bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of measurement protocol on active cervical motion in healthy subjects
Authors: Dvir Zeevi , Werner Victoria , Peretz Chava
Published: March 2006

Background and Purpose

Although the assessment of cervical motion is routinely performed in clinical practice, no standard protocol for this procedure has ever been established formally. The specific aim of the present study was to select from four different measurement protocols the one which was most stable in terms of reproducibility and was appropriate for clinical and/or medicolegal applications.

Method

A repeated measurement, test–retest of cervical motion study design using an ultrasound‐based system for three‐dimensional (3D) motion analysis; cervical range of motion was measured along the six primary directions: flexion; extension; right and left rotation; and right and left lateral flexion, in 20 healthy subjects who were tested twice over a period of lasting from one to four weeks. ‘Protocol A’ (reciprocal–intermittent testing) consisted of moving the head along a given primary direction, return to the neutral position, a pause and then motion to the opposite primary direction and return to neutral position. These movements were repeated three times. ‘Protocol B’ (reciprocal–continuous testing) was identical to Protocol A, but without the pause between the primary directions. ‘Protocol C’ consisted of three repetitions of the same primary direction with a break between two consecutive primary directions. Three sets of six randomly ordered primary directions constituted ‘Protocol D’.

Results

Protocol D was associated with a significantly smaller range of motion and with the least intra‐test reproducibility, as indicated by the coefficient of variation. The differences between the other protocols were largely negligible.

Conclusion

In routine clinical practice, either of protocols A, B or C may be applied. Copyright © 2002 Whurr Publishers Ltd.
Reliability of detecting ‘onset of pain’ and ‘submaximal pain’ during neural provocation testing of the upper quadrant
Authors: Coppieters Michel , Stappaerts Karel , Janssens Koen , Jull Gwendolen
Published: March 2006

Background and Purpose

Conflicting results have been reported with regard to the reliability of neural tissue provocation tests and it is unclear whether repeated testing affects the test results. In the present study, the stability and reliability of the occurrence of ‘onset of pain’ and ‘submaximal pain’ throughout the range of motion during neurodynamic testing was analysed, in both a laboratory and a clinical setting.

Method

A repeated‐measures study design within and between sessions was used. In the laboratory and clinical settings, the base neurodynamic test for the median nerve was performed during a single session on a total of 27 patients with neurogenic cervico‐brachial pain. In addition, the base test and three common variations were performed on two occasions by two examiners on 10 asymptomatic subjects in laboratory conditions only. Patients indicated the moment of ‘submaximal pain’ occurrence, whereas asymptomatic subjects indicated ‘onset of pain’ and ‘submaximal pain’. Corresponding angles at the elbow were recorded by use of an electrogoniometer.

Results

In the asymptomatic group, the intra‐ and inter‐tester reliability within the same session was excellent (intraclass correlation coefficient (ICC2,1 ≥ 0.95; standard error of measurement (SEM) ≤4.9°). Reliability after a 48‐hour interval was moderate (ICC2,1 ≥ 0.69; SEM ≤ 9.9°). The reliability coefficients for the symptomatic group within the same session were comparable with the excellent results of the asymptomatic group, for both the laboratory (ICC2,1 = 0.98; SEM = 2.8°) and clinical settings (ICC2,1 ≥ 0.98; SEM ≤ 3.4°). Consequently, from a statistical perspective, improvements in range of motion as small as approximately 7.5° may be interpreted meaningfully. No significant trend due to repeated testing could be observed when three consecutive repetitions were analysed.

Conclusions

Pain provocation during neurodynamic testing is a stable phenomenon and the range of elbow extension corresponding with the moment of ‘pain onset’ and ‘submaximal pain’ may be measured reliably, both in laboratory and clinical conditions. Copyright © 2002 Whurr Publishers Ltd.
An evaluation of a single chest physiotherapy treatment on mechanically ventilated patients with acute lung injury
Authors: Barker Michael , Adams Sally
Published: March 2006

Background and Purpose

Acute lung injury is a lung pathology that presents frequently on the intensive care unit. Chest physiotherapy, in the form of endotracheal suction, alternate side‐lying and manual hyperinflation, is usually given to patients with this condition with the intention of removing retained pulmonary secretions and recruiting collapsed distal lung units. Despite this common practice there is insufficient research on the effects of chest physiotherapy in patients with acute lung injury being ventilated mechanically. The aim of the present study was to further understanding of the effects of three modes of treatment in chest physiotherapy in an acute lung injury patient group.

Method

This randomized, controlled trial investigated all mechanically ventilated patients with acute lung injury admitted to the adult intensive care unit at Guy's and St Thomas' NHS Trust between August 1996 and July 1997, who matched the inclusion criteria. Patients were randomized into one of three treatment groups: Group 1 (suctioned only); Group 2 (positioned and suctioned); and Group 3 (positioned, manually hyperinflated and suctioned). Baseline and 10, 30 and 60 minutes' post‐treatment data were recorded for dynamic pulmonary compliance, arterial blood gases and haemodynamic variables. Results were analysed by use of an SPSS software package with a repeated‐measures analysis of variance (ANOVA).

Results

Eighteen patients fitted the inclusion criteria. Significant changes were observed in both PaCO2 (p = 0.026) and dynamic compliance (p = 0.019) over time for all three groups. The arterial oxygen to fraction of inspired oxygen ratio (PaO2:FiO2) did not alter significantly in any of the groups. With respect to other oxygenation parameters, mixed venous oxygen saturation (SvO2) showed a significant difference between the groups. Heart rate (HR) and systemic blood pressure (BP) showed statistically significant, but not clinically significant differences over time.

Conclusions

Patients with acute lung injury are notably complex to nurse and may require protracted physiotherapy intervention, which may take many forms. As de‐recruitment was the single most important event that occurred in the present study population, a prescriptive chest physiotherapy approach to treating mechanically ventilated patients with acute lung should be questioned and adapted accordingly. Copyright © 2002 Whurr Publishers Ltd.
Physiotherapists' use of touch in inpatient settings
Authors: Roger John , Darfour Daniel , Dham Anil , Hickman Orit , Shaubach Laura , Shepard Katherine
Published: March 2006

Background and Purpose

Although touch is a basic element in the practice of physiotherapy, no research has been done to establish the type and purpose of practitioner touch in clinical settings. The purpose of the present study was to determine how physiotherapists use touch in inpatient acute and rehabilitation settings.

Method

Fifteen physiotherapists with three or more years' experience were videotaped treating two to three patients. The participant physiotherapists reviewed a videotape of themselves and described the types of touch used and their intent behind each touch. Cross‐case analysis was used to determine common themes in the descriptions. Mutually exclusive categories of touch were then refined, based on the cases.

Results

The most common types of touch used by physiotherapists included assistive touch, touch used to prepare the patient, touch to provide information, caring touch, touch to provide a therapeutic intervention, and touch used to perceive information. The physiotherapists also used 33 different combinations of touch, that is, a single touch used for more than one purpose.

Conclusions

Inpatient physiotherapists clearly perform in a ‘high touch’ arena. Clinical experience was reported as the strongest factor in developing the physiotherapists' sensitivity to patient needs and their skill in using specific types of touch. Further research is needed concerning the way patients perceive and respond to the presence or absence of these various forms of practitioner touch. Copyright © 2002 Whurr Publishers Ltd.
Short‐wave diathermy: current clinical and safety practices
Authors: Shields Nora , Gormley John , O'Hare Neil
Published: March 2006

Background and Purpose

Short‐wave diathermy (SWD) is widely available, yet a comprehensive examination of current clinical practice remains absent from the literature. The present paper aims to assess clinical and safety issues in continuous (CSWD) and pulsed (PSWD) short‐wave diathermy application and subsequently indicate areas for future research.

Method

A postal survey was carried out among 116 senior physiotherapists in 41 Irish hospital‐based physiotherapy departments.

Results

The response rate to the study was 75%. Analysis found that PSWD was the preferred mode of treatment with 27% of respondents using it more than once daily. Respondents considered both modes of treatment indicated for a variety of conditions. CSWD was rated as an effective treatment for chronic osteoarthritis, polyarthritis, non‐specific arthrosis and haematomas. PSWD was reported an effective modality for acute soft tissue injury, haematomas, acute osteoarthritis, sinusitis and rheumatoid arthritis. Dose selection varied greatly but tended to be based on the type, nature and duration of the condition. Analysis of safety practices uncovered concerning findings. Although a high level of agreement was found on measures for patient safety, 30% of respondents reported that no measures for operator safety were taken and only five respondents stated they remained a specified distance from SWD equipment. Measures to ensure the safety of other personnel in the physiotherapy department were also lacking.

Conclusions

Given the availability of SWD equipment and its apparent efficacy in certain conditions, future research should aim to establish this by means of controlled clinical trials. The findings on safety practices underline the urgent need for comprehensive guidelines to ensure the safety of operators, patients and the general public during SWD application. Copyright © 2002 Whurr Publishers Ltd.
Low back pain in individuals with chronic airflow limitation and their partners — A preliminary prevalence study
Authors: Synnot Anneliese , Williams Marie
Published: March 2006

Background and Purpose

The prevalence of low back pain in individuals with chronic airflow limitation, and their partners, is unknown. Individuals with chronic airflow limitation, and their respective partners, are likely to have several risk factors that may increase the predisposition for low back pain. The aim of the present study was to provide preliminary data on the prevalence of low back pain in individuals with chronic airflow limitation, and their partners.

Method

A cross‐sectional observational study design was used. Individuals with chronic airflow limitation, and their partners, were approached at South Australian metropolitan Lung Support Group meetings and invited to participate in the study. Three commonly used questionnaires: theMedical Outcomes Survey Short‐Form 36(MOS SF‐36); theSt George's Respiratory Questionnaire(SGRQ); and the Nordic Low Back Pain Questionnaire (NLBPQ) were used to collect data on general health, respiratory health and low back pain prevalence, respectively. Odds ratios and independent Student'st‐tests were used to analyse data by use ofEpi Info Version 6.0software.

Results

Sixty subjects participated in the study: 41 individuals with chronic airflow limitation and 19 partners of individuals with chronic airflow limitation. The lifetime, 12‐month and seven‐day prevalence of low back pain in individuals with chronic airflow limitation was 69%, 58% and 31%, respectively. The prevalence of low back pain in the partners of individuals with chronic airflow limitation was found to be higher, at 74%, 68% and 58 %, respectively. Four significant relationships between general and respiratory health, and low back pain were demonstrated for individuals with chronic airflow limitation.

Conclusions

The prevalence of low back pain in individuals with chronic airflow limitation was comparable to the lifetime prevalence for the general and older population, and greater than the 12‐month prevalence reported for the older population. The prevalence of low back pain for the partners of individuals with chronic airflow limitation was consistently higher than the lifetime and 12‐month prevalence reported for individuals with chronic airflow limitation, the older population and family care workers. These findings suggest a larger prevalence study of low back pain in individuals with chronic airflow limitation, and their partners, is warranted. Copyright © 2002 Whurr Publishers Ltd.
Intra‐tester reproducibility of pressure biofeedback in measurement of transversus abdominis function
Authors: Storheim Kjersti , Bø Kari , Pederstad Olav , Jahnsen Reidun
Published: March 2006

Background and Purpose

Strength, co‐ordination and timing of transversus abdominis muscle contraction may be important in stabilizing the low back, and contraction of this particular abdominal muscle may be one factor capable of preventing and reducing low back pain in sport and in activities of daily living. The function and strength of the transversus abdominis muscle is difficult to measure. The pressure biofeedback unit (PBU) is a device designed to teach and measure transversus abdominis muscle function. The purpose of the present study was to evaluate intra‐tester reproducibility of the PBU.

Method

The study used a test–retest design. Fifteen healthy subjects (mean age 22.2 years, range 19–28 years) with no history of low back pain participated in the study. After two sessions of practising transversus abdominis muscle contraction, its function was measured in prone position with the PBU device placed over the transversus abdominis muscle. Subjects were instructed to draw in the abdominal wall (for example, lifting it away from the device) after a standardized procedure. Two tests were conducted on two different days, with a seven‐day interval inbetween.

Results

Coefficient of variance (CV) was 21.0% and the standard deviation (SD) of Δ was 1.59.

Conclusion

The use of the PBU should be improved for scientific purposes. However, the device may have a role in providing biofeedback to assist in the instruction of correct transversus abdominis muscle contraction. Copyright © 2002 Whurr Publishers Ltd.
Long term effects of exercise training on physical activity level and quality of life in elderly coronary patients — A three‐ to six‐year follow‐up
Authors: Hage Camilla , Mattsson Eva , Ståhle Agneta
Published: March 2006

Background and Purpose

Physical activity and exercise as part of cardiac rehabilitation after an acute coronary event improves exercise capacity and quality of life in most patients. The aim of the present study was to evaluate physical activity level, health‐related quality of life (HRQL) and perceived health three to six years after an acute myocardial infarction or an episode of unstable angina pectoris in elderly patients and compare this to earlier follow‐up examination data.

Method

Study design: three to six years (mean 4.4 years) after randomization a questionnaire about physical activity level, HRQL and perceived health was mailed to all subjects alive (n = 93) (response rate 96

Results

Since the one‐year follow‐up examination eight subjects had died: five in the intervention group and three in the control group. At randomization, the level of physical activity level was similar in the two groups. Those in the intervention group improved their level of physical activity significantly over time (p = 0.05) in contrast to the control group. Measurements of HRQL showed no statistical difference between the groups by use of the EuroQol instrument. However, a small advantage for the intervention group measured over time was noted.

Conclusion

It is important to include elderly patients in cardiac rehabilitation programmes after an acute coronary event, since even a short period of supervised exercise training has the potential to positively influence physical activity level for as long as three to six years. Copyright © 2003 Whurr Publishers Ltd.
Perceived pain and self‐estimated activity limitations in women with back pain post‐partum
Authors: Nilsson‐Wikmar Lena , Pilo Christina , Pahlbäck Margareta , Harms‐Ringdahl Karin
Published: March 2006

Background and Purpose

In the general population many daily activities have an impact on low back pain. The aim of the present study was to describe pain intensity, localization, type of sensation and perceived activity limitation in women with different back pain patterns post‐partum.

Method

In this cross‐sectional survey 119 women with back pain persisting for two months after having given birth were interviewed and examined on average 7.2 months (range 6–10 months) post‐partum. Based on pain provocation tests, four different back pain pattern groups were identified. Pain could be provoked in the area of the posterior pelvic/sacroiliac joints, in the lumbar spine, both in the posterior pelvic/sacroiliac joints and in the lumbar spine, and in none of the above areas. All women rated pain intensity on a visual analogue scale (VAS, 0–100 mm), and the pain localization and type of sensation were indicated on a pain drawing. They scored their activity limitations by use of the Disability Rating Index (DRI), which covers 12 daily activity items (VAS, 0–100 mm).

Results

There was no significant difference (p = 0.12) in pain intensity (range of medians 19.5–10 mm) between the four groups. However, on average, most areas in the lower back (median 5 mm (range 2–14 mm)), were marked in the group with pain in both the posterior pelvic/sacroiliac joints and in the lumbar spine. The women in the three groups where pain was provoked in the lower area of the back had significantly (p < 0.01) more difficulties with movement‐related daily activities than the group where no pain could be provoked.

Conclusions

The findings of this descriptive study suggest that back pain post‐partum provoked by clinical tests considerably hampers movement‐related activities. It seems important to pay special attention to the women where pain could be provoked in the lower back areas. The women should be identified early in the post‐partum period to initiate adequate treatment. Copyright © 2003 Whurr Publishers Ltd.
Dynamic ankle–foot orthoses as a part of treatment in children with spastic diplegia — Parents' perceptions
Authors: Näslund Annika , Tamm Maare , Ericsson Ann Kristin , Wendt Lennart von
Published: March 2006

Background and Purpose

Dynamic ankle–foot orthoses (DAFOs) are often recommended for children with spastic diplegia in order to facilitate better function. The aim of the present study was to explore how the parents of children with diplegic cerebral palsy experience the use of DAFOs.

Method

A qualitative interview study with a broad research question: ‘How do you perceive that DAFOs influence your child?’ The parents of 15 children, aged 4–18 years, who all had spastic diplegia and wore DAFOs were interviewed.

Results

Content analysis resulted in the following categories: ‘Physical effects’; ‘New functions and activities’; ‘The orthosis as a part of the treatment’; ‘Opportunity for independence and play’; and ‘Problems with DAFOs’. According to the parents, DAFOs appeared to contribute to the (mechanical) changes in posture affecting the muscular system. They meant that when wearing DAFOs the foot and ankle are more stable. This in turn enables postural control and alignment, contributing to functional activities under more favourable physiological conditions. The psychosocial effects were regarded by parents as being just as important as the physical effects.

Conclusion

In clinical practice, DAFOs may (according to parents) be regarded as a suitable complement to other treatments in children with diplegic cerebral palsy. Copyright © 2003 Whurr Publishers Ltd.
Performance after surgical treatment of patients with ankle fractures — 14‐month follow‐up
Authors: Nilsson Gertrud , Nyberg Per , Ekdahl Charlotte , Eneroth Magnus
Published: March 2006

Background and Purpose

Few studies have been published that extensively evaluate physical outcome after ankle fractures. In addition, there is a lack of knowledge of how physical outcome correlates with subjective assessments of symptoms and function after ankle fracture. The purpose of the present study was to investigate outcome after surgical treatment of patients with ankle fracture and to study how well the experience of symptoms and function correlated with the results of clinical physical tests.

Method

The study used a retrospective cross‐sectional study design. Fifty‐four patients, aged 17–64 years, were evaluated 14 months post‐operatively. Evaluation included a questionnaire containing the Olerud–Molander Ankle Score (OMAS) (Olerud and Molander, 1984) and some additional questions. Patients were also called for a physical and radiographic examination.

Results

The median OMAS obtained was 75 (range 10–100). Only 10 (19%) of the patients reported complete recovery and 16 (30%) scored ≥90, indicating good function. The results of the following clinical tests were correlated with OMAS: loaded dorsal extension; ankle circumference; number of toe and heel rises; and single‐limb stance. Those who showed poorer results in physical outcome on the affected side had lower OMAS. No ankles with clear mechanical instability were found, although almost half the patients experienced functional instability that, in turn, was associated with decreased total OMAS.

Conclusions

Both subjectively scored function and physical performance after surgically treated ankle fractures indicated poor results. One reason for this might be insufficient rehabilitation. Copyright © 2003 Whurr Publishers Ltd.
Knee pain in the ACL‐deficient osteoarthritic knee and its relationship to quality of life
Authors: Hartwick Michael , Meeuwisse Willem , Vandertuin Jacqueline , Maitland Murray
Published: March 2006

Background and Purpose

Pain during activities of daily living is a common presenting complaint of individuals with knee osteoarthritis and anterior cruciate ligament injury. Knee pain is also associated with a decrease in quality of life for people with osteoarthritis. The purpose of the present study was to examine the dose–response relationship between knee joint forces and painful symptoms, and whether the acute symptoms, were associated with individuals' quality of life.

Method

This was a cross‐sectional cohort correlation study. Seventeen individuals with anterior cruciate ligament (ACL)‐deficient knees diagnosed with ipsilateral knee osteoarthritis completed the ACL quality of life questionnaire (ACL‐QOL). The subjects also rated pain associated with each of five incremental isometric knee extension tests, proportional to their body weight. Analysis of variance was used to assess the association between pain and normalized torque. Linear regression was used to assess the correlation between the ACL‐QOL score and the total pain experienced during the graded test.

Results

A strong relationship was found between the level of perceived knee pain and the amount of isometric torque produced (Pearson's r = 0.98; p<0.001). There was a statistically significant relationship between pain during the graded isometric test and the ACL‐QOL (Pearson's r = −0.56; p = 0.016).

Conclusions

Since knee joint compression is a function of active isometric knee extension torque, increased painful symptoms were associated with increased compression forces at the knee joint for these subjects. The relationship between pain provocation and disease‐specific quality of life provides evidence for the proposed joint provocation test for this subject population. Weakness caused by osteoarthritis (OA) may, in part, be a negative conditioning response that would need to be overcome in rehabilitation. Copyright © 2003 Whurr Publishers Ltd.
Retest reliability of dynamic balance during standing in older people after surgical treatment of hip fracture
Authors: Dodd Karen , Hill Keith , Haas Romi , Luke Carolyn , Millard Stephanie
Published: March 2006

Background and Purpose

Computerized force platform systems are becoming more widely used in clinical practice to measure balance control; however, their retest reliability has not been documented in people with hip fracture. The present study examined the retest reliability of dynamic weight shift during standing in older people after surgical treatment of hip fractures.

Method

This single group test–retest research design employed a computerized force platform system (the Neurocom Pro‐Balance Master; PBM) to measure the amplitude and symmetry of weight shift in 14 patients with unilateral hip fracture on three test occasions held one hour and 24 hours apart. Subjects performed six trials of a forward–backward and side‐to‐side weight shift task at each test session.

Results

The results showed that reliability was, at best, moderate for forward–backward and side‐to‐side weight shift measures taken over an hour and over a day.

Conclusions

Clinicians should be cautious when using the computerized balance assessment procedures investigated in this study to assess change in dynamic balance ability in older people during the early stages of rehabilitation after surgical treatment of hip fractures. Copyright © 2003 Whurr Publishers Ltd.
Cryotherapy after total knee replacement: a survey of current practice
Authors: Barry Simon , Wallace Louise , Lamb Sarah
Published: March 2006

Background and Purpose

Cryotherapy is commonly used during physio‐therapeutic rehabilitation after total knee replacement (TKR). Evidence for treatment effectiveness is contradictory and there are no clinical guidelines to inform treatment protocols within this patient group. The present survey investigated current cryotherapy practice after TKR throughout the United Kingdom (UK).

Method

A postal survey, containing open and closed questions, was distributed to senior inpatient orthopaedic physiotherapists (n = 453).

Results

The response rate was 67% (304/453) and 58% (263/453) of the responses were completed by physiotherapists who treated TKR patients in the acute phase. Of these, 33% (85/263) routinely applied some form of cryotherapy after TKR. Physiotherapists working in the private sector were more likely to use cryotherapy and had greater access to Cryocuff equipment. The two main methods of cryotherapy application were the Cryocuff device, 59% (155/263) and crushed ice, 30% (79/263). Treatments were applied most frequently between 24 and 48 hours post‐surgery, for 20 minutes, twice a day. Lack of proven efficacy was the most frequently stated reason for not applying cryotherapy treatment, and swelling was the most common indicator for treatment. There was particular uncertainty about the physical management of the Cryocuff device.

Conclusions

There was little consensus with regard to treatment indicators, method of application and the management of cryotherapy after TKR. The results highlight a lack of consistency in the application of cryotherapy after TKR, indicating a need for further research. Copyright © 2003 Whurr Publishers Ltd.
The effect of task uncertainty on muscle activation patterns in 8–10‐year‐old children
Authors: Woo Eunice , Burns Yvonne , Johnston Leanne
Published: March 2006

Background and Purpose

Postural muscle activity accompanying voluntary arm movements has been researched extensively in adults; however, few studies of this kind have been conducted with children. It is not clear whether children respond like adults to internal perturbations, and if so, whether this response is similar across a variety of task conditions. The aims of the present study were to determine the postural muscle activity demonstrated by 8–10‐year‐old children when performing a rapid shoulder flexion movement and to compare the pattern produced under simple reaction‐time versus complex reaction‐time conditions.

Method

Fifteen children with typical motor development participated in this comparative design study. The activity of anterior deltoid and contralateral rectus abdominis, internal oblique, erector spinae, rectus femoris, biceps femoris, tibialis anterior and gastrocnemius muscles was recorded via surface electromyography (EMG). Two tasks were performed: a simple task involving a right shoulder flexion movement; and a complex task involving a right or left shoulder flexion movement. Reaction time (RT) and movement time (MT) of the arm action were also recorded.

Results

Muscle latencies in the complex task were longer than those for the simple task, although only the gastrocnemius muscle showed a significant difference (p = 0.013). Reaction time was also significantly later in the complex task (p = 0.003). Movement time was not significantly different between conditions.

Conclusions

A decrease in task certainty delayed postural muscle activation and reaction time in children aged 8–10 years. The study also demonstrated that children in this age group utilized a mixed postural strategy rather than a proximal‐to‐distal or distal‐to‐proximal pattern, reported in adult studies. Movement time remained unchanged. Copyright © 2003 Whurr Publishers Ltd.
Effect of manual hyperinflation on haemodynamics in an animal model
Authors: Anning Luke , Paratz Jennifer , Wong Wai Pong , Wilson Kathleen
Published: March 2006

Background and Purpose

Manual hyperinflation is a physiotherapy technique that improves static compliance and mobilizes secretions, but has the potential to alter haemo‐dynamic function. The aim of the present study was to investigate the effects of manual hyperinflation on haemodynamic function in a healthy animal model, without the usual confounding effects inherent in an heterogeneous intensive care population.

Method

The study used a within‐subjects design, in an animal research theatre. Nine healthy sheep (eight Border Leicester, one Merino, mean weight 39.5 kg, standard deviation (SD) 1.6 kg) completed the study. The sheep were induced (thiopentane 15–20 ml), intubated, ventilated and surgically instrumented for an arterial line and pulmonary artery catheter. Anaesthesia was maintained by 1.5% halothane/oxygen. Manual hyperinflation was delivered for two minutes with a Mapleson C circuit, using a peak inspiratory pressure of 35cmH2O and an inspiratory:expiratory ratio of 2:1.

Results

Mean tidal volume during manual hyperinflation was 294% (SD 22%) of the ventilator tidal volume. A paired Student's t‐test demonstrated that cardiac output (thermodilution method) decreased significantly (p<0.05) and systemic vascular resistance increased significantly (p<0.01) after manual hyperinflation. A repeated‐measures analysis of variance (ANOVA) and a least‐significant difference pairwise comparison revealed that mean arterial pressure and pulse pressure decreased significantly during (p<0.01) and increased significantly (mean arterial pressure, p<0.05 and mean pulse pressure p<0.001) after the technique. Pulmonary artery pressure also increased significantly during manual hyperinflation (p<0.01). There were no significant effects on right atrial pressure, pulmonary artery occlusion pressure or heart rate.

Conclusion

Significant haemo‐dynamic changes occurred in this animal model. The increased intrathoracic pressure, applied for an increased period during inspiration, decreased cardiac output with compensatory vasoconstriction evident by the increased systemic vascular resistance and mean arterial pressure. The results suggest that there may be a decrease in cardiac output after increased positive pressure in subjects with normal cardiac and respiratory function. Copyright © 2003 Whurr Publishers Ltd.
Living with chronic renal failure: patients' experiences of their physical and functional capacity
Authors: Heiwe Susanne , Clyne Naomi , Dahlgren Madeleine Abrandt
Published: March 2006

Background and Purpose

Several studies have shown that patients with chronic renal failure have reduced physical exercise capacity compared with the expected norm. There are, however, few qualitative studies showing ways in which patients experience their condition in terms of physical and functional capacity, and the limitations this imposes on their daily lives. The aim of the present study was to describe and analyse ways in which patients with chronic renal failure, in the pre‐dialysis phase and patients undergoing haemodialysis or peritoneal dialysis, experienced their physical and functional capacity in their daily lives.

Method

Semi‐structured interviews were used to collect data, which were then analysed according to a contextual analysis within a phenomenographic approach.

Results

Analysis yielded a system of categories describing patients' experiences of mental and physical fatigue, physical and functional capacity, in terms of effect on performance and endurance, and their experience of temporal stress, in terms of lack of time as well as lack of peace in their daily lives.

Conclusions

The results of the study will contribute to our understanding of how these patients experience their daily lives, and will help when meeting patients with chronic renal failure. This knowledge enables physiotherapists to focus rehabilitation training on problem areas that are important to patients themselves. Copyright © 2003 Whurr Publishers Ltd.
Forceplate and accelerometer measures for evaluating the effect of muscle fatigue on postural control during one‐legged stance
Authors: Adlerton Anna‐Karin , Moritz Ulrich , Moe‐Nilssen Rolf
Published: March 2006

Background and Purpose

The control of balance is vital in many sporting activities as well as in activities of daily life. In order to treat deficiencies properly valid and reliable methods are needed to evaluate different aspects of stability. Muscle fatigue has been proposed to cause a change in postural control strategy, and the use of different tools and variables might therefore elucidate these changes. The aims of the present study were: to investigate if forceplate and accelerometer measurements about postural control during one‐legged stance indicate changes in postural control strategy after fatiguing exercise; and to investigate the correlation between forceplate and accelerometer measurements obtained before and after fatiguing exercise.

Method

The study used an experimental design. Twenty‐three healthy women (mean age 26.8 years; range 20–34 years) were studied. Forceplate and accelerometer data were obtained simultaneously and consisted of measures of centre of pressure movements and horizontal trunk acceleration in medio‐lateral and antero‐posterior directions. The calf muscles of the right leg were fatigued by repeated heel rises.

Results

The average amplitude of centre of pressure movements and trunk acceleration increased, whereas the average velocity of centre of pressure movements decreased during fatigue. These changes indicate a change of movement strategy. Moderate correlation between trunk acceleration and centre of pressure movements was seen, confirming the link between the variables, but indicating that different aspects of the ability to control balance were measured.

Conclusions

Calf muscle fatigue has a short‐lasting effect on body balance, with measurements indicating a change in postural control strategy. Different tools and variables are needed to identify different balance control strategies. The procedures used in the present study may be modified to identify subjects with inadequate capacity to choose between balance control strategies; they are also applicable in clinical settings outside a laboratory environment. Copyright © 2003 Whurr Publishers Ltd.
Goal‐directed upper limb movements by children with and without DCD: a window into perceptuo–motor dysfunction?
Authors: Ameratunga Devini , Johnston Leanne , Burns Yvonne
Published: March 2006

Background and Purpose

Developmental co‐ordination disorder (DCD) occurs in at least 6% of school‐aged children. Researchers agree that motor co‐ordination problems evident in DCD are, in part, the result of perceptual and cognitive processes, but the limited research available remains inconclusive. The present study investigated perceptual–motor abilities, with regard to vision, kinaesthesia and cross‐modal judgement, in children with and without DCD.

Method

A cross‐sectional study design was used. Nine children, aged six years (±six months) with DCD, and nine children without DCD, matched for age and gender, participated in the study. The children were required to point with the preferred hand to a target in three different positions under four sensory conditions, either with or without vision. Three‐dimensional motion analysis was used to investigate trajectory lengths, endpoint error and movement time. The results were analysed using a generalized linear mixed model to examine the systematic effects of group, target position and task.

Results

Compared with children without DCD, the children with DCD produced larger endpoint errors, greater movement times and longer trajectories. Children in both groups produced larger endpoint errors, greater movement times and longer trajectories in non‐visually guided aiming versus visually guided aiming tasks.

Conclusions

Children with DCD moved more slowly, with longer movement trajectories and were less accurate than children without DCD when aiming to all target positions under all sensory conditions. The greatest error and trajectory length occurred for both groups when aiming movements were performed in the absence of vision. As children in the DCD group had difficulties with movement executed under kinaesthetic or visual control, the results indicate that the normal advantage of vision displayed by children without DCD is not apparent, and visual and kinaesthetic problems may be present in children with DCD. Copyright © 2004 Whurr Publishers Ltd.
Attitudes and beliefs of Brazilian and Australian physiotherapy students towards chronic back pain: a cross‐cultural comparison
Authors: Ferreira Paulo H , Ferreira Manuela L , Latimer Jane , Maher Christopher G , Refshauge Kathryn , Sakamoto Ana , Garofalo Rodrigo
Published: March 2006

Background and Purpose

The attitudes and beliefs of physiotherapists and students can potentially influence the outcome of treatment of low back pain. These attitudes and beliefs may be influenced by external factors, such as ethnicity. No study that compared the attitudes and beliefs of physiotherapy students from different cultural backgrounds, such as from Brazil or Australia, towards chronic low back pain was found. The purpose of the present study was therefore to compare the attitudes and beliefs of Brazilian physiotherapy students with those of Australian physiotherapy students and to published data from North American healthcare providers, and to investigate whether a history of chronic low back pain affects students' attitudes and beliefs.

Method

A survey study design was used. Data were collected from 153 Brazilian physiotherapy students and compared with existing data from Australian physiotherapy students who had never been exposed to a chronic low back pain teaching module. Students' attitudes and beliefs were assessed by use of the HC‐PAIRS questionnaire. These data were also compared with published data from North American healthcare providers.

Results

The Brazilian physiotherapy students had significantly higher scores on the HC‐PAIRS questionnaire than the Australian students and the North American healthcare providers. A previous history of chronic low back pain did not affect students' attitudes and beliefs.

Conclusions

As demonstrated by higher HC‐PAIR scores, the Brazilian physiotherapy students agree more strongly with the notion that low back pain justifies disability and activity limitation than do Australian physiotherapy students and North American healthcare providers. A history of chronic low back pain does not affect students' attitudes and beliefs. Copyright © 2004 Whurr Publishers Ltd.
Effect of problem‐based learning on stages of change for exercise behaviour in patients with coronary artery disease
Authors: Kamwendo Kitty , Tingström Pia , Bergdahl Björn , Svensson Elisabeth
Published: March 2006

Background and Purpose

Physical activity plays an important part in preventing coronary artery disease and is targeted in most rehabilitation and education programmes. The aim of the present study was to evaluate stages of change for exercise behaviour in patients with a recent event of coronary artery disease.

Method

A randomized two‐group, pre–post‐test design was used. Fifty‐seven subjects were included in the problem‐based learning intervention group and 61 subjects were included in the traditional rehabilitation control group. Data were analysed by intention‐to‐treat. A single‐item five‐category scale, based on the ‘Stages of Change’ model was used to measure the level of exercise behaviour. The statistical analysis used two non‐parametric approaches for ordered categorical data.

Results

There was a significant systematic change over time towards the extreme scale categories in both groups. This suggested that individuals who were inactive before the intervention regressed, whereas individuals with some interest in physical activity remained static or improved. No significant differences between groups were found.

Conclusion

Problem‐based learning did not significantly influence patients' progression through exercise behaviour stages. Rehabilitation teams should be observant of inactive participants and their greater risk of regression. Copyright © 2004 Whurr Publishers Ltd.
Variability in pain intensity, physical and psychological function in non‐acute, non‐traumatic neck pain
Authors: Clair Dean , Edmondston Stephen , Allison Garry
Published: March 2006

Background and Purpose

Variability in clinical presentation among patients with neck pain disorders, in relation to symptom severity and the effect of the disorder on their physical and psychological function, has not been well documented. The present study examined the variability in pain intensity, physical and emotional or cognitive function in patients with non‐acute, non‐traumatic neck pain, and the extent to which these factors are associated at the time of referral for physiotherapy treatment.

Method

The study utilized a survey of patients referred for physiotherapy treatment for non‐acute, non‐traumatic neck pain. Seventy‐two patients (mean age 58 years; SD 15.5 years) with a symptom duration ranging from four weeks to 30 years were recruited. Each completed measures of pain intensity using a visual analogue scale, and neck‐pain related disability by use of the ‘Neck Pain and Disability’ scale (NPAD). Frequency distributions were calculated to examine variability in pain intensity, the total NPAD score and the effect of the disorder on different aspects of physical and emotional or cognitive function. Relationships between pain intensity, and physical and psychological function, were also examined.

Results

Pain intensity was normally distributed with a mean score of 6.3 cm (SD 2.5 cm). NPAD scores were normally distributed (mean 54.8%; SD 18%). Similar variability was noted in each of the NPAD factor scores for neck function, pain intensity, emotional or cognitive function and activities of daily living. Pain intensity was significantly (p<0.01) correlated with the total NPAD score (r = 0.55) and with each of the four effects of neck pain represented in the NPAD sub‐domains (r = 0.42–0.63). Symptom duration was not significantly correlated with pain intensity, or with the severity of disability, as reflected in the total NPAD score.

Conclusions

The results highlight the variability between patients with neck pain, in relation to pain intensity and the effect of the disorder on physical and psychological function. Identifying the specific effects of the neck pain disorder in individual cases is important when defining the treatment objectives and selecting measures of treatment response. Copyright © 2004 Whurr Publishers Ltd.
Cardiorespiratory responses to aquatic treadmill walking in patients with rheumatoid arthritis
Authors: Hall Jane , Grant Jim , Blake David , Taylor Gordon , Garbutt Gerard
Published: March 2006

Background and Purpose

Hydrotherapy is popular with patients with rheumatoid arthritis (RA). Its efficacy as an aerobic conditioning aid is equivocal. Patients with RA have reduced muscle strength and may be unable to achieve a walking speed commensurate with an aerobic training effect because the resistance to movement increases with speed in water. The physiological effects of immersion may alter the heart rate–oxygen consumption relationship (HR–V̇O2) with the effect of rendering land‐based exercise prescriptions inaccurate. The primary purpose of the present study was to compare the relationships between heart rate (HR), and ratings of perceived exertion (RPE), with speed during land and water treadmill walking in patients with RA.

Method

The study design used a two‐factor within‐subjects model. Fifteen females with RA (47 ±8 SD years) completed three consecutive bouts of walking for five minutes at 2.5, 3.5 and 4.5 km/h−1 on land and water treadmills. Expired gas, collected via open‐circuit spirometry, HR and RPE were measured.

Results

HR and RPE increased on land and in water as speed increased. Below 3.5 km/h−1V̇O2 was significantly lower in water than on land (p<0.01 ). HR was lower (p<0.001 ), unchanged and higher (p<0.001 ) at 2.5, 3.5 and 4.5 km/h−1 in water than on land. RPE was significantly higher in water than on land (p<0.05 ). V̇O2 was approximately 60% of the predicted VO2 max during the fast walking speed in water. For a given V̇O2, HR was approximately nine beats/min−1 and RPE 1–2 points on the 6–20 Borg scale, higher in water than on land.

Conclusions

The study showed that the metabolic demand of walking at 4.5 km/h−1 was sufficient to stimulate an increase in aerobic capacity. The use of land‐based prescriptive norms would underestimate the metabolic cost in water. Therefore, in water HR should be increased by approximately 9 beats/min−1 to achieve similar energy demands to land treadmill walking. Copyright © 2004 Whurr Publishers Ltd.