bluuebunny/crossref_metadata_2025 huggingface dataset:
In-hospital Mortality and Morbidity after Surgical Treatment of Unruptured Intracranial Aneurysms in the United States, 1996–2000: The Effect of Hospital and Surgeon Volume
Authors: Barker Fred G. , Amin-Hanjani Sepideh , Butler William E. , Ogilvy Christopher S. , Carter Bob S.
Published: February 2017

OBJECTIVE

We sought to determine the risk of adverse outcome after contemporary surgical treatment of patients with unruptured intracranial aneurysms in the United States. Patient, surgeon, and hospital characteristics were tested as potential outcome predictors, with particular attention to the surgeon's and hospital's volume of care.

METHODS

We performed a retrospective cohort study with the Nationwide Inpatient Sample, 1996 to 2000. Multivariate logistic and ordinal regression analyses were performed with endpoints of mortality, discharge other than to home, length of stay, and total hospital charges.

RESULTS

We identified 3498 patients who were treated at 463 hospitals, and we identified 585 surgeons in the database. Of all patients, 2.1% died, 3.3% were discharged to skilled-nursing facilities, and 12.8% were discharged to other facilities. The analysis adjusted for age, sex, race, primary payer, four variables measuring acuity of treatment and medical comorbidity, and five variables indicating symptoms and signs. The statistics for median annual number of unruptured aneurysms treated were eight per hospital and three per surgeon. High-volume hospitals had fewer adverse outcomes than hospitals that handled comparatively fewer unruptured aneurysms: discharge other than to home occurred after 15.6% of operations at high-volume hospitals (20 or more cases/yr) compared with 23.8% at low-volume hospitals (fewer than 4 cases/yr) (P = 0.002). High surgeon volume had a similar effect (15.3 versus 20.6%, P = 0.004). Mortality was lower at high-volume hospitals (1.6 versus 2.2%) than at hospitals that handled comparatively fewer unruptured aneurysms, but not significantly so. Patients treated by high-volume surgeons had fewer postoperative neurological complications (P = 0.04). Length of stay was not related to hospital volume. Charges were slightly higher at high-volume hospitals, partly because arteriography was performed more frequently than at hospitals that handled comparatively fewer unruptured aneurysms.

CONCLUSION

For patients with unruptured aneurysms who were treated in the United States between 1996 and 2000, surgery performed at high-volume institutions or by high-volume surgeons was associated with significantly lower morbidity and modestly lower mortality.
Developing an Anterior Cervical Diskectomy and Fusion Simulator for Neurosurgical Resident Training
Authors: Ray Wilson Z. , Ganju Aruna , Harrop James S. , Hoh Daniel J.
Published: February 2017

BACKGROUND:

Surgical simulators are useful in many surgical disciplines to augment residency training. Duty hour restrictions and increasing emphasis on patient safety and attending oversight have changed neurosurgical education from the traditional apprenticeship model. The Congress of Neurological Surgeons Simulation Committee has been developing neurosurgical simulators for the purpose of enhancing resident education and assessing proficiency.

OBJECTIVE:

To review the initial experience with an anterior cervical diskectomy and fusion (ACDF) simulator.

METHODS:

The first ACDF training module was implemented at the 2012 Congress of Neurological Surgeons Annual Meeting. The 90-minute curriculum included a written pretest, didactics, a practical pretest on the simulator, hands-on training, a written posttest, a practical posttest, and postcourse feedback. Didactic material covered clinical indications for ACDF, comparison with other cervical procedures, surgical anatomy and approach, principles of arthrodesis and spinal fixation, and complication management. Written pretests and posttests were administered to assess baseline knowledge and evidence of improvement after the module. Qualitative evaluation of individual performance on the practical (simulator) portion was included.

RESULTS:

Three neurosurgery residents, 2 senior medical students, and 1 attending neurosurgeon participated in the course. The pretest scores were an average 9.2 (range, 6-13). Posttest scores improved to 11.0 (range, 9-13; P = .03).

CONCLUSION:

Initial experience with the ACDF simulator suggests that it may represent a meaningful training module for residents. Simulation will be an important training modality for residents to practice surgical technique and for teachers to assess competency. Further development of an ACDF simulator and didactic curriculum will require additional verification of simulator validity and reliability.
Ketoprofen Tissue Permeation in Swine Following Cathodic Iontophoresis
Authors: Panus Peter C , Ferslew Kenneth E , Tober-Meyer Brunhilde , Kao Race L
Published: February 2017

Background and Purpose. Pharmacokinetic assessment of drug tissue permeation following iontophoresis is limited. The depth of ketoprofen tissue permeation following cathodic iontophoresis (4 mA, 40 minutes) and the stereoselectivity of drug delivery were examined in this study.Subjects. Ketoprofen (750 mg) was iontophoresed onto one porcine medial thigh, with passive drug permeation conducted on the other thigh.Methods. Skin, subcutaneous fascia, and muscle biopsies from the drug delivery sites were harvested and stored separately, and the “R” and “S” ketoprofen enantiomers were determined.Results. Iontophoretic and passive applications yielded equivalent total ketoprofen concentrations in the skin and fascia. In contrast, multivariate analysis demonstrated that the ketoprofen concentration in the first centimeter of muscle following iontophoresis was greater than the drug concentration in the deeper underlying muscle layers and greater than that delivered to any muscle layer following passive delivery. No transcutaneous stereoselective delivery of ketoprofen was detected.Conclusion and Discussion. Compared with passive delivery, iontophoresis enhances nonstereoselective ketoprofen permeation into the fascia-muscle interface. With delivery to deeper tissue sites, however, there is no apparent enhancement over passive application.
Quadriceps Femoris and Hamstring Muscle Function in a Person With an Unstable Knee
Authors: Maitland Murray E , Ajemian Stanley V , Suter Esther
Published: February 2017

Background and Purpose. The purpose of this case report is to describe the evaluation, treatment, and short-term outcome for an individual with chronic, progressively worsening instability of the knee during gait associated with anterior cruciate ligament (ACL) insufficiency.Case Description. The patient was a 34-year-old man who sustained bilateral ACL injuries. Subsequently, an autograft reconstruction of the left knee ACL was performed. Eight months post-reconstruction, the left knee was unstable despite bracing. Gait analysis and tests to determine the presence of muscle inhibition were performed prior to and after 12 weeks of training. Isometric torque of the knee extensors and flexors was measured with the knee in 90 degrees of flexion. A training program primarily consisted of electromyographic biofeedback during thigh muscle exercises, balance exercises, and gait.Outcomes. Muscle inhibition decreased and maximal isometric knee flexion and extension torques increased during the 12-week training period. Gait analysis demonstrated a 50% decrease in the maximum knee extensor moment and an increase in walking speed.Discussion. Selected gait variables, torque production, and muscle inhibition may change in a person with an unstable knee. The measurement of variables that have previously been documented as mechanisms of knee instability during walking allows for the selection of a specific treatment approach.
Speed-Dependent Reductions of Force Output in People With Poststroke Hemiparesis
Authors: Brown David A , Kautz Steven A
Published: February 2017

Background and Purpose. Movement is slow in people with poststroke hemiparesis. Moving at faster speeds is thought by some researchers to exacerbate of abnormal or unwanted muscle activity. The purpose of this study was to quantify the effects of increased speed on motor performance during pedaling exercise in people with poststroke hemiparesis. Subjects. Twelve elderly subjects with no known neurological impairment and 15 subjects with poststroke hemiparesis of greater than 6 months' duration were tested. Methods. Subjects pedaled at 12 randomly ordered workload and cadence combinations (45-, 90-, 135-, and 180-J workloads at 25, 40, and 55 rpm). Pedal reaction forces were used to calculate work done by each lower extremity. Electromyographic activity was recorded from 7 lower-extremity muscles. Results. The main finding was that net mechanical work done by the paretic lower extremity decreased as speed increased in all subjects. The occurrence of inappropriate muscle activity on the paretic side, however, was not exacerbated in that the vastus medialis muscle on the paretic side did not show a consistent further increase in its prolonged activity at higher speeds. The mechanics of faster pedaling resulted in greater net negative mechanical work because, at higher pedaling rates, the prolonged vastus medialis muscle activity is present during a greater portion of the cycle. Conclusion and Discussion. The lessened force output by the paretic limb is mainly the result of the inherent mechanical demands of higher-speed pedaling and not due to exacerbation of impaired neural control.
Interpreting Validity Indexes for Diagnostic Tests: An Illustration Using the Berg Balance Test
Authors: Riddle Daniel L , Stratford Paul W
Published: February 2017

Physical therapists routinely make diagnostic and prognostic decisions in the course of patient care. The purpose of this clinical perspective is to illustrate what we believe is the optimal method for interpreting the results of studies that describe the diagnostic or prognostic accuracy of examination procedures. To illustrate our points, we chose the Berg Balance Test as an exemplar measure. We combined the data from 2 previously published research reports designed to determine the validity of the Berg Balance Test for predicting risk of falls among elderly people. We calculated the most common validity indexes, including sensitivity, specificity, predictive values, and likelihood ratios for the combined data. Clinical scenarios were used to demonstrate how we believe these validity indexes should be used to guide clinical decisions. We believe therapists should use validity indexes to decrease the uncertainty associated with diagnostic and prognostic decisions. More studies of the accuracy of diagnostic and prognostic tests used by physical therapists are urgently needed.
Endurance Training of the Trunk Extensor Muscles in People With Subacute Low Back Pain
Authors: Chok Beverley , Lee Raymond , Latimer Jane , Tan Seang Beng
Published: February 2017

Background and Purpose. Clinicians treating patients with low back pain often use exercise to reduce pain and improve function. The aim of this study was to evaluate the effectiveness of trunk extensor endurance training in reducing pain and decreasing disability in subjects with subacute low back pain (ie, onset of back pain within 7 days to 7 weeks). Subjects and Methods. Patients were randomly assigned to either an experimental group or a control group. A visual analog scale and the Pain Rating Index (PRI) of the McGill Pain Questionnaire (MPQ) were used to obtain baseline measurements of pain. The Roland-Morris Disability Questionnaire (RMDQ) was used to measure disability, and the Sorensen Test was used to measure trunk extensor endurance. Subjects in the experimental group attended exercise sessions 3 times per week for 6 weeks. Subjects in the control group did not do exercises. Both groups were given back care advice and hot packs for 15 minutes, 3 to 5 times per week. Reassessments were carried out at 3 and 6 weeks. Results. There were differences between the 2 groups at 3 weeks with regard to pain intensity during the evaluation session, pain experienced over the preceding 24 hours, the total MPQ PRI, the sensory component of the MPQ PRI, and the RMDQ. At 6 weeks, no differences were found for pain measurements, disability scores, and holding time on the Sorensen Test. Conclusion and Discussion. Trunk extensor endurance training reduced pain and improved function at 3 weeks but resulted in no improvement at 6 weeks when compared with the control group. Endurance exercise is considered to expedite the recovery process for patients with an acute episode of low back pain.
Measurement of Sacroiliac Joint Dysfunction: A Multicenter Intertester Reliability Study
Authors: Freburger Janet K , Riddle Daniel L
Published: February 2017

Background and Purpose. Previous research suggests that visual estimates of sacroiliac joint (SIJ) alignment are unreliable. The purpose of this study was to determine whether handheld calipers and an inclinometer could be used to obtain reliable measurements of SIJ alignment in subjects suspected of having SIJ dysfunction. Subjects. Seventy-three subjects, evaluated at 1 of 5 outpatient clinics, participated in the study. Methods. A total of 23 therapists, randomly paired for each subject, served as examiners. The angle of inclination of each innominate was measured while the subject was standing. The position of the innominates relative to each other was then derived. An intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and a kappa coefficient were calculated to examine the reliability of the derived measurements. Results. The ICC was .27, the SEM was 5.4 degrees, and the kappa value was .18. Conclusion and Discussion. Measurements of SIJ alignment were unreliable. Therapists should consider procedures other than those that assess SIJ alignment when evaluating the SIJ.
Development of the Physical Therapy Outpatient Satisfaction Survey (PTOPS)
Authors: Roush Susan E , Sonstroem Robert J
Published: February 2017

Background and Purpose. The purposes of this 3-phase study were (1) to identify the underlying components of outpatient satisfaction in physical therapy and (2) to develop a test that would yield reliable and valid measurements of these components. Subjects. Three samples, consisting of 177, 257, and 173 outpatients from 21 facilities, were used in phases 1, 2, and 3, respectively. Methods and Results. In phase 1, principal component analyses (PCAs), reliability checks, and correlations with social desirability scales were used to reduce a pool of 98 items to 32 items. These analyses identified a 5-component model of outpatient satisfaction in physical therapy. The phase 2 PCA, with a revised pool of 48 items, indicated that 4 components rather than 5 components represented the best model and resulted in the 34-item Physical Therapy Outpatient Satisfaction Survey (PTOPS). Factor analyses conducted with phase 2 and phase 3 data supported this conclusion and provided evidence for the internal validity of the PTOPS scores. The 4-component scales were labeled “Enhancers,” “Detractors,” “Location,” and “Cost.” Responses from subsamples of phase 3 subjects provided evidence for validity of scores in that the PTOPS components of “Enhancers,” “Detractors,” and “Cost” appeared to differentiate overtly satisfied patients from overtly dissatisfied patients. “Location” and “Enhancer” scores discriminated subjects with excellent attendance at scheduled physical therapy sessions from those with poor attendance. Conclusion and Discussion. In this study, we identified components of outpatient satisfaction in physical therapy and used them to develop a test that would yield valid and reliable measurements of these components.
The Relationship Between Submaximal Activity of the Lumbar Extensor Muscles and Lumbar Posteroanterior Stiffnesss
Authors: Shirley Debra , Lee Michael , Ellis Elizabeth
Published: February 2017

Background and Purpose. Some patients with low back pain are thought to have increased lumbar posteroanterior (PA) stiffness. Increased activity of the lumbar extensors could contribute to this stiffness. This activity may be seen when a PA force is applied and is thought to represent much less force than occurs with a maximal voluntary contraction (MVC). Although MVCs of the lumbar extensors are known to increase lumbar PA stiffness, the effect of small amounts of voluntary contraction is not known. In this study, the effect of varying amounts of voluntary isometric muscle activity of the lumbar extensors on lumbar PA stiffness was examined. Subjects. Twenty subjects without low back pain, aged 26 to 45 years (X̄=34, SD=5.6), participated in the study. Methods. Subjects were asked to perform an isometric MVC of their lumbar extensor muscles with their pelvis fixed by exerting a force against a steel plate located over their T4 spinous process. They were then asked to perform contractions generating force equivalent to 0%, 10%, 30%, 50%, and 100% of that obtained with an MVC. Posteroanterior stiffness at L4 was measured during these contractions. Results. A Friedman one-way analysis of variance for repeated measures demonstrated a difference in PA stiffness among all levels of muscle activity. Conclusion and Discussion. Voluntary contraction of the lumbar extensor muscles will result in an increase in lumbar PA stiffness even at low levels of activity.
Back Care Instructions in Physical Therapy: A Trend Analysis of Individualized Back Care Programs
Authors: Kerssens Jan J , Sluijs Emmy M , Verhaak Peter FM , Knibbe Hanneke JJ , Hermans Irma MJ
Published: February 2017

Background and Purpose. The treatment of people with low back pain often includes giving a variety of instructions about back care. The objective of our study was to explore the content and sequence of these instructions. Subjects. Our database contained information on 1,151 therapy sessions for 132 patients who were treated by 21 therapists. Methods. Hierarchical linear modeling was used to establish trends in instructions during the course of treatment. Instructions were measured by means of a registration form. Results. Pain management instructions were given at the start of treatment and then decreased in later sessions. Instructions about taking care of the back in daily activities followed the same course. Exercise instructions were introduced after the start of treatment and were spread evenly across the visits. The number of recommendations about general fitness decreased during treatment. Conclusion and Discussion. The majority of back care instructions were spread evenly across therapy visits. Relatively little variation in instructions among patients was seen, which may indicate a lack of individualization of the back care programs.
Use of Computed Tomography and Plantar Pressure Measurement for Management of Neuropathic Ulcers in Patients With Diabetes
Authors: Mueller Michael J , Smith Kirk E , Commean Paul K , Robertson Douglas D , Johnson Jeffrey E
Published: February 2017

Background and Purpose. Total contact casting is effective at healing neuropathic ulcers, but patients have a high rate (30%–57%) of ulcer recurrence when they resume walking without the cast. The purposes of this case report are to describe how data from plantar pressure measurement and spiral x-ray computed tomography (SXCT) were used to help manage a patient with recurrent plantar ulcers and to discuss potential future benefits of this technology. Case Description. The patient was a 62-year-old man with type 1 diabetes mellitus (DM) of 34 years' duration, peripheral neuropathy, and a recurrent plantar ulcer. Although total contact casting or relieving weight bearing with crutches apparently allowed the ulcer to heal, the ulcer recurred 3 times in an 18-month period. Spiral x-ray computed tomography and simultaneous pressure measurement were conducted to better understand the mechanism of his ulceration. Outcomes. The patient had a severe bony deformity that coincided with the location of highest plantar pressures (886 kPa). The results of the SXCT and pressure measurement convinced the patient to wear his prescribed footwear always, even when getting up in the middle of the night. The ulcer healed in 6 weeks, and the patient resumed his work, which required standing and walking for 8 to 10 hours a day. Discussion. Following intervention, the patient's recurrent ulcer healed and remained healed for several months. Future benefits of these methods may include the ability to define how structural changes of the foot relate to increased plantar pressures and to help design and fabricate optimal orthoses.
Status of the Year 2000 Health Goals for Physical Activity and Fitness
Authors: Francis Kennon T
Published: February 2017

In Healthy People 2000, the national strategy for improving the health of the American people by the year 2000, lifestyle factors such as physical inactivity are major determinants of chronic disease and disability. Despite the documented benefits of exercise in enhancing health and reducing the risk of premature death, only 1 of the 13 physical activity and fitness objectives of Healthy People 2000 has been met or exceeded. Although progress toward 5 objectives for the year 2000 has been made, 3 objectives are actually farther from attainment. Coronary heart disease death rates (Objective 1.1) have declined, and the prevalence of overweight people (Objective 1.2) has increased. Overall physical activity in adults (Objectives 1.3 and 1.4) and strengthening and stretching activities in children (Objective 1.6) have increased, but reduction in the percentage of sedentary persons (Objective 1.5) has showed no change. The proportion of the population adopting sound dietary practices combined with regular physical activity to attain appropriate body weight (Objective 1.7) has declined. Even though participation in daily school physical education (Objective 1.8) has shown a decline during the past several years, students who are enrolled in physical education classes are spending more time performing physical activities (Objective 1.9). The proportion of work sites offering employer-sponsored physical activity and fitness programs (Objective 1.10) has increased substantially, surpassing the year 2000 goal. Data to update progress for increasing physical activity levels of children (Objectives 1.3–1.5), community exercise facilities (Objective 1.11), clinician counseling about physical activity (Objective 1.12), and improvement in personal self-care activities (Objective 1.13) are not yet available.
Cardiopulmonary Responses of Middle-Aged Men Without Cardiopulmonary Disease to Steady-Rate Positive and Negative Work Performed on a Cycle Ergometer
Authors: Chung Frank , Dean Elizabeth , Ross Jocelyn
Published: February 2017

Background and Purpose. Understanding physiological responses to negative work allows therapists to be more knowledgeable when they prescribe this form of exercise. The physiological responses of 12 men without cardiopulmonary disease, aged 39 to 65 years (x̄=49.7, SD=9.3), to negative work (eccentric muscle contractions) and to positive work (concentric muscle contractions) were compared. Subjects and Methods. Subjects performed the 2 types of work on a motorized cycle ergometer at pedaling frequencies of 35, 55, and 75 rpm with a constant power output of 60 W. Steady-rate values of oxygen consumption (V̇o2), heart rate (HR), minute ventilation (V̇e), tidal volume (Vt), and breathing frequency (fb) were obtained during 6 test conditions (positive and negative work at each of the 3 pedaling frequencies). Results. Values for all measures were greater during positive work than during negative work, except for fb. During positive work, values for all variables were greatest at 75 rpm, except for fb. During negative work, V̇o2 and HR were greater at 75 and 35 rpm than at 55 rpm, and V̇e and Vt were greater at 75 rpm than at 55 rpm. Breathing frequency was not different among pedaling frequencies. Conclusion and Discussion. The results confirmed that negative work performed on a cycle ergometer is associated with low metabolic cost in older men without cardiopulmonary disease. Although V̇e was determined primarily by changes in Vt during negative work, a comparable disproportionate increase in fb was observed at the start of negative work. Such changes in breathing patterns have implications for the prescription of negative work for patients with lung disease.
Diagnosis of Intermittent Vascular Claudication in a Patient With a Diagnosis of Sciatica
Authors: Gray John C
Published: February 2017

Background and Purpose. The purpose of this case report is to illustrate the importance of medical screening to rule out medical problems that may mimic musculoskeletal symptoms. Case Description. This case report describes a woman who was referred with a diagnosis of sciatica but who had signs and symptoms consistent with vascular stenosis. The patient complained of bilateral lower-extremity weakness with her pain intensity at a minimal level in the region of the left sacroiliac joint and left buttock. She also reported numbness in her left leg after walking, sensations of cold and then heat during walking, and cramps in her right calf muscle. She did not report any leg pain. A medical screening questionnaire revealed an extensive family history of heart disease. Examination of the lumbar spine and nervous system was negative. A diminished dorsalis pedis pulse was noted on the left side. Stationary cycling in lumbar flexion reproduced the patient's complaints of lower-extremity weakness and temporarily abolished her dorsalis pedis pulse on the left side. Outcomes. She was referred back to her physician with a request to rule out vascular disease. The patient was subsequently diagnosed, by a vascular specialist, with a “high-grade circumferential stenosis of the distal-most aorta at its bifurcation.” Discussion. This case report points out the importance of a thorough history, a medical screening questionnaire, and a comprehensive examination during the evaluation process to rule out medical problems that might mimic musculoskeletal symptoms.
Behaviors That Cause Clinical Instructors to Question the Clinical Competence of Physical Therapist Students
Authors: Hayes Karen W , Huber Gail , Rogers Jean , Sanders Babette
Published: February 2017

Background and Purpose. Clinical instructors (CIs) observe behavior to determine whether students have the skills assumed necessary for safe and effective delivery of physical therapy services. Studies have examined assumptions about necessary skills, but few studies have identified the types of student behaviors that are “red flags” for CIs. This study examined the student behaviors that negatively affect students' clinical performance, which can alert CIs to inadequate performance. Subjects. Twenty-eight female and 5 male CIs discussed the performance of 23 female and 17 male students who were anonymous. Methods. Using questionnaires and semistructured interviews that were taped and transcribed, CIs described demographics and incidents of unsafe and ineffective physical therapy. After reading the transcripts, investigators identified and classified the behaviors into categories and checked their classification for reliability (κ=.60–.75). Results. Behaviors in 3 categories emerged as red flags for CIs: 1 cognitive category—inadequate knowledge and psychomotor skill (43% of 134 behaviors)—and 2 noncognitive categories—unprofessional behavior (29.1%) and poor communication (27.6%). The CIs noticed and valued noncognitive behaviors but addressed cognitive behaviors more often with students. Students who did not receive feedback about their performance were unlikely to change their behavior. The CIs used cognitive behaviors often as reasons to recommend negative outcomes. Conclusion and Discussion. Clinical instructors need to identify unacceptable cognitive and noncognitive behaviors as early as possible in clinical experiences. Evidence suggests that they should discuss their concerns with students and expect students to change.
Low-Intensity Laser Therapy for Benign Fibrotic Lumps in the Breast Following Reduction Mammaplasty
Authors: Nussbaum Ethne L
Published: February 2017

Background and Purpose. Fibrotic masses in the breast secondary to fat necrosis or hematoma are a complication of breast reduction mammaplasty. The treatment commonly recommended for this condition is early surgical debridement of necrotic tissue from the entire area, which causes scarring. This case report describes the use of low-intensity laser therapy for fibrotic lumps following reduction mammaplasty. Case Description. The patient was a 46-year-old woman who had breast reduction surgery 80 days prior to referral for physical therapy. At the time of referral, the largest mass was 8.0 cm in diameter. The patient reported pain and said she was distressed about the breast disfigurement. Laser irradiation was initiated at an energy density (ED) of 20 J/cm2 and a pulse repetition rate of 5,000 pulses per second. The laser settings were adjusted during the 8-month treatment period. The final ED was 50 J/cm2. Outcomes. The mass was 33% of its original size after 3 treatments over the initial 11-day period. Pain relief was immediate. The rate of resolution decreased after the initial period. The patient had some tissue thickening at the time of discharge after 6 months of treatment. Discussion. This case demonstrates the potential use of laser therapy as a treatment for benign breast lumps following mammaplasty.
Acute Effects of Thirty Minutes of Light-Intensity, Intermittent Exercise on Patients With Chronic Fatigue Syndrome
Authors: Clapp Lisa L , Richardson Mark T , Smith Joe F , Wang Minqi , Clapp Anthony J , Pieroni Robert E
Published: February 2017

Background and Purpose. Currently, there is no consensus on exercise prescription for patients with chronic fatigue syndrome (CFS). This investigation examined whether light-intensity, intermittent physical activity exacerbated symptoms in patients with CFS immediately following exercise to 7 days following exercise. Subjects. Subjects were 9 women (mean age=44.2 years, SD=8.4, range=29-56; mean weight=74.2 kg, SD=18.8, range=56.36-110.91; and mean height=1.63 m, SD=0.8, range=1.55-1.78) and 1 man (age=48 years, weight=97.1 kg, and height=1.98 m) who met the Centers for Disease Control and Prevention's criteria for CFS. Methods. Subjects performed 10 discontinuous 3-minute exercise bouts (separated by 3 minutes of recovery) at a self-selected, comfortable walking pace on a treadmill. Oxygen consumption, minute ventilation, respiratory exchange ratio, and heart rate were measured every minute during the exercise session. To assess degree of disability, general health status, activity level, symptoms, and mood, subjects completed various questionnaires before and after exercise. Results. Results indicated that degree of disability, general health status, symptoms, and mood did not change immediately and up to 7 days following exercise. Conclusion and Discussion. Thirty minutes of intermittent walking did not exacerbate symptoms in subjects with CFS. The physiological data did not show any abnormal response to exercise. Although this study did not determine whether 30 minutes of continuous versus intermittent exercise would exacerbate symptoms, all 10 subjects felt that they could not exercise continuously for 30 minutes without experiencing symptom exacerbation. Despite this limitation, the results indicate that some individuals with CFS may be able to use low-level, intermittent exercise without exacerbating their symptoms.
An Application of Upper-Extremity Constraint-Induced Movement Therapy in a Patient With Subacute Stroke
Authors: Blanton Sarah , Wolf Steven L
Published: February 2017

Background and Purpose. The purpose of this case report is to demonstrate the application of constraint-induced movement therapy with an individual with upper-extremity hemiparesis within 4 months after sustaining a cerebrovascular accident (stroke). Such patients often fail to develop full potential use of their affected upper extremity, perhaps due to a “learned nonuse phenomenon.” Case Description. The patient was a 61-year-old woman with right-sided hemiparesis resulting from an ischemic lacunar infarct in the posterior limb of the left internal capsule. The patient's less-involved hand was constrained in a mitten so that she could not use the hand during waking hours, except for bathing and toileting. On each weekday of the 14-day intervention period, the patient spent 6 hours being supervised while performing tasks using the paretic upper extremity. Pretreatment, posttreatment, and 3-month follow-up outcome measures included the Wolf Motor Function Test and the Motor Activity Log (MAL). Outcomes. For the Wolf Motor FunctionTest, both the mean and median times to complete 16 tasks improved from pretreatment to posttreatment and from posttreatment to follow-up. Results of the MAL indicated an improved self-report of both “how well” and “how much” the patient used her affected limb in 30 specified daily tasks. These improvements persisted to the follow-up. Discussion. Two weeks of constraining the unaffected limb, coupled with practice of functional movements of the impaired limb, may be an effective method for restoring motor function within a few months after cerebral insult. Encouraging improvements such as these strongly suggest the need for a group design that would explore this type of intervention in more detail.
Effects of Footwear on Measurements of Balance and Gait in Women Between the Ages of 65 and 93 Years
Authors: Arnadottir Solveig A , Mercer Vicki S
Published: February 2017

Background and Purpose. Footwear is not consistently standardized in the administration of the Functional Reach Test (FRT), Timed Up & Go Test (TUG), and 10-Meter Walk Test (TMW). This study was conducted to determine whether footwear affected performance on these tests in older women. Subjects. Thirty-five women, aged 65 to 93 years, were recruited from assisted living facilities and retirement communities. Methods. Each subject performed the FRT, TUG, and TMW while wearing walking shoes, wearing dress shoes, and barefooted. Because of space constraints at the facilities where the testing was performed, 22 subjects performed the FRT and TUG on a linoleum floor and 13 subjects performed the tests on a firm, low-pile, carpeted floor. All 35 subjects completed the TMW on a firm, low-pile, carpeted floor. One-way repeated-measures analyses of variance (ANOVAs) and a Tukey Honestly Significant Difference test were used to compare the outcomes for the 3 footwear conditions, with separate ANOVAs conducted for the different floor surfaces for the FRT and TUG. Results. Subjects performed better on the FRT when barefooted or wearing walking shoes compared with when they wore dress shoes, regardless of floor surface. Differences were found among all footwear conditions for the TUG performed on the linoleum floor and for the TMW. For these tests, the women moved fastest in walking shoes, slower barefooted, and slowest wearing dress shoes. Conclusion and Discussion. Footwear should be documented and should remain constant from one test occasion to another when the FRT, TUG, and TMW are used in the clinic and in research. Footwear intervention may improve performance of balance and gait tasks in older women.
Quality of Life After Pulmonary Rehabilitation: Assessing Change Using Quantitative and Qualitative Methods
Authors: Camp Pat G , Appleton Jessica , Reid W Darlene
Published: February 2017

Background and Purpose. The purpose of this study was to use quantitative and qualitative research methods to evaluate quality-of-life (QOL) changes in patients with chronic obstructive pulmonary disease (COPD) after pulmonary rehabilitation. Subjects. Twenty-nine individuals with COPD (18 women and 11 men), with a mean age of 69 years (SD=8.6, range=53–92), participated. Methods. Subjects were assessed before and after a 5-week control phase and after a 5-week rehabilitation phase using the Chronic Respiratory Questionnaire (CRQ), the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and spirometry. Our qualitative research was based on a subsample of 7 subjects who were interviewed after pulmonary rehabilitation. Results. Pulmonary rehabilitation improved QOL, as demonstrated by increases of 22% and 14% in the physical function categories of the CRQ and the SF-36, respectively, and by an increase of 10% in the CRQ's emotional function category. The qualitative data indicated how pulmonary rehabilitation influenced QOL. Conclusion and Discussion. The use of both quantitative and qualitative methods illustrated the nature of improvement in QOL after pulmonary rehabilitation. Improved physical function, less dyspnea, and a heightened sense of control over the subjects' COPD resulted in increased confidence and improved emotional well-being.
Effectiveness of a Home Program of Ischemic Pressure Followed by Sustained Stretch for Treatment of Myofascial Trigger Points
Authors: Hanten William P , Olson Sharon L , Butts Nicole L , Nowicki Aimee L
Published: February 2017

Background and Purpose. Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs. Subjects. Forty adults (17 male, 23 female), aged 23 to 58 years (X̄=30.6, SD=9.3), with one or more TPs in the neck or upper back participated in this study. Methods. Subjects were randomly divided into 2 groups receiving a 5-day home program of either ischemic pressure followed by general sustained stretching of the neck and upper back musculature or a control treatment of active range of motion. Measurements were obtained before the subjects received the home program instruction and on the third day after they discontinued treatment. Trigger point sensitivity was measured with a pressure algometer as pressure pain threshold (PPT). Average pain intensity for a 24-hour period was scored on a visual analog scale (VAS). Subjects also reported the percentage of time in pain over a 24-hour period. A multivariate analysis of covariance, with the pretests as the covariates, was performed and followed by 3 analyses of covariance, 1 for each variable. Results. Differences were found between the treatment and control groups for VAS scores and PPT. No difference was found between the groups for percentage of time in pain. Conclusion and Discussion. A home program, consisting of ischemic pressure and sustained stretching, was shown to be effective in reducing TP sensitivity and pain intensity in individuals with neck and upper back pain. The results of this study indicate that clinicians can treat myofascial TPs through monitoring of a home program of ischemic pressure and stretching.
Diagonal Trunk Muscle Exercises in Peripartum Pelvic Pain: A Randomized Clinical Trial
Authors: Mens Jan MA , Snijders Chris J , Stam Henk J
Published: February 2017

Background and Purpose. Exercises for low back and pelvic pain are supposed to increase muscle force to reduce symptoms, but they could exacerbate symptoms by loading of the spinal and pelvic structures. The purpose of this study was to investigate the value of graded exercises of the diagonal trunk muscle systems. Subjects. The subjects were 44 women with persistent pelvic pain after pregnancy (mean age=31.7 years, SD=3.2, range=23.6–37.5; mean period postpartum=4.1 months, SD=2.2, range=1.7–5.6). Methods. Subjects were randomly assigned to 1 of 3 groups: (1) a group that performed exercises to increase the force of the diagonal trunk muscle systems, (2) a group that received training of the longitudinal trunk muscle systems, and (3) a group that was instructed to refrain from exercises. Pain, fatigue, perceived general health, and mobility of the pelvic joints as measured with radiographs were the outcome measures. Results. After 8 weeks, no differences were found among the 3 groups. Conclusion and Discussion. In treating patients with persistent pelvic pain, training of the diagonal trunk muscle systems, without individual coaching, has no additional value above instructions and use of a pelvic belt without exercises. Whether the treatment is ineffective or whether exacerbation of symptoms due to loading of the spinal and pelvic structures obscures any potential benefit of increased muscle force cannot be determined from the study design.
Investigation of Trunk and Extremity Movement Associated With Passive Head Turning in Newborns
Authors: Clopton Nancy A , Duvall Tonya , Ellis Brent , Musser Melissa , Varghese Simmi
Published: February 2017

Background and Purpose. Physical therapist examination of pediatric clients or clients with neurological conditions often includes the observation of stereotypical movement patterns such as the asymmetrical tonic neck reflex and righting reactions. The purpose of this study was to investigate whether extremity and trunk responses to passive head turning could be documented in newborn infants. Subjects and Methods. Forty-two newborns with no known medical problems were videotaped within 5 days of birth while an investigator turned their heads left and right. Videotapes were stopped at 5-second intervals to record the direction of head turn with the rest of the body obscured. A second investigator recorded trunk and extremity position with the head obscured. Results. The direction of head turning affected upper-and lower-extremity position, with extension stronger on the face side. The direction of trunk convexity was also affected by head position, with the trunk convex to the side to which the face was turned. Conclusion and Discussion. Extremity responses and trunk responses to passive head turning can be documented corresponding to patterns reported for the asymmetrical tonic neck reflex and righting reflexes in neonates with no known medical problems more frequently than would occur by chance.
The Relationship of Lumbar Flexion to Disability in Patients With Low Back Pain
Authors: Sullivan M Scott , Shoaf Lisa Donegan , Riddle Daniel L
Published: February 2017

Background and Purpose. Physical therapists routinely assess spinal active range of motion (AROM) in patients with low back pain (LBP). The purpose of this study was to use 2 approaches to examine the relationship between impairment of lumbar spine flexion AROM and disability. One approach relied on the use of normative data to determine when an impairment in flexion AROM was present. The other approach required therapists to make judgments of whether the flexion AROM impairment was relevant to the patient's disability. Subjects. Fifteen physical therapists and 81 patients with LBP completed in the study. Methods. Patients completed the Roland-Morris Back Pain Questionnaire (RMQ), and the therapists assessed lumbar spine flexion AROM using a dual-inclinometer technique at the initial visit and again at discharge. Results. Correlations between the lumbar flexion AROM measure and disability were low and did not vary appreciably for the 2 approaches tested. Conclusion and Discussion. Measures of lumbar flexion AROM should not be used as surrogate measures of disability. Lumbar spine flexion AROM and disability are weakly correlated, suggesting that flexion AROM measures should not be used as treatment goals.
An Analysis of the Relationship Between the Utilization of Physical Therapy Services and Outcomes of Care for Patients After Total Hip Arthroplasty
Authors: Freburger Janet K
Published: February 2017

Background and Purpose. The effect of physical therapy intervention on the outcomes of care for patients treated in acute care hospitals has not been widely studied. This study examined the relationship between physical therapy utilization and outcomes of care for patients following total hip arthroplasty. Subjects. The sample consisted of 7,495 patients treated in US academic health center hospitals in 1996 who survived their inpatient stay and received physical therapy interventions. Methods. The primary data source was the University HealthSystem Consortium Clinical Data Base. Physical therapy use was assessed by examining physical therapy charges. Outcomes of care were assessed in terms of the total cost of care (ie, whether the care was more costly or less costly than expected, taking into account patient characteristics) and in terms of discharge destination (ie, whether the patient was discharged home or elsewhere). Regression analyses were conducted to examine the relationship between physical therapy use and outcomes. Results. Physical therapy intervention was directly related to a total cost of care that was less than expected and to an increased probability of discharge home. Conclusion and Discussion. The results of this study provide preliminary evidence to support the use of physical therapy intervention in the acute care of patients following total hip arthroplasty and indicate the need for further study of this topic.
A Guide for Use and Interpretation of Kinesiologic Electromyographic Data
Authors: Soderberg Gary L , Knutson Loretta M
Published: February 2017

Physical therapists are among the most common users of electromyography as a method for understanding function and dysfunction of the neuromuscular system. However, there is no collection of references or a source that provides an overview or synthesis of information that serves to guide either the user or the consumer of electromyography and the data derived. Thus, the purpose of this article is to present a guide, accompanied by an inclusive reference list, for the use and interpretation of kinesiologic electromyographic data. The guide is divided into 4 major sections: collecting, managing, normalizing, and analyzing kinesiologic electromyographic data. In the first of these sections, the issues affecting data collection with both indwelling and surface electrodes are discussed. In the second section, data management through alternative forms of data processing is addressed. In the third section, various reasons and procedures for data normalization are discussed. The last section reviews qualitative descriptors once used as the only means of analyzing data, then focuses on more quantitative procedures that predominate today. The guide is intended as a tool for students, educators, clinicians, and beginning researchers who use and interpret kinesiologic electromyographic data. Modifications will likely be needed as alternative forms of collecting, managing, normalizing, and analyzing electromyographic data are proposed, used in various settings, and reported in the literature.