Source:PM&R, Volume 4, Issue 10
Thomas J. Schnitzer, Nicole Wysocki, Danielle Barkema, James Griffith, Victoria Lent, Meghan Romba, Rachel Welbel, Sheena Bhuva, Bindu Manyam, Sarah Linn
Huwebes, Oktubre 25, 2012
Calcaneal Quantitative Ultrasound Compared With Hip and Femoral Neck Dual-Energy X-Ray Absorptiometry in People With A Spinal Cord Injury
Publication year: 2012
Source:PM&R, Volume 4, Issue 10
Thomas J. Schnitzer, Nicole Wysocki, Danielle Barkema, James Griffith, Victoria Lent, Meghan Romba, Rachel Welbel, Sheena Bhuva, Bindu Manyam, Sarah Linn
Objective To evaluate the sensitivity and specificity of calcaneal quantitative ultrasound (QUS) measurements for identifying osteoporosis determined by dual-energy x-ray absorptiometry (DXA) at the hip in a spinal cord injury (SCI) population. Design Cross-sectional retrospective review of data collected in the bone health registry of persons with a disability. Setting Inpatients and outpatients at a single acute rehabilitation hospital. Participants A convenience sample of 66 participants, both inpatients and outpatients, with a spinal cord injury. Methods Calcaneal T scores were determined by ultrasound, and bone density of the lumbar spine, total hip, and femoral neck were determined by DXA. Main Outcome Measurements Right and left calcaneal QUS T scores and right and left hip and femoral neck DXA T scores. Results Right and left hip DXA T scores were strongly associated with corresponding right and left calcaneal QUS T scores (right: r = .72, P < .001; left: r = .70, P < .001). Similar associations were found when we evaluated femoral neck T scores and calcaneal QUS T scores. Receiver operating characteristic analysis for evaluating QUS to identify DXA-defined osteoporosis demonstrated an area under the curve of 0.81 for all participants (acute and chronic injury) and 0.68 for those with a chronic SCI. Conclusions A strong association exists between calcaneal QUS T scores and bone density T scores at the hip measured by DXA. QUS may have a place in the screening of people with SCI 1 year or more after their injury to evaluate their bone status.
Source:PM&R, Volume 4, Issue 10
Thomas J. Schnitzer, Nicole Wysocki, Danielle Barkema, James Griffith, Victoria Lent, Meghan Romba, Rachel Welbel, Sheena Bhuva, Bindu Manyam, Sarah Linn
Miyerkules, Oktubre 24, 2012
Extended Exercise Rehabilitation After Hip Fracture Improves Patients' Physical Function: A Systematic Review and Meta-Analysis
Although the principal goal of hip fracture management is a return to the pre-event functional level, most survivors fail to regain their former levels of autonomy. One of the most effective strategies to mitigate the fracture's consequences is therapeutic exercise.
The purpose of this study was to review and quantify the reported effects of an extended exercise rehabilitation program offered beyond the regular rehabilitation period on improving physical functioning for patients with hip fractures.
The Cochrane libraries, PubMed, CINAHL, PEDro, and EMBASE were searched to April 2012.
All randomized controlled trials comparing extended exercise programs with usual care for community-dwelling people after hip fracture were included in the review.
Two reviewers conducted each step independently. The data from the included studies were summarized, and pooled estimates were calculated for 11 functional outcomes.
Thirteen trials were included in the review and 11 in the meta-analysis. The extended exercise program showed modest effect sizes (ESs), which reached significance, under random theory, for knee extension strength for the affected and nonaffected sides (ES=0.47, 95% confidence interval [CI]=0.27–0.66, and ES=0.45, 95% CI=0.16–0.74, respectively), balance (ES=0.32, 95% CI=0.15–0.49), physical performance-based tests (ES=0.53, 95% CI=0.27–0.78), Timed "Up & Go" Test (ES=0.83, 95% CI=0.28–1.4), and fast gait speed (ES=0.42, 95% CI=0.11–0.73). Effects on normal gait speed, Six-Minute Walk Test, activities of daily living and instrumental activities of daily living, and physical function subscale of the 36-Item Short-Form Health Survey (SF-36-PF) did not reach significance. Community-based programs had larger ESs compared with home-based programs.
To the authors' knowledge, this is the first meta-analysis to provide evidence that an extended exercise rehabilitation program for patients with hip fractures has a significant impact on various functional abilities. The focus of future research should go beyond just effectiveness and study the cost-effectiveness of extended programs.
Source: http://ptjournal.apta.org/cgi/content/short/ptj.20110274v2?rss=1
Which Prognostic Factors for Low Back Pain Are Generic Predictors of Outcome Across a Range of Recovery Domains?
Recovery from low back pain (LBP) is multidimensional and requires the use of multiple-response (outcome) measures to fully reflect these many dimensions. Predictive prognostic variables that are present or stable in all or most predictive models that use different outcome measures could be considered "universal" prognostic variables.
The aim of this study was to explore the potential of universal prognostic variables in predictive models for 4 different outcome measures in patients with mechanical LBP.
Predictive modeling was performed using data extracted from a randomized controlled trial. Four prognostic models were created using backward stepwise deletion logistic, Poisson, and linear regression.
Data were collected from 16 outpatient physical therapy facilities in 10 states. All 149 patients with LBP were treated with manual therapy and spine strengthening exercises until discharge. Four different measures of response were used: Oswestry Disability Index and Numeric Pain Rating Scale change scores, total visits, and report of rate of recovery.
The set of statistically significant predictors was dependent on the definition of response. All regression models were significant. Within both forms of the 4 models, meeting the clinical prediction rule for manipulation at baseline was present in all 4 models, whereas no irritability at baseline and diagnosis of sprains and strains were present in 2 of 4 of the predictive models.
The primary limitation is that this study evaluated only 4 of the multiple outcome measures that are pertinent for patients with LBP.
Meeting the clinical prediction rule was prognostic for all outcome measures and should be considered a universal prognostic predictor. Other predictive variables were dependent on the outcomes measure used in the predictive model.
Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120216v2?rss=1
Is supervised exercise training safe in patients with anorexia nervosa? A meta-analysis
Publication year: 2012
Source:Physiotherapy
L.W.C. Ng, D.P. Ng, W.P. Wong
Background Anorexia nervosa is an eating disorder that is often preceded by excessive physical activity. As such, exercise is not often prescribed in the clinical management of individuals with anorexia nervosa. Objective To examine the effects of supervised exercise training in patients with anorexia nervosa. Data sources Five databases were searched from their inception to Week 14 of 2011 using the subject headings ‘anorexia’ and ‘exercise’ to identify relevant studies. Eligibility criteria PRISMA guidelines were followed. Studies that investigated the effects of inclusion of supervised exercise training in clinical management with usual management in patients diagnosed with anorexia nervosa were included in this review. Case reports were excluded. Data extraction and synthesis Two reviewers independently extracted data using a standardised assessment form. Quality assessment was rated for the controlled trials and single-group studies using the PEDro scale and Downs and Black scale, respectively. Fixed or random effect approaches were used to determine effect size, depending on the heterogeneity of the studies. Results Pooled randomised controlled trials and quasi-randomised studies showed no significant effect of supervised exercise training on selected anthropometric measurements, while the single-group studies showed significant improvement in weight and body fat. Although Short Form-36 revealed no training effect, distorted feelings about food and exercise were reduced. Cardiovascular fitness also improved with no decrease in weight. Limitations Heterogeneity of exercise training programmes, small sample size (n Conclusions Inclusion of supervised exercise training in the comprehensive management of patients with anorexia nervosa appears to be safe, as no detrimental effect was observed in anthropometry. Strength and cardiovascular fitness were also shown to improve.
Source:Physiotherapy
L.W.C. Ng, D.P. Ng, W.P. Wong
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Chartered Society of Physiotherapy's identification of national research priorities for physiotherapy using a modified Delphi technique
Publication year: 2012
Source:Physiotherapy, Volume 98, Issue 3
Gabrielle Rankin, Alison Rushton, Pat Olver, Ann Moore
Objective To define research priorities to strategically inform the evidence base for physiotherapy practice. Design A modified Delphi method using SurveyMonkey software identified priorities for physiotherapy research through national consensus. An iterative process of three rounds provided feedback. Round 1 requested five priorities using pre-defined prioritisation criteria. Content analysis identified research themes and topics. Round 2 requested rating of the importance of the research topics using a 1–5 Likert scale. Round 3 requested a further process of rating. Quantitative and qualitative data informed decision-making. Level of consensus was established as mean rating ≥3.5, coefficient of variation ≤30%, and ≥55% agreement. Consensus across participants was evaluated using Kendall's W . Participants Four expert panels (n n Findings Response rates of 53–78% across three rounds were good. The identification of 24/185 topics for musculoskeletal, 43/174 for neurology, 30/120 for cardiorespiratory and medical rehabilitation, and 30/113 for mental and physical health and wellbeing as priorities demonstrated discrimination of the process. Consensus between participants was good for most topics. Measurement validity of the research topics was good. The involvement of multiple stakeholders as participants ensured the current context of the intended use of the priorities. Conclusions From a process of national consensus involving key stakeholders, including service users, physiotherapy research topics have been identified and prioritised. Setting priorities provides a vision of how research can contribute to the developing research base in physiotherapy to maximise focus.
Source:Physiotherapy, Volume 98, Issue 3
Gabrielle Rankin, Alison Rushton, Pat Olver, Ann Moore
PhysioDirect: Supporting physiotherapists to deliver telephone assessment and advice services within the context of a randomised trial
Publication year: 2012
Source:Physiotherapy
Annette Bishop, Jill Gamlin, Jeanette Hall, Cherida Hopper, Nadine E. Foster
Physiotherapy-led telephone assessment and advice services for patients with musculoskeletal problems have been developed in many services in the UK, but high quality trial data on clinical and cost effectiveness has been lacking. In order to address this ‘The PhysioDirect trial’ (ISRCTN55666618), was a pragmatic randomised trial of a PhysioDirect telephone assessment and advice service. This paper describes the PhysioDirect system used in the trial and how physiotherapists were trained and supported to use the system and deliver the PhysioDirect service. The PhysioDirect system used in the trial was developed in Huntingdon and now serves a population of 350,000 people. When initiating or providing physiotherapy-led telephone assessment and advice services training and support for physiotherapists delivering care in this way is essential. An enhanced skill set is required for telephone assessment and advice particularly in listening and communication skills. In addition to an initial training programme, even experienced physiotherapists benefit from a period of skill consolidation to become proficient and confident in assessing patients and delivering care using the telephone. A computer-based system assists the delivery of a physiotherapy-led musculoskeletal assessment and advice service. Clinical Trials Registration Number (ISRCTN55666618).
Source:Physiotherapy
Annette Bishop, Jill Gamlin, Jeanette Hall, Cherida Hopper, Nadine E. Foster
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Individualized Behavioral Assessments and Maternal Ratings of Mastery Motivation in Mental Age-Matched Toddlers With and Without Motor Delay
Mastery motivation is a precursor of later developmental outcomes. Evidence about whether toddlers with motor delay have lower mastery motivation is inconclusive.
To examine differences between mental age matched toddlers with and without motor delay on various mastery motivation indicators.
A mental age and gender matched case-control study.
Twenty-two children with motor delay, aged 23 – 47 months, and 22 children developing typically, aged 15 – 29 months were recruited. Persistence and mastery pleasure were measured with behavioral tasks that were moderately challenging for each child and with maternal ratings using the Dimensions of Mastery Questionnaire (DMQ). The DMQ was rated by the mother based on her perception of her child's motivation. Two types of structured tasks (a puzzle and a cause-effect toy selected to be moderately challenging for each individual child) were administered in a laboratory setting and recorded on videos. Paired t tests or Wilcoxon signed rank tests were used to examine group differences in persistence and mastery pleasure (α=.007; two tailed).
Children with motor delay were rated lower on DMQ persistence than the typically developing group, but they did not show significantly lower persistence on the structured tasks. There were no significant differences in mastery pleasure between the two groups on either measure.
Large within sample variability on the tasks and small sample size makes subgroup analysis (e.g., different severities) difficult.
Toddlers with motor delays did not show lower persistence and pleasure when given tasks that were moderately challenging; however, mothers tended to view their delayed toddlers as having lower motivation. Clinicians and parents should provide appropriately challenging tasks to increase children's success and motivation.
Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120068v1?rss=1
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