Self-Management Improves Outcomes in Persons With Limb Loss
Wegener and colleagues conducted a randomized, controlled investigation of the influence of a community-based self-management (SM) program on the pain and depression associated with limb loss. Five hundred and twelve (512) participants were randomized into two groups: 287 attended 9 sessions of SM training and 235 took part in routine support group activities. Evaluation at the end of training and 6 months later revealed that while both groups showed improvements, those undergoing self management training had reduced their risk of depression to about half that of the support group. The self management group also displayed a higher confidence in their self-efficacy, although reports of pain intensity and quality of life did not differ significantly between the groups. The authors conclude that SM training provides benefits beyond those available from support groups alone. • SEE PAGE 373
Patima Silsupadol, PT, PhD
Anne Shumway-Cook, PT, PhD
Vipul Lugade, MS
Paul van Donkelaar, PhD
Li-Shan Chou, PhD
Ulrich Mayr, PhD
Marjorie H. Woollacott, PhD
Effects of Single-Task Versus Dual-Task Training on Balance Performance in Older Adults: A Double-Blind, Randomized Controlled Trial
Silsupadol and colleagues assessed the benefits of dual task training in a randomized controlled trial of 23 elderly adults with balance impairments. All participants received twelve 45-minute training sessions with 8 undergoing traditional balance training; 8 a program that emphasized simultaneous attention to balance and a cognitive task, and 7 a regimen that required shifting between balance and cognitive tasks. The 3 groups displayed similar improvements in their Berg Balance scores and gait speed. However, only those in the dual task groups maintained their improvements in gait speed under dual tasking conditions. There was a suggestion that training with a shifting attention component was superior as this group was the only one to show improvements 1 year later. The authors conclude that single task training may not be beneficial in dual task conditions, whereas dual task training, particularly that requiring a shifting of attention, may be. • SEE PAGE 381
Stephen D. Gill, BPhty
Helen McBurney, PhD
Debra L. Schulz, DPhysio
Land-Based Versus Pool-Based Exercise for People Awaiting Joint Replacement Surgery of the Hip or Knee: Results of a Randomized Controlled Trial
Gill and colleagues address the long standing controversy about the relative benefits of land and water-based exercise in 82 adults with lower extremity arthritis awaiting hip or knee replacement. All subjects received an education session and a home assessment. However, half underwent 12 sessions of pool therapy and half an equal number of land-based exercise sessions. The investigators found that, with the exception of the water-based group reporting less post-session pain, that the 2 groups differed minimally in terms of the study's primary (the WOMAC pain and function scales) or secondary (timed walk, chair stand and SF-36 scores) outcomes at either the end of the intervention or at follow-up. The authors concluded that while their findings were limited by sample size, the differences between the approaches appear limited. • SEE PAGE 388
Christopher J. Standaert, MD
Stanley A. Herring, MD
Expert Opinion and Controversies in Musculoskeletal and Sports Medicine: Stingers
Stingers, defined as a transient episode of lancinating upper extremity pain that may be associated with weakness and neck pain, are a relatively common problem in contact sports. Symptoms frequently resolve rapidly but can become a perplexing problem in that they may become recurrent or lead to weakness and permanent neurological deficits. Standaert and Herring review the pathophysiology of stingers and provide a systematic approach to their assessment, treatment and return-to-play decision making. The authors note that stingers are potentially serious injuries and that athletes displaying persistent pain, neurological deficits, or recurrences require thorough evaluation. • SEE PAGE 402
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