0.019). The blood pressure (BP) was higher in the urban clinic, but not significantly so. The mean arterial pressure (MAP) of all three groups was high (115 mm HG). The distance covered in the six‐minute walking test was surprisingly low at the urban and the rural clinic. Overall, in all three settings patients' hypertension was not well‐controlled. The patients were not fit when compared to their age‐predicted metabolic equivalent (MET) values. This lack of fitness may indicate that exercise programmes could be of value. Copyright © 1996 Whurr Publishers Ltd.
Why exercise?: A preliminary investigation of an exercise motivation index among individuals with rheumatic conditions and healthy individuals
Authors: Stenström Christina H. , Boestad Cecilia , Carlsson Marie , Edström Maria , Reuterhäll Åsalill
Published: March 2006

The study was undertaken to investigate the test‐retest stability and the criterion‐related validity of a modified Swedish version of an exercise motivation index (EMI), and its use with individuals with rheumatic conditions, and with healthy individuals who exercised regularly. The EMI consists of 23 statements divided into three sub‐scores for physical, psychological and social motivation. Ninety‐five individuals with rheumatic conditions (mean age 60 years, mean symptom duration 15 years, 79% female) and 131 healthy individuals (mean age 52 years, 76% female), all attending exercise classes at least once a week, filled out the EMI. Sub‐samples also filled out three visual analogue scales designed to measure physical, psychological and social exercise motivation, and filled out the EMI a second time one week later. The results indicated that psychological and physical exercise motivation was equally important in both samples. Social motivation was less important in both samples, but more pronounced in the rheumatic sample and among older individuals. In the rheumatic sample, physical motivation was more important among women and psychological motivation was more important among younger individuals. Test‐retest stability for the EMI was satisfactory in both samples, while criterion‐related validity was poor. The results of our preliminary investigation of the EMI suggest that the survey of physical, psychological and social motivation for exercise seems meaningful. Further work on the validity of the EMI is needed. Copyright © 1997 Whurr Publishers Ltd.
Physiotherapists' use of evidence based practice: a cross‐national study
Authors: Turner Pat , Whitfield T.W. Allan
Published: March 2006

This study investigated clinical physiotherapists' reasons for their use of treatment techniques, with a particular focus on their utilisation of journal review and research literature. A questionnaire was completed by 180 physiotherapists in England and 141 physiotherapists in Australia. Despite the greater prevalence of pre‐registration degree respondents in Australia, there were no differences between the two national groups in their reasons given for choice of treatment techniques. The basis of over 90% of each groups' choice of techniques reflected what was taught during their initial training. Experience of treatment effects on prior patients, and information gained in practice‐related courses, were also primary reasons. Research literature ranked least in importance as a basis for choosing techniques, and review articles fared little better. The results indicated that these physiotherapists relied mainly on information gained from formal pre‐ and post‐ registration courses. By implication, the most obvious means of influencing physiotherapists' attitudes to research utilisation lies with those responsible for physiotherapy education. Copyright © 1997 Whurr Publishers Ltd.
A revised group exercise program for osteoarthritis of the knee
Authors: Fransen Marlene , Margiotta Ezio , Crosbie Jack , Edmonds John
Published: March 2006

The purpose of this study was to determine the effectiveness of a group exercise program for subjects with osteoarthritis of the knee referred for physiotherapy in terms of pain, physical function and gait. This study was initiated after an initial group exercise program at this centre failed to demonstrate significant changes in pain, physical function or gait. The study was based on repeated measures with a two month follow up, carried out in the outpatients department of a large public hospital. Pain levels in various functional situations were assessed on visual analogue scales, physical function with the Stanford Health Assessment Questionnaire, and quantitative gait variables at a normal and a fast self‐selected speed with an electric foot switch walkway. On completion of the program (n=40) more than 90% of the pain and physical function scores demonstrated significant improvements without increases in medication, use of walking aids or fatigue. The gait variables of velocity, cadence and stride length at both self‐selected speeds demonstrated significant increases at this assessment without deterioration of gait symmetry. All improvements were maintained at the two month follow up assessments. This study suggests that a clinically realistic group exercise program supplemented with a home program can reduce pain, increase physical function and objective gait measures in subjects with osteoarthritis of the knee. Copyright © 1997 Whurr Publishers Ltd.
A weight bearing method for determining forefoot posting for orthotic fabrication
Authors: Cummings Gordon S. , Higbie Elizabeth J.
Published: March 2006

Orthotic prescription for forefoot posting is commonly based upon measures of the forefoot performed on a non‐weightbearing foot. However, the relationship of measures of the unloaded foot to determine orthotic prescription for compensatory forefoot function during gait is still in question. Another approach to determine orthotic prescription is to measure the height of forefoot posting necessary to prevent excessive pronation of the subtalar joint during weightbearing. Therefore, the purpose of this study was to determine the intrarater, interrater and day‐to‐day reliability of forefoot measures during an active, weightbearing movement. Thirty‐two volunteers, 18 females (mean age 38.9 ± 15.3 yr) and 18 males (mean age 44.8 ± 20.6 yr) participated in the study. Four examiners performed repeated forefoot measures on both feet using the weightbearing technique during two test sessions separated by a week. Intrarater and interrater reliability (ICC (3,1)) ranged from 0.90 to 0.95 and 0.87 to 0.94, respectively. Day‐to‐day reliability (ICC (1,1)) ranged from 0.84 to 0.88 for all measures. We conclude that the weightbearing method used in this study to determine forefoot posting is reliable. The acceptable reliability of this method justifies the need for future investigations of the validity and the clinical efficacy of this technique for orthotic prescription. Copyright © 1997 Whurr Publishers Ltd.
Solution structure of the plant defensin VrD1 from mung bean and its possible role in insecticidal activity against bruchids
Authors: Liu Yaw‐Jen , Cheng Chao‐Sheng , Lai Szu‐Ming , Hsu Ming‐Pin , Chen Ching‐San , Lyu Ping‐Chiang
Published: March 2006

Vigna radiata plant defensin 1 (VrD1) is the first reported plant defensin exhibiting insecticidal activity. We report herein the nuclear magnetic resonance solution structure of VrD1 and the implication on its insecticidal activity. The root‐mean‐square deviation values are 0.51 ± 0.35 and 1.23 ± 0.29 Å for backbone and all heavy atoms, respectively. The VrD1 structure comprises a triple‐stranded antiparallel β‐sheet, an α‐helix, and a 310 helix stabilized by four disulfide bonds, forming a typical cysteine‐stabilized αβ motif. Among plant defensins of known structure, VrD1 is the first to contain a 310 helix. Glu26 is highly conserved among defensins; VrD1 contains an arginine at this position, which may induce a shift in the orientation of Trp10, thereby promoting the formation of this 310 helix. Moreover, VrD1 inhibits Tenebrio molitor α‐amylase. α‐Amylase has an essential role in the digestion of plant starch in the insect gut, and expression of the common bean α‐amylase inhibitor 1 in transgenic pea imparts complete resistance against bruchids. These results imply that VrD1 insecticidal activity has its basis in the inhibition of a polysaccharide hydrolase. Sequence and structural comparisons between two groups of plant defensins having different specificity toward insect α‐amylase reveal that the loop between β2 and β3 is the probable binding site for the α‐amylase. Computational docking experiments were used to study VrD1–α‐amylase interactions, and these results provide information that may be used to improve the insecticidal activity of VrD1. Proteins 2006. © 2006 Wiley‐Liss, Inc.
Löwdin population analysis with and without rotational invariance
Authors: Bruhn George , Davidson Ernest R. , Mayer Istvan , Clark Aurora E.
Published: March 2006

Theoretical arguments and calculations are presented concerning atomic orbital‐based population analyses, as well as the way they are affected by rigid rotation of the molecule. It was recently shown that the Löwdin distribution of atomic charges (atomic populations computed in a Löwdin‐orthogonalized basis) is, in general, not rotationally invariant unless an initial atom‐centered basis of pure spherical harmonics is used or the atomic orbitals on the same atom are pre‐orthogonalized. In the present work, we compare the effect of linear transformations of the initial basis on charges within a series of organic, transition metal, and actinide compounds that have been computed in a basis containing either the Cartesian 6d and 10f orbitals or the pure spherical harmonics (5d, 7f components), respectively. Löwdin populations obtained without pre‐orthogonalization are orientationally dependent when computed in the 6d‐, 10f‐component basis and the asymmetric distribution of the Löwdin atomic charges among symmetry‐equivalent atoms is observed. © 2006 Wiley Periodicals, Inc. Int J Quantum Chem, 2006
Quantum wave packet calculation of reaction probabilities, cross sections, and rate constants for H+ + LiH → Li + H reaction
Authors: Gögtas Fahrettin
Published: March 2006

The H+ + LiH → Li + H reactive scattering has been studied using a quantum real wave packet method. The state‐to‐state and state‐to‐all reaction probabilities for the entitled collision have been calculated at zero total angular momentum. The probabilities for J > 0 are estimated from the J = 0 results by using J‐shifting approximation based on the Capture model. The integral cross sections and thermal rate constants are then calculated. © 2006 Wiley Periodicals, Inc. Int J Quantum Chem, 2006
Rural Surgery in Southern Sudan
Authors: Meo Giuseppe , Andreone Dario , De Bonis Umberto , Cometto Giorgio , Enrico Stefano , Giustetto Guido , Kiss Alberto , Landra Marino , Palmas Maria , Sacchi Laura , Taliente Peter , Vergnano Guido
Published: March 2006

Introduction

This article reports a retrospective analysis of a 6‐year experience of providing surgical care in remote areas of southern Sudan under extremely adverse conditions.

Methods

Teams of expatriate consultants (surgeon, anesthetist, scrub nurse) carried out 28 “surgical missions” with the aims of treating surgical cases previously selected and of training local personnel in basic surgery on the job.

Results

A total of 1642 patients (71% males, 30% under the age of 16) have undergone an operation. Altogether, 1264 elective procedures (77%) and 378 emergency procedures (23%) were performed. Hernia surgery comprised the main workload, followed by proctologic and gynecologic operations. Most operations were performed under spinal anesthesia. Other cases required ketamine, and a small number of patients had local anesthesia. There were 14 fatal complications, most of them related to the delay in obtaining medical attention. Based on the training results, the Sudanese personnel of two of the five health centers involved in the program are already fully autonomous. Two doctors and two nurses are proficient in essential surgery; two not qualified nurses are proficient in “primary” anesthesia; and others are proficient in scrubbing and surgical nursing.

Conclusions

This report demonstrates that it is feasible to establish surgical services in rural areas of developing countries by utilizing simple facilities, providing them with basic equipment, and employing local personnel selected and trained on the job by teams composed of a consultant surgeon, anesthetist, and scrub nurse. This seems to be the only realistic possibility for providing surgical care to the rural populations of the least developed countries.
Competence Assessment of Laparoscopic Operative and Cognitive Skills: Objective Structured Clinical Examination (OSCE) or Observational Clinical Human Reliability Assessment (OCHRA)
Authors: Tang B. , Hanna G. B. , Carter F. , Adamson G. D. , Martindale J. P. , Cuschieri A.
Published: March 2006

Background

There is no agreed system that is acknowledged as the ideal assessment of laparoscopic operative and cognitive skills. A new approach that combines Objective Structured Clinical Examination (OSCE) and Observational Clinical Human Reliability Assessment (OCHRA) was developed and used to assess trainees’ operative and cognitive skills during laparoscopic training courses.

Methods

Performance of 60 trainees participating in 3‐day essential laparoscopic skills training (cognitive and psychomotor) courses were assessed and scored using both OSCE and OCHRA.

Results

The study showed significant inverse correlations between the number of technical errors identified by OCHRA and the scores obtained by OSCE for individual tasks performed either by electro‐surgical hook or laparoscopic scissors (r = −0.864 and r = −0.808, respectively). Significant differences between trainees were observed in relation to both overall OSCE scores and OCHRA parameters: execution time, total errors, and consequential errors (P < 0.001).

Conclusions

OCHRA provides a discriminative feedback assessment of laparoscopic operative skills. OCHRA and OSCE are best regarded as complementary assessment tools for operative and cognitive skills. The present study has documented significant variance between surgical trainees in the acquisition of both cognitive and operative skills.
Civilian Duodenal Gunshot Wounds: Surgical Management Made Simpler
Authors: Talving Peep , Nicol Andrew J. , Navsaria Pradeep H.
Published: March 2006

Introduction

Low‐velocity gunshot wounds cause most civilian duodenal injuries. The objective of this study was to describe a simplified surgical algorithm currently in use in a South African civilian trauma center and to verify its validity by measuring morbidity and mortality.

Methods

A retrospective chart review of patients with duodenal gunshot injuries during the study period January 1999 to December 2003 was performed. Data points accrued included patient demographics, admission hemodynamic status and resuscitative measures, laparotomy damage control procedures, methods of surgical repair of the duodenal injury, associated injuries, length of intensive care and hospital stays, complications, and mortality.

Results

A total of 75 consecutive patients with gunshot injuries to the duodenum were reviewed. Primary repair was performed in 54 patients (87%), resection and reanastomosis in 7 (11%), and pancreatoduodenectomy in 1 (2%) during the initial phases. The overall morbidity and mortality were 58% and 28%, respectively. Duodenum‐related complications were recorded in nine (15%) patients: two duodenal fistulas, one duodenal obstruction, and six cases of suture‐line dehiscence. Overall and duodenum‐related morbidity rates in patients with combined pancreatoduodenal injuries were 83% and 17%, respectively. Duodenum‐related mortality occurred in three (4.8%) patients.

Conclusions

Most civilian low‐velocity duodenal gunshot injuries treated with simple primary repair result in overall morbidity, mortality, and duodenum‐related complication rates comparable to those in reports where more complex surgical procedures were employed. Primary repair is also applicable for most combined pancreatic and duodenal gunshot injuries.