The Effects of Hip and Ankle Stretching on Gait Function of Older People
Gait speed decreases with age in conjunction with a number of neurologic and musculoskeletal changes. Christiansen examines the susceptibility of one of these, decreases in lower-extremity joint range of motion (ROM), to a lower-extremity stretching program involving 40 healthy elderly adults. Subjects were randomized into 2 groups. Half maintained their normal level of activities and the remainder performed an 8-week home-based hip and knee stretching program. Outcome measures were freely chosen gait speed, stride length, and joint ROM. At the end of the study, the stretching, but not the control, group had increased its combined hip and knee and ankle ROM in a statistically significant manner. More importantly, group that had stretched also displayed a statistically significant .07-m/s increase in its freely chosen gait speed that was felt to be clinically meaningful. • SEE PAGE 1421
Diana H. Rintala, PhD
Susan L. Garber, MA
Jeffrey D. Friedman, MD
Sally Ann Holmes, MD
Preventing Recurrent Pressure Ulcers in Veterans With Spinal Cord Injury: Impact of a Structured Education and Follow-Up Intervention
Rintala and colleagues assessed the impact of an individualized education and follow-up program in a group of 41 veterans with spinal cord injury or dysfunction undergoing surgical repair of a pressure ulcer. Subjects were randomized into 3 groups. Twenty received individualized pressure ulcer education and monthly structured telephone follow-up calls; 11 received monthly mail or telephone follow-ups without educational content; and 10 received a similar nonspecific follow-up on a quarterly basis. Subjects were followed until the time of ulcer recurrence, death, or a maximum of 2 years. Assessment revealed that the average time to ulcer recurrence in the education and structured follow-up group (19.6mo) was almost twice that of the roughly 10 months of the other groups (P=.002). The investigators conclude that individualized education and structured monthly contacts may delay the recurrence of surgically repaired pressure ulcers. • SEE PAGE 1429
Mary P. Galea, PhD
Pazit Levinger, PhD
Noel Lythgo, PhD
Chris Cimoli, BAppSci (Physio)
Robert Weller, MBBS, FRAFM
Elizabeth Tully, PhD
Joan McMeeken, MSc
Roger Westh, MBBS, FRACS
A Targeted Home and Center-Based Exercise Program for People After Total Hip Replacement: A Randomized Clinical Trial
Supervised exercise programs are known to be beneficial for patients who have recently undergone a total hip arthroplasty (THA). Galea and colleagues take this knowledge 1 step further and assess the relative benefits of a supervised rehabilitation center-based and an unsupervised home lower-extremity exercise program. Twenty-three subjects with unilateral THAs participated in a randomized controlled trial: all took part in an 8-week program, with 11 undergoing a supervised center-based exercises and 12 a similar unsupervised home program. Members of each group improved significantly in terms of quality of life, stair climbing, walking speed, and gait with between-group comparisons revealing little or no statistically significant differences in their performance. The researchers conclude that patients with THAs can benefit from both center-based and unsupervised home-based exercise program—and note that the latter is far cheaper. • SEE PAGE 1442
Ranjana Banerjea, PhD
Usha Sambamoorthi, PhD
Frances Weaver, PhD
Miriam Maney, MS
Leonard M. Pogach, MD, MBA
Thomas Findley, MD, PhD
Risk of Stroke, Heart Attack, and Diabetes Complications Among Veterans With Spinal Cord Injury
There is evidence that the high rates of obesity, dyslipedemia, hypertension, and diabetes reported by physicians to be present in people with spinal cord injury (SCI) may not be reflected in an elevated prevalence rate of diabetes in this group. Banerjea and colleagues explore the reason for this possible dichotomy in a cross-sectional study that used the Veterans Administration's SCI and diabetes databases. The investigators confirmed the rate of diabetes (15%) among the 8769 veterans indentified as having an SCI was similar to that of the general population of a similar age. However, they also identified an 8% increase in the death rates of the veterans with diabetes and SCI and noted that the rate of vascular complications (eg, stroke, renal failure) in the veterans with both conditions (about 50%) was twice that of those with SCI alone. The investigators conclude that the low prevalence rates of diabetes in people with SCI are misleading in that they are the results of an increased death rate in this group. • SEE PAGE 1448
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