bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability of clinical balance outcome measures in the elderly
Authors: Giorgetti Marie Magliozzi , Harris Bette Ann , Jette Alan
Published: March 2006

Background and Purpose

Simple, practical and reliable clinical balance outcome measures are needed to assess baseline status and response to treatment in older people. The reliability of the clinical measures used in this testing protocol had not been determined for this population. This study assessed the inter‐rater reliability of three commonly used clinical measuress of balance: one leg standing, tandem gait and functional reach.

Method

Two samples of older people were used: (1) non‐disabled and (2) disabled community dwellers. All testing was performed in a single session by two trained examiners according to a standardized protocol. Intra‐class correlations were calculated comparing the means of each clinical balance test for Examiner 1 with Examiner 2.

Results

Reliability coefficients were 0.75 for one leg standing, 0.73 for functional reach, and 0.31 for tandem gait for the non‐disabled sample. Reliability coefficients were 0.85 for one leg standing, 0.79 for functional reach, and 0.62 for tandem gait for the disabled sample.

Conclusions

These findings for the one leg standing and functional reach testing protocols in disabled and non‐disabled older people can be used as outcome measures. Further study should be directed towards improving the reliability of the tandem gait test for use with older people. Copyright © 1998 Whurr Publications Ltd.
Improvement in ejection fraction by hydrotherapy as rehabilitation in patients with chronic pulmonary emphysema
Authors: Kurabayashi Hitoshi , Machida Izumi , Kubota Kazuo
Published: March 2006

Background and Purpose

It has been reported that breathing exercise by immersion in combination with expiring into water improved pulmonary function and blood–gas exchange in patients with chronic obstructive pulmonary disease (COPD). This effect may result from respiratory muscle exercise against hydraulic pressure and decreased dead space by increased sub‐abdominal pressure. Increased cardiac function by bathing is suggested to contribute to the effect. To clarify the effect of the breathing exercise by immersion on cardiac function, a study was made of cardiac function during the exercise in patients with emphysema.

Method

Echocardiography, respiratory function test and arterial blood gas analysis were performed during a two‐month breathing exercise programme in a pool filled with 38°C water for 12 patients (aged 70.9 ± 9.1 years) with stable chronic pulmonary emphysema who were treated at our hospital between 1993 and 1996. The patients breathed in whilst standing in a pool and breathed out through the mouth while sinking the nose under water. This exercise was repeated for 30 min per day and continued for six days a week for two months.

Results

The ejection fraction increased significantly after each 30‐minute exercise (N=12; p<0.01) as well as after the two‐month exercise programme (N=12, p<0.05). Left ventricular end‐diastolic and systolic dimensions at rest decreased significantly after the two‐month exercise programme (N=12, p<0.01). The ratio of forced expired volume in one second to forced vital capacity (FEV1:FVC) increased and PaCO2 decreased following this programme (N=12, p<0.05).

Conclusions

These results suggest that the breathing exercise by immersion is useful not only in treating emphysema but also in improving cardiac function. Copyright © 1998 Whurr Publications Ltd.
Prevalence of back, neck and shoulder problems in the inner city: implications for the provision of physiotherapy services in primary healthcare
Authors: Lock Catherine , Allgar Victoria , Jones Kevin , Marples Gwen , Chandler Colin , Dawson Pam
Published: March 2006

Background and Purpose

More general practitioners are offering physiotherapy services within primary healthcare; however, this provision may result in increased demand. Resource allocation, based on previous patterns of consultation for musculoskeletal conditions, may be inadequate since the need for treatment in the community may not have been met in the past. Therefore the aim of this study was to determine the prevalence of back, neck and shoulder problems that had restricted normal activity for more than one week during the last year and which health professionals (if any) patients had consulted about their symptoms.

Method

A postal survey of 2400 adult patients selected at random from four general practices in Newcastle upon Tyne (600 from each practice).

Results

A total of 1546 questionnaires were returned, a 64% response rate. Overall, 40% of respondants reported having at least one back, neck and/or shoulder problem. Back problems were most common (30%), followed by those with neck (21%) and shoulder (20%) problems. Approximately one‐third of those with problems consulted no one, a further third consulted a general practitioner and only one in six consulted a physiotherapist.

Conclusions

There is a high prevalence of substantial back, neck and shoulder problems in the community and thus a wider provision of physiotherapy services within primary healthcare may be required to manage the considerable levels of potentially unmet need. Copyright © 1999 Whurr Publishers Ltd.
Motivation for change in patients with prolonged musculoskeletal disorders: a qualitative two‐year follow‐up study
Authors: Grahn Birgitta , Stigmar Kjerstin , Ekdahl Charlotte
Published: March 2006

Background and Purpose

The purpose of this study was to obtain a deeper understanding of the process of motivation for change in patients with prolonged musculoskeletal disorders and to identify factors that might influence change resulting in increased independence.

Method

A qualitative two‐year follow‐up study. Data collection and analysis were performed according to the qualitative case study design. An initial conceptual framework was developed to bound and guide the study. Twenty patients were selected using purposive sampling with respect to motivation level (highly motivated to less‐motivated) to create a sample of maximum variation. Data were collected using repeated interviews and standardized scales. The study comprised three data collection periods.

Results

Motivation for change followed different processes depending on the level at entry to the study. The highly motivated patients improved in independence, the moderately motivated ones remained at an unchanged level and the less‐motivated patients became more dependent. Central themes of importance to the process of motivation for change were: the utilization of professional networks (healthcare, regional social insurance office), emotional support (nuclear family, close relatives), use of personal coping resources (energy, positive beliefs, problem‐solving) and social support at work (employers, colleagues).

Conclusions

The performance of a structured motivation analysis, including questions about emotional networks and social support at work in addition to the clinical examination of the patient, is recommended. This might guide healthcare professionals when it comes to motivation for change in the patient. Copyright © 1999 Whurr Publishers Ltd.
Forward Leaning Reaching task in Sitting (FLRS): a new measure for clinical evaluation of hamstring length in children
Authors: Salén Marianne , Hirschfeld Helga , Olsson Åsa
Published: March 2006

Background and Purpose

In this study, the rotation of the pelvis was taken into account when assessing the length of hamstrings. A new measure for clinical evaluation was developed to establish reference values of hamstring length in children without movement disabilities for different age groups. Subjects (N = 60) were 3‐, 6‐, 10‐ and 14‐year‐old children (N = 15 for each age group). These values could be helpful in deciding treatment interventions in children with movement disabilities, for example cerebral palsy, when hamstring length is in question.

Method

The study was performed with subjects sitting and reaching for a touch control on a wall whilst voluntarily rotating the pelvis forwards. By use of digitized video frames, the spatial angles of the lumbar spine and pelvis, as well as the joint angles of hip and knee, were computed at the initial and end positions of a forward leaning reaching task in sitting (FLRS). The active forward leaning induced a forward rotation of the pelvis, causing stretch on the hamstring muscle with extended knee.

Results

The results of spatial and joint angle measurements suggest that the difference of the hip joint angle between initial erect and final forward leaned sitting may be used as reference values for hamstring length. Reference values are based on the mean (±SE) of means (mean of 15 children, that is, group and individual means of ten trials).

Conclusions

The age group reference values obtained may indirectly give information as to whether the hamstring length of a child with cerebral palsy is within the normative value of age‐related control subjects. The new test developed in this study provides a convenient means for measuring hamstring length and could enhance clinical evaluation. Copyright © 1999 Whurr Publishers Ltd.
Physical activity in the life of the patient with rheumatoid arthritis
Authors: Kamwendo Kitty , Askenbom Malin , Wahlgren Cecilia
Published: March 2006

Background and Purpose

Physical activity is an important tool used by patients with rheumatoid arthritis (RA) in order to reduce inflammation and pain as well as preserve and improve function. The aim of this study was to investigate how patients with RA perceive and relate to physical activity in everyday life.

Method

Ten patients diagnosed with RA were interviewed. The data collected were transcribed and analysed for categories of meaning and main themes. Inter‐judge reliability was tested and showed an 81.5% agreement.

Results

Three themes were identified. The first represented a ‘driving force’ and included two positively loaded categories ‘satisfaction’ and ‘support’, and two negatively loaded categories ‘keep at bay’ and ‘intimidation’. The second theme was ‘hindrance’ and included the categories ‘internal barrier’ and ‘external barrier’ and, finally, the third theme ‘physical activity’ included the categories ‘organized activity’ and ‘everyday activity’.

Conclusion

Physical exercise was an important strategy for patients with RA and was promoted primarily by patients' own experiences, positive as well as negative. A salutogenic (explaining health) approach to patient education, as well as an increased use of everyday activities as additional exercise, is advocated. Copyright © 1999 Whurr Publishers Ltd.
Relationship between balance abilities and mobility aids in elderly patients at discharge from an acute care setting
Authors: Graham Dorothea , Newton Roberta A
Published: March 2006

Background and Purpose

At the time of discharge from the acute care setting, patients may not be evaluated for a mobility aid and it is possible this may represent an unmet need. The first purpose of this study was to examine the agreement between the Berg Balance Test (BBT) (Newton, 1997) and the Global Balance Rating scale (GBR) (Leahy, 1991) in terms of acute care patients' need for mobility aids. The second was to determine if there was an increase in mobility aid usage at the time of discharge.

Method

Thirty inpatients (mean age 76.7 years) were assessed by use of the BBT and the GBR. The therapist rating patients with the GBR also determined the type of mobility aid provided at discharge.

Results

At admission, 23/30 individuals did not use a mobility aid and seven used a cane. At discharge, nine subjects were independent ambulators, 10 needed a cane and 11 needed a walker. There was no significant agreement between the GBR in relation to the BBT to determine the need for a mobility aid. There was a significant increase (p = 0.05) in the number of subjects using a mobility aid at the time of discharge as compared to admission to the acute care setting.

Conclusions

Therapists should not rely on the GBR as an indicator of balance, hence the need for an assistive device until reliability and validity measures have been conducted. Therapists should use a functional assessment tool, such as the BBT, since it is reliable and a valid measure of balance ability and has been demonstrated to predict cane use. Since patients are relatively inactive in the acute care setting, referral to physical therapy for functional assessment and mobility aid recommendations should be an integral part of discharge planning. Copyright © 1999 Whurr Publishers Ltd.
Validity of weight distribution and sway measurements of the Balance Performance Monitor
Authors: Haas Bernhard M , Burden Adrian M
Published: March 2006

Background and Purpose

The Balance Performance Monitor (BPM) is a device which provides auditory and visual feedback on weight distribution and the magnitude of lateral and anterior–posterior sway during quiet standing. This study investigated the validity of the measurements provided by the BPM using a Kistler force plate (KFP) as the gold standard.

Method

Percentage weight distribution between the BPM foot plates was validated using both a series of calibration weights and the vertical component of ground reaction force, measured by the KFP, during normal standing in 18 young normal subjects. The lateral and anterior–posterior sway indices from the BPM were validated against the standard deviation of the position of the centre of pressure, again obtained using the KFP, during normal standing with eyes open and eyes closed and standing with feet together with eyes open. Concurrent validity of the percentage weight distribution measurements was assessed by calculating the ‘limits of agreement’ between the corresponding measurements from the BPM and KFP and the 95% confidence intervals for these ‘limits’. Differences in the units of measurement obtained from the BPM and KFP resulted in the concurrent validity of the sway indices being assessed using correlation and regression.

Results

Excellent agreement was found between the percentage weight distribution values provided by the BPM and the KFP, which showed that the BPM may read only 3% of body weight above or below that given by the KFP. High correlations (r = 0.61–0.99) were found between both the lateral and anterior–posterior sway indices from the BPM and the motion of the centre of pressure from the KFP in the respective direction. Despite this, further analysis of regression equations and the 95% prediction intervals showed poor concurrent validity of the BPM sway indices in relation to KFP measurements. This was thought to be due to the different methods by which the sway indices and the motion of the centre of pressure were calculated.

Conclusions

The BPM may be used to provide a valid measure of the symmetry aspect, but not necessarily the steadiness aspect of postural control. Copyright © 2000 Whurr Publishers Ltd.
Functional status among elderly Norwegian fallers living at home
Authors: Bergland Astrid , Pettersen Anne Marie , Laake Knut
Published: March 2006

Background and Purpose

Falls and their after‐effects are important contributors to disability in old age, but may be mitigated. The relationship between self‐reported health and functioning and falling is examined in the present study.

Method

The study design was cross‐sectional. Data were collected from interviews with 431 community‐dwelling Norwegian subjects aged 67–97 years. Physical health was assessed through items from the Multidimensional Functional Assessment of Older Adults (MFAQ), supplemented with the Body Mass Index (BMI). General health/psychosocial health was assessed with the General Health Questionnaire (GHQ‐20), the Mini‐mental State Examination, two general health items and items concerning mental and social health from the MFAQ. Falls during the last six months were registered and scored 0 (no falls), 1(one fall) or 2 (two or more falls).

Results

During the previous six months 24.1% of subjects reported falling. Four variables: ‘Perceived difficulty in keeping balance in walking’, ‘Troubled by heart pounding/shortness of breath’, sum score on the GHQ factor ‘Depression/hopelessness’, and a higher value on BMI, were independently associated with number of falls reported.

Conclusions

Score value on ‘Perceived difficulty in keeping balance in walking’ was the strongest significant predictor of falls in the present study. In contrast with other studies, no association between anxiety, general health and falling was observed. Copyright © 2000 Whurr Publishers Ltd.
Physiotherapists in Balint group training
Authors: Dahlgren Madeleine Abrandt , Almquist Andreas , Krook Johan
Published: March 2006

Background and Purpose

Balint group training (BGT) is a method widely used for enhancing understanding of the relationship and communication between health professionals and their patients. Participants meet in small groups, on a regular basis, with a tutor to discuss their experiences of problem cases. The method was originally developed in the 1950s for enhancing understanding of the doctor–patient relationship. Few studies have focused on BGT and physiotherapists. The aim of the present study was to describe and analyse physiotherapists' experiences of participation in BGT as a means of learning and understanding the physiotherapist–patient relationship.

Method

Semi‐structured, in‐depth interviews were conducted with three physiotherapists working in private practice, all participating in BGT. The intervews were transcribed and subjected to a qualitative analysis.

Results

The results are presented in a sequential model, featuring eight themes in which the physiotherapists' experiences of the training process are portrayed.

Conclusions

The results suggest that BGT and sharing the experiences of others may be considered a way of enhancing understanding of the patient encounter in clinical practice, possibly to the benefit of physiotherapists and their patients. Copyright © 2000 Whurr Publishers Ltd.
Effect of positioning on respiratory synchrony in non‐ventilated pre‐term infants
Authors: Maynard Veronica , Bignall Simon , Kitchen Sheila
Published: March 2006

Background and Purpose

Body position can play an important role in an infant's recovery from respiratory disease, but few studies have accounted for sleep state which is known to have a direct influence on the control of respiratory muscles as well as on metabolic and circulatory changes. The purpose of this study was to examine the influence of body position on respiratory function in pre‐term infants whilst accounting for sleep state.

Method

Thoraco‐abdominal motion was assessed using respiratory inductance plethysmography (RIP) to provide measures of relative rib cage (RC) and abdominal (AB) movement in ten non‐ventilated pre‐term infants. Continuous measurements of oxygen saturation (SaO2), pulse and heart rate (HR), were made and sleep state was recorded using behavioural criteria and electro‐oculogram (EOG) measurements.

Results

The results showed a significant increase in HR in supine, but no significant difference in SaO2 as a function of position, compared to the prone position where a significant reduction was found in thoraco‐abdominal asynchrony for both groups and a reduction in variability in both HR and SaO2. Intra‐subject variability of thoraco‐abdominal motion as a function of position demonstrated no significant difference on return to supine or on return to prone, illustrating good repeatability of measures.

Conclusions

Prone positioning of pre‐term infants recovering from respiratory disease may improve respiratory function. As measured, the improvement in respiratory synchrony in prone position brings pre‐term infants' breathing pattern into line with that expected in term infants. Copyright © 2000 Whurr Publishers Ltd.
A comparison of the timing of muscle activity during sitting down compared to standing up
Authors: Ashford Stephen , De Souza Lorraine
Published: March 2006

Background and Purpose

This study was designed to investigate the temporal pattern of the activation and de‐activation of muscles during sitting down to a seated position. The aim was to determine if reproducible patterns existed in the timing of muscle activation and deactivation, in normal subjects, and to compare that produced for sitting down with the pattern produced for standing up.

Method

The 10 subjects used for the experiment were a convenience sample consisting of healthy male volunteers aged 19–32 years. The design was that of a descriptive study. Subjects were instructed to stand up and sit back down to a seated position. During this activity kinematic (movement) and electromyo‐graphic (EMG) data were collected. A pattern of timing for the activity of different muscles or groups was produced and this was compared with the movement occurring.

Results

The study found a consistent pattern of EMG activity during sitting down from a standing position. This pattern was documented and the pattern was compared with that produced during standing up.

Conclusions

The results demonstrated that a consistent pattern of muscle activation and de‐activation was produced in this group of subjects during sitting down. The pattern of muscle activation and de‐activation for sitting down was documented. When comparing the pattern produced during sitting down with that produced during standing up it is apparent that some of the muscles were active during both movement patterns at the same relative point in the pattern. Copyright © 2000 Whurr Publishers Ltd.
Manual hyperinflation — Effects on respiratory parameters
Authors: Patman Shane , Jenkins Sue , Stiller Kathy
Published: March 2006

Background and Purpose

Manual hyperinflation (MH) of the lungs is commonly used by physiotherapists in the treatment of intubated mechanically ventilated patients with the aim of increasing alveolar oxygenation, reversing atelectasis or mobilizing pulmonary secretions. However, the efficacy of MH, used in isolation, has not been clearly established.

Method

This randomized, controlled trial investigated the effects of MH on lung compliance (CL), the arterial oxygen to fraction of inspired oxygen ratio (PaO2:FIO2) and the alveolar–arterial oxygen tension difference (A–a)PO2 in 100 medically stable, mechanically ventilated subjects who had undergone coronary artery surgery (CAS). Post‐CAS subjects were used for this study as they constitute a large, homogeneous and accessible group. Subjects were randomized to either a control group (non‐MH group) or to a treatment group (MH group) which received MH within four hours of surgery.

Results

After four minutes of MH there were significant improvements in CL, PaO2:FIO2 and (A–a)PO2 with values remaining above baseline measures at 60 min post‐intervention. The mean improvement in CL was 6 ml/cmH2O (approximately 15%), 56 mmHg for PaO2:FIO2 (approximately 17%) and 29 mmHg for (A–a)PO2 (approximately 17%) immediately post‐intervention. No significant changes in mean CL, PaO2:FIO2 or (A–a)PO2 were seen in the non‐MH group.

Conclusions

MH performed in the stable ventilated patient significantly increased CL and PaO2:FIO2 and decreased (A–a)PO2, but the clinical significance of this improvement is unclear. Further investigations are required to validate the findings of this study as well as to determine the therapeutic value of MH on patient outcome. Copyright © 2000 Whurr Publishers Ltd.
Socio‐affective characteristics and properties of extrinsic feedback in physiotherapy
Authors: Talvitie Ulla
Published: March 2006

Background and Purpose

The usual approach in physiotherapy is to communicate the desired action by means of some combination of verbal instruction and explanation, visual demonstration and manual assistance. Patients' and physiotherapists' communication and acts express socio‐affective elements which influence the atmosphere governing this interaction. The purpose of this study was to investigate the socio‐affective characteristics of the verbal, visual and manual feedback given to their patients by physiotherapists in the performance of their duties.

Method

Data were collected by videotaping patient–physiotherapist interaction. Systematic observation was used to depict physiotherapists' and patients' verbal and physical communications. The observation instrument consisted of the categories of verbal communication, physical activities and the socio‐affective features of communication.

Results

The physiotherapists used verbal and physical guidance more and visual guidance less. In the main, the properties of the feedback given were motivational and reinforcing. Information feedback appeared very seldom. Verbal cues were mostly short comments. The main significance of manual cueing was in the tactile input that was used in orienting patients to produce the correct movement. The most effective way of helping patients to understand the purpose of the action and the sequential organization of the subroutine of the movement was to give a demonstration containing the relevant visual and verbal cues.

Conclusions

The extensive use of verbal and manual guidance found in this study needs to be thought over carefully, especially as physiotherapists seemed to use these techniques more as routine than as a result of careful consideration. The socio‐affective atmosphere seems to influence physiotherapists' ways of giving feedback to their patients. Further research is needed to determine the most effective way of arranging guidance strategies for physiotherapists to produce effective feedback. Copyright © 2000 Whurr Publishers Ltd.
Is dosage of physiotherapy a critical factor in deciding patterns of recovery from stroke: a pragmatic randomized controlled trial
Authors: Partridge Cecily , Mackenzie Mathew , Edwards Susan , Reid Andrea , Jayawardena Sue , Guck Nikki , Potter Jonathon
Published: March 2006

Background and Purpose

The best treatment and management of stroke patients has been shown to be in stroke units by multidisciplinary rehabilitation teams. Since the composition of stroke units differs it is important to know the extent to which the different components contribute to this result. Physiotherapy is one component of most rehabilitation teams and recent systematic reviews have shown that patients with stroke receiving more physiotherapy achieve more recovery from disability. However, information about the actual amounts of physiotherapy needed to achieve this result is not known.

Method

A pragmatic, randomized, single‐blind, controlled trial comparing recovery from disability in subjects receiving the current standard amount of 30 minutes' physiotherapy with those receiving double that amount (60 minutes). The study included measures of physical performance and function, psychological aspects of anxiety and depression, and perceived control over recovery.

Results

Some 114 subjects were recruited to the study; full six‐week data are available for 104 subjects and six‐month data for 93 subjects. Comparison of initial to six‐week difference scores in the control and intervention groups of the whole sample did not show a significant difference. Scrutiny of the recovery curves of the whole sample showed that, in half the sample, three distinct patterns of recovery were demonstrated.

Conclusion

These results suggest that doubling the physiotherapy time available for patients in a stroke unit will not provide a measurable benefit for all patients. The subgroup analysis of patterns of recovery must be regarded as speculative, but provides the basis for hypotheses about those likely to respond well to more intensive therapy. Copyright © 2000 Whurr Publishers Ltd.
Reliability of goniometric measurements and visual estimates of hip ROM in patients with osteoarthrosis
Authors: Holm Inger , Bolstad Bjørg , Lütken Teresa , Ervik Anne , Røkkum Magne , Steen Harald
Published: March 2006

Background and Purpose

Range of motion (ROM) measurements have been included in several hip scores evaluating the results after hip surgery. The clinical procedures of performing these measurements vary and disagreement exists about the accuracy of visual estimatess compared to goniometer measurements. The purpose of this study was to study the reliability of goniometric measurements and visual estimates of hip ROM in patients with osteoarthrosis.

Method

Hip ROM measurements (abduction, adduction, extension, flexion and internal/external rotation) were recorded by four different teams on the same day and were repeated one week later. Teams 1, 2 and 3 consisted of physiotherapists using standardized goniometric measurements. Team 4 involved an experienced orthopaedic surgeon making the assessments from visual estimates only. Twenty‐five patients (6 M, 19 F; mean age 68.5 years, range 46–76 years) with osteoarthrosis of the hip, verified both clinically and radiologically, participated in the study.

Results

With the exception of abduction (p=0.03), there were no significant differences between the measurements recorded on the first and the second occasions for the same teams. The coefficient of variance was 5.5% for flexion (lowest) and 26.1% for extension (highest). Reproducibility was best for flexion. There was also high reliability when all the arcs of motion were summed up (abuction + adduction + extension + flexion + internal/external rotation). With the exception of internal rotation, there were highly significant differences between the teams when two people performed the measurements compared to the values measured by a single individual. Concordance, expressed as the standardized agreement index, between visual estimates made by one individual (the orthopaedic surgeon) and goniometric measurements made by two experienced physiotherapists, were 0.77–0.83 which indicates good agreement.

Conclusion

The reproducibility of hip ROM measurements was highest for flexion. There was also high reliability when all the six arcs of motion were summed up. Concordance between visual estimates and goniometric measurements indicates good agreement. Copyright © 2000 Whurr Publishers Ltd.
Accuracy of prediction of walking for young stroke patients by use of the FIM
Authors: Thornton Heather , Jackson Diana , Turner‐Stokes Lynne
Published: March 2006

Background and Purpose

Clinical prediction of walking outcome after a stroke is essential for effective discharge planning. However, its accuracy has hardly been explored. This study took place in a regional unit admitting patients with complex neurological disabilities for specialist inpatient rehabilitation. The aim was to compare predicted outcome (goal score) with achieved outcome (discharge score) on the seven‐point locomotion subscale of the Functional Independence Measure (FIM), to evaluate its precision and identify factors influencing accuracy.

Method

Admission, goal and discharge scores were analysed retrospectively for 141 subjects (90 M; 51 F) admitted consecutively to the Unit with median age 54 years (range 15–68 years) with median length of stay 13.6 weeks (range 3–35 weeks).

Results

Ninety subjects (64%) gained from two to six points; 50 subjects (35%) gained one point or showed no change. One patient deteriorated by two points. Excluding patients admitted with the highest score (FIM level 7), the overall level of agreement between predicted and discharge scores was moderate (weighted kappa 0.47). Prediction was accurate to ±1 point in 113 subjects (80%). Overprediction by ≥2 points occurred in 16 subjects (11%) and underprediction by ≥2 points in 12 subjects (9%). Analysis of the most‐disabled cohort, admitted with FIM levels 1 or 2 scores, revealed a higher sensitivity for predicting ‘independence’ (FIM levels 5–7) (78%) than ‘dependence’ (FIM levels 1–4) (65%). Accuracy was not affected by age, gender or side of stroke. Inaccurate predictions were associated with lower admission FIM level scores (p=−0.26;p=0.002) and a greater length of stay (p=0.36;p<0.001). Subjects with quad‐riplegia were more likely to have inaccurate outcome predictions made than those with hemiplegia (p=0.025) and those with neglect were more likely to have inaccurate outcome predictions made than those without neglect (p=0.017).

Conclusion

Further investigation into clinical prediction and the variables which confound accuracy is needed for effective planning. Copyright © 2001 Whurr Publishers Ltd.
Exercises and education as secondary prevention for recurrent low back pain
Authors: Soukup Margret Grotle , LÖnn Jan , GlomsrÖd Bredo , BÖ Kari , Larsen Stig
Published: March 2006

Background and Purpose

Exercise and education is a common physiotherapy approach in the prevention of low back pain. A Mensendieck exercise programme consisting of exercises and ergonomical education has, in a previous study, been shown to be effective in preventing recurrent low back pain during one‐year follow‐up. The purpose of the present study was to evaluate the long‐term effect of the Mensendieck exercise programme on people with recurrent episodes of low back pain who, when entering the study, had finished treatment for their last episode of low back pain.

Method

A randomized controlled clinical trial in which 41 women and 36 men were allocated to either a Mensendieck or control group. The Mensendieck subjects received 20 group sessions of exercises and ergonomical education over 13 weeks. The control subjects were not offered any prophylactic therapy, but were free to receive treatment or exercises. Outcome measures were the number of recurrences of low back pain, sick leave, low back function and general functional status.

Results

At three‐year follow‐up, 11 subjects had been lost to the study. Survival analysis showed a significant reduction (p=0.02) in subjects experiencing recurrent low back pain in the Mensendieck group compared to the control group. Significant improvements in pain and function scores were reported in both groups. There was no significant difference between the groups in pain, function or sick leave.

Conclusion

A Mensendieck exercise programme seems efficient in reducing recurrent episodes of low back pain at three‐year follow‐up, but it did not influence sick leave, pain or function scores. Copyright © 2001 Whurr Publishers Ltd.
Accuracy of reproducing hand position when using active compared with passive movement
Authors: Laufer Yocheved , Hocherman Shraga , Dickstein Ruth
Published: March 2006

Background and Purpose

Evaluating proprioception is relevant to physical rehabilitation because of its significance in motor control. One method of proprioceptive testing involves having subjects either imitate or point at a joint position or movement which was presented via a passive movement. However, as the muscle spindles are subject to central fusimotor control, the proprioceptive system may be better‐tuned to movements created by active muscular contraction than to passive movements. The objective of the present study was to determine whether accuracy of reproducing hand position is dependent on whether proprioceptive input is obtained via an active or a passive movement.

Method

Thirty‐nine healthy volunteers (mean age (±SD) 24.6 (±3.6) years) participated in the study. Subjects' right hands, which were obscured from view, were acoustically guided to five targets on a digitizer tablet with either an active or passive upper extremity movement. Subjects were then asked to reproduce the targets' location by either reaching to them with the unseen hand or by use of a laser beam. Distance from target and angular deviations were calculated in both absolute and relative terms. Repeated measures analysis of variance (ANOVA) was performed for each variable followed by predetermined contrasts.

Results

Comparison between the active and passive conditions when reconstruction of target location was guided kinaesthetically indicates significant differences in absolute distance, range and angular deviation. The comparison when reconstruction of target location was guided visually indicates significant differences in absolute distance, absolute angle and angular deviation.

Conclusions

The ability to reproduce hand position accurately is enhanced when position is encoded by active upper extremity movement compared with passive movement. The results have implications for the design of strategies for evaluating as well as treating patients with impaired proprioception and limited movement. Copyright © 2001 Whurr Publishers Ltd.
Effect of elbow flexion contractures on the ability of people with C5 and C6 tetraplegia to lift
Authors: Harvey Lisa , Crosbie Jack
Published: March 2006

Background and Purpose

It is commonly assumed that minor elbow flexion contractures prevent people with C5–C6 tetraplegia and paralysis of the triceps brachii muscles from bearing full body weight through their upper limbs. The aim of the present study was to determine the effect of simulated bilateral elbow flexion contractures on the ability of these individuals to bear weight through their upper limbs and to determine whether full passive elbow extension is truly critical for lifting body weight.

Method

A biomechanical study was performed. Body weight lifted was measured under conditions that simulated bilateral elbow flexion contractures. Five people with motor complete C6 tetraplegia and one person with motor complete C5 tetraplegia, all with bilateral paralysis of the triceps brachii muscles, were recruited to the study. Subjects were fitted with bilateral elbow splints that restricted elbow extension but did not restrain elbow flexion nor prevent the elbow from collapsing, and were seated on an instrumented platform that measured vertical forces under the buttocks. Subjects pushed down through their hands and lifted under five different conditions, namely: with no elbow splints; with bilateral elbow splints adjusted to restrict elbow extension by 5–10°; by 15–20°; by 25–30° and with bilateral elbow splints adjusted to allow unrestricted movement of the elbow joint. Maximal weight lifted from under the buttocks, for each condition, was expressed in relation to weight under the buttocks during unsupported sitting (that is, ‘seated body weight’).

Results

Subjects lifted progessively less weight from under their buttocks as passive elbow restriction was progressively restricted. However, one subject lifted all his seated body weight when elbow extension was restricted by 5–10° and another lifted all his seated body weight when elbow extension was restricted by 5–10° and 15–20°.

Conclusions

Minor elbow flexion contractures will not alone prevent people with tetraplegia and paralysis of the triceps brachii muscles from lifting. Full passive elbow extension is not critical for the performance of this task. Copyright © 2001 Whurr Publishers Ltd.
Concurrent validity of the NK hand dexterity test
Authors: MacDermid Joy C , Mulè Mary
Published: March 2006

Background and Purpose

The present study evaluated the concurrent validity of the NK hand dexterity test (NKHDT) by use of three separate analyses: (1) the correlation between the NKHDT and a criterion comparator (Jebson's Hand Function Test (JHFT)); (2) the correlation between both dexterity tests and a patient‐rated function questionnaire; and (3) the ability of subscales to differentiate between subjects with and without upper extremity pathology.

Method

The study population included 40 individuals with a variety of musculoskeletal problems affecting the upper extremity and 10 individuals without any history of upper extremity problems. Both dexterity tests were administered on a single occasion according to a standard protocol. Subjects also completed a rating scale which evaluated self‐care, household work, work and recreation on an 0–10‐point scale.

Results

The validity of the NKHDT was supported in all three analyses because: (1) the correlation between the NKHDT and JHFT subtests was moderate to strong (Pearson's r=0.47–0.87) and stronger when the objects were more similar in size; (2) both scales correlated to a similar extent with patient‐rated function (Pearson's r=–0.34–0.67); and (3) all subscales were statistically different between subjects with and without upper extremity pathology (p<0.01).

Conclusions

The present study supports the use of the NKHDT as a measure of hand dexterity. Copyright © 2001 Whurr Publishers Ltd.
Vertical anthropometric measures and low back pain in adolescents
Authors: Steele Samuel , Grimmer Karen , Williams Marie , Gill Tiffany
Published: March 2006

Background and Purpose

The present paper explores aspects of a large dataset of adolescent potentiates of low back pain. Standing, trunk and shoulder height, subischial height, weight and mean leg length are examined in relation to reports of low back pain in the last two weeks, in strata of age and gender.

Method

The present study examined 1254 adolescents, aged 11–18 years, drawn from 12 Adelaide public high schools during 1998.

Results

At each year of age, girls reported significantly more low back pain than boys. Girls and boys at each year of age provided different relationships between low back pain and anthropometric features, highlighting the unique nature of adolescent growth. The most consistent findings were anthropometric differences between 16‐year‐old boys, and 13‐ and 15‐year‐old girls, with and without low back pain, who may be at critical stages of the peak growth curve.

Conclusion

We suggest a high prevalence of low back pain in adolescents, and that young sufferers with low back pain may be reflecting attributes of their stage of anthropometric growth. Copyright © 2001 Whurr Publishers Ltd.
Manual hyperinflation: consistency and modification of the technique by physiotherapists
Authors: Patman Shane , Jenkins Sue , Smith Kate
Published: March 2006

Background and Purpose

The present study aimed to evaluate the consistency with which physiotherapists apply manual hyperinflation to a test lung using the Air‐Viva‐2 or Mapleson‐B resuscitation circuit, and their ability to modify the technique as pulmonary characteristics change.

Method

A quasi‐experimental, randomized, repeated‐measures design was used to study 16 volunteer physiotherapists performing manual hyperinflation to a test lung simulating three clinical situations. Each subject applied manual hyperinflation to the test lung for each simulation three times in one day using the resuscitation circuit that they would normally use in their clinical practice. Eight subjects used the Air‐Viva‐2 circuit and eight used the Mapleson‐B circuit. Measurements of tidal volume (VT), peak airway pressure (Paw) and fraction of delivered oxygen (FDO2) were recorded during each testing period. Inflation rate and minute volume were calculated.

Results

As compliance decreased and airway resistance increased, VT decreased and Paw increased. Of the eight subjects using the Air‐Viva‐2 circuit, only three subjects delivered greater than 0.80 FDO2. All subjects using the Mapleson‐B circuit delivered greater than 0.85 FDO2.

Conclusions

Subjects demonstrated good consistency in the application of manual hyperinflation for all three simulations and modified their technique appropriately as simulated pulmonary characteristics changed. Copyright © 2001 Whurr Publishers Ltd.
Validity of the EK scale: a functional assessment of non‐ambulatory individuals with Duchenne muscular dystrophy or spinal muscular atrophy
Authors: Steffensen Birgit , Hyde Sylvia , Lyager Søren , Mattsson Eva
Published: March 2006

Background and Purpose

The EK scale comprises ten categories (EK 1–10), each contributing to an overall picture of function in the non‐ambulatory stage of Duchenne muscular dystrophy (DMD). The purpose of the present study was to investigate content and construct validity of the EK scale as a tool to discriminate between levels of functional ability in individuals with DMD or spinal muscular atrophy (SMA) who were non‐ambulatory.

Method

Data from a sample of 56 subjects with DMD and 38 with SMA, who were non‐ambulatory, were obtained from four separate studies. The relationship of functional ability by use of the EK scale and (1) muscle strength, (2) contractures, (3) forced vital capacity and (4) years of wheelchair dependency were assessed. All items of the EK scale were used except the one representing severe hypoventilation.

Results

Regression analyses showed that the EK sum was the most significant explanatory variable (p<0.05) of all variables measured to explain muscle strength in both DMD and SMA subjects. The individual categories of EK (1–10) all contributed as significant explanatory variables (p<0.05) to the other variables measured.

Conclusions

The categories and items of the EK scale were relevant and valid as means of discriminating between levels of functional performance in the population studied which was evidence of content and construct validity. Copyright © 2001 Whurr Publishers Ltd.
The recovery of walking ability and subclassification of stroke
Authors: Baer Gillian , Smith Mark
Published: March 2006

Background and Purpose

The recovery of walking after a stroke is a key functional goal for many patients. Reports vary, but approximately 50–80% of patients will regain some degree of walking ability following stroke (Skilbeck et al., 1983). There are few data available to show whether different subclassifications of stroke have distinct patterns of gait recovery. The present paper describes the pattern of walking recovery in a population of stroke patients classified according to the Oxfordshire Community Stroke Project classification (Bamford et al., 1991).

Method

A prospective observational study. Stroke patients (n=238) admitted to the inpatient Stroke Rehabilitation Unit at the Western General Hospital, Edinburgh were initially included, with data for 185 patients ultimately available for analysis. Standardized measures of recovery of 10 steps and a 10‐metre walk were used routinely to examine recovery time of walking ability. The main outcome measures consisted of days taken to achieve a 10‐step walk, days to achieve a 10‐metre walk, and initial and discharge gait velocity over 10 metres.

Results

Eighty‐nine per cent of the sample (n=164) achieved a 10‐step walk in a median time of five days and a 10‐metre walk in eight days. The median initial gait velocity was 0.45 m/s which improved by discharge to 0.55 m/s. Further analysis by subgroup revealed that subjects sustaining a partial anterior circulation infarct, lacunar infarct or posterior circulation infarct recovered significantly more quickly than those subjects with a total anterior circulation infarct (Kruskal Wallis test for days to achieve 10 steps (H = 22.524, N = 164, df = 3) p<0.001; Kruskal Wallis test for days to achieve a 10‐metre walk (H = 22.586, N = 164, df = 3) p<0.001.

Conclusions

An hierarchical pattern of recovery of gait was observed with definite variation between the subclassifications of stroke. It is suggested that further work needs to be undertaken to identify more accurately the factors that may influence the recovery of walking following stroke. Copyright © 2001 Whurr Publishers Ltd.