bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetes Mellitus and Gait Dysfunction: Possible Explanatory Factors
Authors: Brach Jennifer S , Talkowski Jaime B , Strotmeyer Elsa S , Newman Anne B 
Published: September 2008

Background and Objective
Gait characteristics differ in individuals with diabetes compared with those without diabetes. Limited information regarding potential explanatory factors for this association exists. This study examined the association between diabetes and gait characteristics in older adults and explored potential explanatory factors.

Design
A cross-sectional, observational study design was used.

Methods
At the 1998–1999 clinic visit, 558 ambulatory older adults (mean age=79 years) from the Pittsburgh site of the Cardiovascular Health Study had an assessment of their gait characteristics, diabetes, health status, cognition, mood, lower-extremity circulation and sensation, vision, lower-extremity strength (force-producing capacity), physical activity, and body mass index (BMI). A series of linear regression models were developed to examine the association between diabetes and gait characteristics and to examine potential explanatory factors for the associations.

Results
Diabetes was related to gait speed (β=−.06 m/s); however, the association was partially explained by health status variables, cognition, mood, lower-extremity circulation and sensation, visual impairment, lower-extremity strength, physical activity, and BMI. Health status and lower-extremity strength each explained the greatest proportion of the association (β reduced 66% by each). Diabetes was related to step width (β=.02 m), and the association could not be explained by the examined factors.

Conclusions
Diabetes was associated with gait alterations in older adults. Slowed gait speed appears to be secondary to the peripheral effect of the disease on other body systems. The effect of diabetes on step width was not explained in the analyses and may be related to peripheral motor nerve function or central influences of the disease, which could not be assessed in this study.
Inflammatory Osteolysis in Diabetic Neuropathic (Charcot) Arthropathies of the Foot
Authors: Sinacore David R , Hastings Mary K , Bohnert Kathryn L , Fielder Faye A , Villareal Dennis T , Blair Vilray P , Johnson Jeffrey E 
Published: September 2008

ObjectiveOsteolysis and low bone mineral density (BMD) are underappreciated consequences of several chronic diseases that may elevate the risk for fracture. The purpose of this study was to assess tarsal BMD associated with acute inflammation (ie, inflammatory osteolysis) in individuals with chronic diabetes mellitus (DM), peripheral neuropathy (PN), and recent-onset neuropathic (Charcot) arthropathy (NCA) of the foot.Research Design and MethodsThis was a case-control study of 32 people (11 men, 21 women) with DM, PN, and NCA of the foot or ankle. The subjects with DM, PN, and NCA were compared with 64 age-, sex-, and race-matched control subjects (24 men, 40 women) without DM, PN or NCA. Within the first 3 weeks of cast immobilization, BMD was estimated in both calcanei using quantitative ultrasonometry. Acute inflammation was confirmed by comparing skin temperature differences between the feet of the subjects with DM, PN, and NCA and the feet of the control subjects.ResultsSkin temperature differences averaged 6.7°F (SD=4.0°F) (involved foot minus noninvolved foot) in the feet of the subjects with DM, PN, and NCA compared with 0.0°F (SD=1.3°F) in the feet of the control subjects. Calcaneal BMD averaged 384 mg/cm2 (SD=110) in the involved feet and 467 mg/cm2 (SD=123) in the noninvolved feet of the subjects with DM, PN, and NCA and 545 mg/cm2 (SD=121) in combined right and left feet of the control subjects.ConclusionsInflammation in individuals with DM, PN, and NCA may contribute to or exacerbate a rapid loss of BMD. Inflammatory osteolysis may be a prominent factor responsible for both the spontaneous onset of neuropathic fracture and the insidious and progressive foot deformity that is the hallmark of the chronic Charcot foot.
Clinical Measures of Physical Fitness Predict Insulin Resistance in People at Risk for Diabetes
Authors: Chen Chiao-Nan , Chuang Lee-Ming , Wu Ying-Tai 
Published: September 2008

Background and Purpose
Physical inactivity has been well documented as a risk factor for type 2 diabetes. Previous studies measured the level of physical activity either with questionnaires or with direct measurements of maximum oxygen uptake. However, questionnaires are patient-report measures, and methods for obtaining direct maximum oxygen uptake measurements often are not available clinically. The purpose of this study was to investigate whether clinical measurement of health-related physical fitness with a simple test battery can predict insulin resistance, a precursor of type 2 diabetes, in people at risk for diabetes.

Subjects and Methods
A total of 151 volunteers with at least one diabetes risk factor (overweight, hypertension, dyslipidemia, family history, impaired glucose tolerance, gestational diabetes, or delivering a baby weighing more than 4.0 kg) were recruited. Insulin resistance (as determined with the homeostasis model assessment of insulin resistance [HOMA-IR]), physical fitness (including body composition, as determined with the body mass index and waist circumference), muscle strength (handgrip strength [force-generating capacity]), muscle endurance (sit-up test), flexibility (sit-and-reach test), and cardiorespiratory endurance (step test) were measured, and a physical activity questionnaire was administered. Backward regression analysis was used to build the prediction models for insulin resistance from components of physical fitness and physical activity.

Results
Body mass index, muscle strength, and cardiorespiratory fitness predicted HOMA-IR in men (adjusted R2=.264). In women, age, waist circumference, and cardiorespiratory fitness were the predictors of HOMA-IR (adjusted R2=.438).

Discussion and Conclusion
Clinical measures of physical fitness can predict insulin resistance in people at risk for diabetes. The findings support the validity of clinical measures of physical fitness for predicting insulin resistance in people at risk for diabetes.
Comparison of Combined Aerobic and High-Force Eccentric Resistance Exercise With Aerobic Exercise Only for People With Type 2 Diabetes Mellitus
Authors: Marcus Robin L , Smith Sheldon , Morrell Glen , Addison Odessa , Dibble Leland E , Wahoff-Stice Donna , LaStayo Paul C 
Published: September 2008

Background and PurposeThe purpose of this study was to compare the outcomes between a diabetes exercise training program using combined aerobic and high-force eccentric resistance exercise and a program of aerobic exercise only.Subjects and MethodsFifteen participants with type 2 diabetes mellitus (T2DM) participated in a 16-week supervised exercise training program: 7 (mean age=50.7 years, SD=6.9) in a combined aerobic and eccentric resistance exercise program (AE/RE group) and 8 (mean age=58.5 years, SD=6.2) in a program of aerobic exercise only (AE group). Outcome measures included thigh lean tissue and intramuscular fat (IMF), glycosylated hemoglobin, body mass index (BMI), and 6-minute walk distance.ResultsBoth groups experienced decreases in mean glycosylated hemoglobin after training (AE/RE group: −0.59% [95% confidence interval (CI)=−1.5 to 0.28]; AE group: −0.31% [95% CI=−0.60 to −0.03]), with no significant between-group differences. There was an interaction between group and time with respect to change in thigh lean tissue cross-sectional area, with the AE/RE group gaining more lean tissue (AE/RE group: 15.1 cm2 [95% CI=7.6 to 22.5]; AE group: −5.6 cm2 [95% CI=−10.4 to 0.76]). Both groups experienced decreases in mean thigh IMF cross-sectional area (AE/RE group: −1.2 cm2 [95% CI=−2.6 to 0.26]; AE group: −2.2 cm2 [95% CI=−3.5 to −0.84]) and increases in 6-minute walk distance (AE/RE group: 45.5 m [95% CI=7.5 to 83.6]; AE group: 29.9 m [95% CI=−7.7 to 67.5]) after training, with no between-group differences. There was an interaction between group and time with respect to change in BMI, with the AE/RE group experiencing a greater decrease in BMI.Discussion and ConclusionSignificant improvements in long-term glycemic control, thigh composition, and physical performance were demonstrated in both groups after participating in a 16-week exercise program. Subjects in the AE/RE group demonstrated additional improvements in thigh lean tissue and BMI. Improvements in thigh lean tissue may be important in this population as a means to increase resting metabolic rate, protein reserve, exercise tolerance, and functional mobility.
Assessing Improvement in Patients Who Report Small Limitations in Functional Status on Condition-Specific Measures
Authors: Stratford Paul W. , Spadoni Gregory F. 
Published: September 2008

Purpose: Our purpose was to describe the challenges associated with detecting improvement of patients who present with small but important limitations in functional status. There are three components to this article: (1) introduction of the challenges, (2) presentation of proposed solutions, and (3) case illustrations. Summary of Key Points: Three factors contribute to the identified challenges: (1) little room is available on the scale to detect improvement, (2) regression towards the mean, and (3) the nonlinear properties of most self-report measures. Two strategies were identified to overcome these challenges: (1) to average the results of measurements performed on different occasions and (2) to apply a patient-specific measure. Examples of the successful application of these strategies are presented for two patients with low back pain. Conclusions: Averaging measurements taken on different occasions and applying patient-specific measures represent effective strategies for detecting improvement in patients who present with small limitations in functional status.
Outcomes of Home-Based Rehabilitation Provided by Primary Therapists for Patients with Rheumatoid Arthritis: Pilot Study
Authors: Li Linda C. , Davis Aileen M. , Lineker Sydney , Coyte Peter C. , Bombardier Claire 
Published: September 2008

Purpose: To evaluate the outcomes of patients with rheumatoid arthritis (RA) receiving treatment from a rheumatology-trained primary therapist and to assess the feasibility of the research protocol. Method: The experimental (E) group received treatment from a primary therapist in addition to their overall medical care. The usual care (UC) group continued receiving usual medical care. The first 10 patients completed the Health Assessment Questionnaire, a pain visual analogue scale, and the Arthritis Community Research and Evaluation Unit RA Knowledge Questionnaire. Patients were classified as clinical responders if they showed 20% improvement in two-thirds of core measures between baseline and 6 months. Baseline assessment was performed immediately prior to randomization. All patients completed the EuroQol and a monthly health resource use questionnaire. Results: A trend towards improvement was found in the E group (n = 11) in all clinical measures at discharge (approximately 6 weeks from baseline) and 6 months from baseline. In contrast, the UC group (n = 13) showed a slight deterioration in pain (at 6 weeks) and in disease-specific knowledge (at 6 months). Three of six patients in the E group and one of four patients in the UC group met the criteria of clinical responders. Conclusions: The study suggests an improvement trend in patient outcomes after treatment from a primary therapist and that the study protocol is feasible for a full-scale clinical trial.
Prevalence of and Risk Factors Associated with Neck Problems in Undergraduate Physiotherapy Students
Authors: Bialocerkowski Andrea E. , Grimmer Karen A. , Nyland Leah J. 
Published: September 2008

Purpose: To determine the point prevalence of and risk factors associated with neck problems in undergraduate physiotherapy students. Method: In March 2001, all undergraduate students enrolled in the bachelor of physiotherapy program at the University of South Australia were invited to participate in this study. Students completed a reliable and valid questionnaire over four recall periods, eliciting information as to the prevalence of neck problems and possible risk factors (environmental factors and students' demographic characteristics). Results: Two hundred fifty students (response rate = 72%) participated. The prevalence of neck problems was 61% over the lifetime, 55% over the previous year, 38% over the previous month, and 32% over the previous week. The point prevalence increased substantially between the first and second years and continued at this higher level during the fourth year. Second- and fourth-year students were approximately twice as likely to experience neck problems compared with first-year students. Being female and exposure to multiple occupational activities for long periods of time were significantly associated with neck problems. Study and stress were also contributing factors. Conclusions: Students and lecturers should attend to the risk factors associated with developing neck problems in undergraduate physiotherapy students. Addressing these risk factors could possibly lead to a reduction in neck problems later in practice.
Exercise Training for Individuals with Coronary Artery Disease or Heart Failure
Authors: Mandic Sandra , Riess Kenneth , Haykowsky Mark J. 
Published: September 2008

Purpose: Cardiovascular disease is the leading cause of mortality in Canada, resulting in impaired aerobic capacity (VO2peak) that leads to a reduced ability to perform activities of daily living. We examine the mechanisms responsible for the decline in VO2peak found in individuals with coronary artery disease (CAD) or heart failure (HF). In addition, the role that exercise rehabilitation plays in attenuating the decline in VO2peak and strength is reviewed. Finally, we provide an exercise program that can be used by physiotherapists to improve the overall physical fitness of patients with CAD or HF. Summary of Key Points: Aerobic training and resistance training, as part of a comprehensive cardiac rehabilitation program, have been shown to improve VO2peak, muscle strength, and quality of life while reducing mortality in individuals with CAD or HF. Physiotherapists should incorporate these effective interventions in the rehabilitation of individuals with CAD or HF. Recommendations: Individuals with CAD or HF should be encouraged to perform regular moderate-intensity aerobic and resistance training to improve their physical fitness and quality of life.
Investigating Care Provided by Physical Therapists Treating People with Rheumatoid Arthritis: Pilot Study
Authors: Lineker Sydney C. , Hurley Laurie , Wilkins Annette 
Published: September 2008

Purpose: To describe the management of rheumatoid arthritis by physical therapists (PTs) in Ontario and to explore factors that influence the delivery of client-centred care. Methods: PTs working in rheumatology asked consecutive, nonsurgical patients to complete standardized assessments at baseline and discharge. PT interventions were compared with those recommended by published clinical practice guidelines. After discharge, patients were mailed the WASCANA Client-Centred Care Survey (WCCS). Results: Twenty-six PTs recruited 53 patients. The mean number of hours of treatment was 7.6 over a mean time frame of 68 days. The most frequent interventions were exercise (100%), education, and physical modalities (both 94.6%). There were important clinical improvements in several outcome measures (effect sizes > 0.3). The Numerical Pain Rating Scale and the Arthritis Impact Measurement Scales-2 (AIMS2) pain score improved the most, with effect sizes of > 0.6. Forty-five patients (80%) returned WCCS questionnaires. Mean scores were good (< 2) for five of the six WCCS domain scores and borderline (2.1) for one domain, community integration. Conclusions: Patients reported improved outcomes, especially less pain, suggesting that a pain measure would be useful in evaluating PT interventions for persons with rheumatoid arthritis. In general, PTs provided evidence-based and client-centred care; however, there may be potential to improve care by helping patients more fully integrate into the community.
Aerobic Exercise for Individuals with Chronic Obstructive Pulmonary Disease
Authors: Gupta Renu , Brooks Dina 
Published: September 2008

Purpose: Pulmonary rehabilitation has been found to consistently improve exercise capacity, quality of life, and symptoms in individuals with chronic obstructive pulmonary disease (COPD). Different types of exercise can be integrated into a pulmonary rehabilitation program. For the purposes of this article, we focus specifically on aerobic exercise, providing recommendations for optimal aerobic exercise prescription in individuals with COPD. Summary of Key Points: Individuals with all degrees of severity of COPD can benefit from participation in an exercise-training program in inpatient, outpatient, or home-based settings. Aerobic exercise training using the large muscle groups of the lower extremities, via ground-based walking, a treadmill, a cycle ergometer, or a combination of all three modalities, is preferred. High-intensity training yields significant physiological improvements in aerobic fitness. However, in individuals with COPD, training intensity should be guided by patient tolerance and safety. Interval training is an alternate option for patients who cannot sustain continuous periods of high-intensity exercise. Individuals with COPD should aim to exercise at least three to five times per week, completing 20 to 30 minutes per session. Conclusions: The clinical recommendations provided serve as a guide to help optimize aerobic fitness in individuals with COPD. As with all exercise prescriptions, clinicians should consider the individual needs and goals of the patient when designing an aerobic exercise program.
Evidence-Based Physiotherapy for Acute Low Back Pain: A Composite Clinical Algorithm Synthesized from Seven Recent Clinical Guidelines
Authors: Holohan Vanessa , Deenadayalan Yamini , Grimmer Karen 
Published: September 2008

Purpose: To produce a composite evidence-based treatment algorithm for physiotherapy management of acute low back pain (LBP) using current, high-quality, English-language clinical guidelines. Methods: A systematic literature review of library databases and Internet search engines was performed to identify full-text, Englishlanguage clinical guidelines on the physiotherapy treatment of acute LBP. Quality assessment of the guidelines was undertaken by two independent reviewers using the AGREE instrument. Guideline recommendations were synthesized into interventions that were supported by strong, moderate or weak evidence. A composite clinical algorithm for physiotherapy management of acute LBP was developed. Results: Seven guidelines were included. Keeping active, written patient education, manipulation and referral to a spine specialist had strong supporting evidence for the management of acute non-radiating LBP. There were a large number of treatment options with moderate or inconclusive evidence. Bed rest and massage, as stand-alone treatments, had strong evidence of harm for patients with acute non-radiating LBP. Conclusions: Based on current evidence, a composite algorithm was constructed to assist physiotherapists when making treatment decisions for acute LBP. A synthesis of current clinical guideline recommendations provides physiotherapists with readily interpretable guidance for the management of acute LBP and encourages the uptake of best-evidence treatment options.
The Consequences of Delisting Publicly Funded, Community-Based Physical Therapy Services in Ontario: A Health Policy Analysis
Authors: Gordon Melanie , Waines Barbara , Englehart Jennifer , Montgomery Susan , Devitt Rachel , Holyoke Paul , Cott Cheryl A. , Landry Michel D. 
Published: September 2008

Purpose: Because publicly-funded, community-based physical therapy (PT) services through Ontario's network of Schedule 5 providers were partially delisted in April 2005, we examined the perceived consequences of this policy decision among different provider categories following partial delisting. Schedule 5 providers or clinics, renamed “Designated Physiotherapy Clinics” following partial delisting, are privately-owned and operated facilities that have agreements with Ontario's Ministry of Health and Long-Term Care to deliver publicly funded services for eligible clients. Methods: A health policy research approach used semi-structured telephone interviews with 33 physical therapists from Schedule 5 clinics, home care settings, hospitals, and private clinics within the Greater Toronto Area and across Ontario. Results: Schedule 5 providers perceived an immediate decrease in demand, whereas PT providers from other categories reported no change at the time of interview. Conversely, all providers forecasted decreased access for ineligible clients but a potential for improved access and reduced wait times among those who remained eligible. In the final analysis, PT informants in all categories agreed that partial delisting was an improved policy decision compared with full delisting, as proposed initially. Conclusions: Perceived consequences appeared to depend on provider type. However, informants from all provider categories cautioned that this policy decision would have a significant impact on the health status of some Ontarians. Further research is warranted to explore the long-term effects of this policy decision.
Use of Electrophysical Agents: Findings and Implications of a Survey of Practice in Metro Toronto
Authors: Nussbaum Ethne L. , Burke Sarah , Johnstone Leslie , Lahiffe Geraldine , Robitaille Eric , Yoshida Karen 
Published: September 2008

Purposes: (1) To determine the availability, use and factors associated with the use of electrophysical agents (EPAs) in the management of patients with musculoskeletal impairments in physical therapy (PT) outpatient clinics in Metro Toronto and (2) to determine sources of EPA information used by physical therapists (PTs) and their perceived need for continuing EPA education. Method: Information was collected by a questionnaire distributed to all eligible PTs in the defined area. Data included the characteristics of PTs and clinics, availability and use of EPAs by PTs, treatments received by patients, sources and influence of EPA information, use of support personnel and PTs' past education and future needs. Results: The response rate was 54.1 per cent. The results were analyzed for 125 eligible PTs. On a typical day, treatment excluded EPAs for 29 per cent of patients. Treatment included one, two and three or more EPAs for 36, 26, and 9 per cent of patients, respectively. On average, PTs used EPAs for more than half of their patients: the most significant factors associated with EPA use were type of patient funding and number of patients treated per hour. Place of entry-level education and years since graduation were associated with the sources and perceived importance of EPA information that PTs used. More than half of the respondents indicated an interest in continuing EPA education. Conclusions: EPAs are commonly included in PT management of persons with musculoskeletal impairments. Entry-level and continuing education should promote use of EPAs based on scientific evidence.