Archives of Physical Medicine and Rehabilitation

Clinical Effectiveness of Low-Level Laser Therapy as an Adjunct to Eccentric Exercise for the Treatment of Achilles' Tendinopathy: A Randomized Controlled Trial

Steve Tumilty, Suzanne McDonough, Deirdre A. Hurley, G. David Baxter — 2012-05-01

Abstract: Tumilty S, McDonough S, Hurley DA, Baxter GD. Clinical effectiveness of low-level laser therapy as an adjunct to eccentric exercise for the treatment of Achilles' tendinopathy: a randomized controlled trial. Objective: To investigate the effectiveness of low-level laser therapy (LLLT) as an adjunct to a program of eccentric exercises for the treatment of Achilles' tendinopathy. Design: Randomized controlled trial with evaluations at baseline and 4, 12, and 52 weeks. Setting: Primary care clinic. Participants: Participants with midportion Achilles' tendinopathy were randomly assigned to 2 groups (LLLT n=20: mean age ± SD, 45.6±9.1y; placebo n=20: mean age ± SD, 46.5±6.4y). The 12-week evaluation was completed by 36 participants (90%), and 33 participants (82.5%) completed the 52-week evaluation. Intervention: Both groups of participants performed eccentric exercises over a 3-month period. In addition, they received either an active or placebo application of LLLT 3 times per week for the first 4 weeks; the dose was 3J per point. Main Outcome Measures: The primary outcome was the Victorian Institute of Sport Assessment–Achilles' questionnaire (VISA-A) score at 12 weeks; secondary outcome was a visual analog scale for pain. Outcomes were measured at baseline and 4, 12, and 52 weeks. Results: Baseline characteristics exhibited no differences between groups. At the primary outcome point, there was no statistically significant difference in VISA-A scores between groups (P>.05). The difference in VISA-A scores at the 4-week point significantly favored the placebo group (F1=6.411, sum of squares 783.839; P=.016); all other outcome scores showed no significant difference between the groups at any time point. Observers were blinded to groupings. Conclusions: The clinical effectiveness of adding LLLT to eccentric exercises for the treatment of Achilles' tendinopathy has not been demonstrated using the parameters in this study.

Effectiveness of Supported Employment for Veterans With Spinal Cord Injuries: Results From a Randomized Multisite Study

2012-05-01

Abstract: Ottomanelli L, Goetz LL, Suris A, McGeough C, Sinnott PL, Toscano R, Barnett SD, Cipher DJ, Lind LM, Dixon TM, Holmes SA, Kerrigan AJ, Thomas FP. Effectiveness of supported employment for veterans with spinal cord injuries: results from a randomized multisite study. Objective: To examine whether supported employment (SE) is more effective than treatment as usual (TAU) in returning veterans to competitive employment after spinal cord injury (SCI). Design: Prospective, randomized, controlled, multisite trial of SE versus TAU for vocational issues with 12 months of follow-up data. Setting: SCI centers in the Veterans Health Administration. Participants: Subjects (N=201) were enrolled and completed baseline interviews. In interventional sites, subjects were randomly assigned to the SE condition (n=81) or the TAU condition (treatment as usual–interventional site [TAU-IS], n=76). In observational sites where the SE program was not available, 44 subjects were enrolled in a nonrandomized TAU condition (treatment as usual–observational site [TAU-OS]). Interventions: The intervention consisted of an SE vocational rehabilitation program called the Spinal Cord Injury Vocational Integration Program, which adhered as closely as possible to principles of SE as developed and described in the individual placement and support model of SE for persons with mental illness. Main Outcome Measures: The primary study outcome measurement was competitive employment in the community. Results: Subjects in the SE group were 2.5 times more likely than the TAU-IS group and 11.4 times more likely than the TAU-OS group to obtain competitive employment. Conclusions: To the best of our knowledge, this is the first and only controlled study of a specific vocational rehabilitation program to report improved employment outcomes for persons with SCI. SE, a well-prescribed method of integrated vocational care, was superior to usual practices in improving employment outcomes for veterans with SCI.

Comparison of the Efficacy of Transcutaneous Electrical Nerve Stimulation, Interferential Currents, and Shortwave Diathermy in Knee Osteoarthritis: A Double-Blind, Randomized, Controlled, Multicenter Study

2012-03-30

Abstract: Atamaz FC, Durmaz B, Baydar M, Demircioglu OY, Iyiyapici A, Kuran B, Oncel S, Sendur OF. Comparison of the efficacy of transcutaneous electrical nerve stimulation, interferential currents, and shortwave diathermy in knee osteoarthritis: a double-blind, randomized, controlled, multicenter study. Objective: To compare the effectiveness of transcutaneous electrical nerve stimulation (TENS), interferential currents (IFCs), and shortwave diathermy (SWD) against each other and sham intervention with exercise training and education as a multimodal package. Design: A double-blind, randomized, controlled, multicenter trial. Setting: Departments of physical medicine and rehabilitation in 4 centers. Participants: Patients (N=203) with knee osteoarthritis (OA). Interventions: The patients were randomized by the principal center into the following 6 treatment groups: TENS sham, TENS, IFCs sham, IFCs, SWD sham, and SWD. All interventions were applied 5 times a week for 3 weeks. In addition, exercises and an education program were given. The exercises were carried out as part of a home-based training program after 3 weeks' supervised group exercise. Main Outcome Measures: Primary outcome was a visual analog scale (0–100mm) to assess knee pain. Other outcome measures were time to walk a distance of 15m, range of motion, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Nottingham Health Profile, and paracetamol intake (in grams). Results: We found a significant decrease in all assessment parameters (P<.05), without a significant difference among the groups except WOMAC stiffness score and range of motion. However, the intake of paracetamol was significantly lower in each treatment group when compared with the sham groups at 3 months (P<.05). Also, the patients in the IFCs group used a lower amount of paracetamol at 6 months (P<.05) in comparison with the IFCs sham group. Conclusions: Although all groups showed significant improvements, we can suggest that the use of physical therapy agents in knee OA provided additional benefits in improving pain because paracetamol intake was significantly higher in the patients who were treated with 3 sham interventions in addition to exercise and education.

Short-Term Effects of 890-Nanometer Radiation on Pain, Physical Activity, and Postural Stability in Patients With Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Study

Ru-Lan Hsieh, Min-Tzu Lo, Wei-Cheng Liao, Wen-Chung Lee — 2012-03-30

Abstract: Hsieh R-L, Lo M-T, Liao W-C, Lee W-C. Short-term effects of 890-nanometer radiation on pain, physical activity, and postural stability in patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled study. Objective: To investigate the effects of short-term light therapy with 890-nm radiation on pain, physical activity, and postural stability in patients with knee osteoarthritis (OA). Design: A double-blind, randomized, placebo-controlled study. Setting: Rehabilitation clinic. Participants: Women (n=62) and men (n=10) with a mean age of 61.2 years (range, 40–88y). All patients fulfilled the combined clinical and radiographic criteria for knee OA as established by the American College of Rheumatology, and all had obtained a Kellgren-Lawrence score of 2 or more. Interventions: Participants received 6 sessions, lasting 40 minutes each, of active or placebo radiation treatment over the knee joints for 2 weeks (wavelength, 890nm; radiant power output, 6.24W; power density, 34.7mW/cm2 for 40 minutes; total energy, 41.6J/cm2 per knee per session). Main Outcome Measures: Participants were assessed weekly over 4 weeks using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain, stiffness, and physical function. Physical activity (timed stair climbing, 10-m fast-speed walking, and chair-rising time) and postural stability (using the postural stability evaluation system) were also assessed. The pain score on WOMAC was the primary outcome variable. Data were analyzed by repeated-measures analysis of covariance. Results: Compared with baseline, no significant improvement was observed between groups for pain (P=.546), stiffness (P=.573), or physical function (P=.904). No significant improvement was noted for physical activity including the 10-m fast-speed walking time (P=.284), stair-climbing time (P=.202), stair-descending time (P=.468), chair-rising time (P=.499), or postural stability (P=.986) at the 4 follow-up assessments. Follow-up assessments were conducted after 1 week of treatment (thus, after 3 treatments); after 2 weeks of treatment (thus, after 6 treatments); and 1 and 2 weeks, respectively, after treatment was terminated. Although we found a significant time effect for the 10-m fast-speed walking time (P<.001) in the 2 groups, and a significant group effect in the improvement of stair-climbing time in the treatment group (P=.032), the group × time interaction effects were not significant. Conclusions: Short-term 890-nm radiation therapy for patients with knee OA provided no beneficial effect in improving pain, physical activity, and postural stability.

The Trajectory of Physical and Mental Health From Injury to 5 Years After Multiple Trauma: A Prospective, Longitudinal Cohort Study

Helene L. Soberg, Arnstein Finset, Olav Roise, Erik Bautz-Holter — 2012-03-29

Abstract: Soberg HL, Finset A, Roise O, Bautz-Holter E. The trajectory of physical and mental health from injury to 5 years after multiple trauma: a prospective, longitudinal cohort study. Objectives: To describe the trajectory of physical and mental health from injury to 5 years postinjury for patients with multiple trauma, and to examine predictors of recovery of physical and mental health. Design: A prospective, longitudinal cohort study with data from injury (baseline), the return home (t1), and 1 (t2), 2 (t3), and 5 (t4) years. Setting: Hospital and community setting. Participants: Patients (N=105; mean age ± SD, 35.3±14.0y; age range, 18−67y; 83% men) with multiple trauma and a New Injury Severity Score (NISS) ≥16 treated at a regional trauma referral center. Mean NISS ± SD was 34.6±12.6, and mean Glasgow Coma Scale (GCS) score ± SD was 12.2±3.9. Interventions: Not applicable. Main Outcome Measures: Medical Outcomes Study 36-Item Short-Form Health Survey physical component summary (PCS) and mental component summary (MCS), injury severity parameters, and World Health Organization Disability Assessment Schedule II (WHODAS II) for activities and participation. Results: The proportion with poor physical health (<40 points on the PCS) stabilized at 56% at t4 from 81% at t1. The proportion with poor mental health (<40 points on the MCS) stabilized at 31% at t4 from 43% at t1. Generalized estimating equations showed that predictors of PCS were time points of measurement (Wald, 85.50; P<.001), GCS (B=−.48, P=.004), time in hospital/rehabilitation (B=−.22, P=.001), and the rank-transformed WHODAS II subscales Getting around (B=.16, P<.001) and Participation in society (B=.06, P=.015). Predictors of MCS were time points of measurement (Wald 13.46, P=.004), sex (men/women) (B=−4.24, P=.003), education (low/high) (B=3.43, P=.019), and WHODAS II cognitive function (B=.18, P<.001) and Participation in society (B=.18, P≤.001). Conclusions: Physical and mental health over the 5 years improved with time, but was still significantly below population means. The physical and mental health status stabilized, but the recovery trajectories differed for physical and mental health. Predictors of health were personal and injury-related factors and function in a biopsychosocial perspective.

An Exploration of Modifiable Risk Factors for Depression After Spinal Cord Injury: Which Factors Should We Target?

2012-03-22

Abstract: Bombardier CH, Fann JR, Tate DG, Richards JS, Wilson CS, Warren AM, Temkin NR, Heinemann AW, for the PRISMS Investigators. An exploration of modifiable risk factors for depression after spinal cord injury: which factors should we target? Objective: To identify modifiable risk factors for depression in people with spinal cord injury (SCI). Design: Cross-sectional survey. Setting: Outpatient and community settings. Participants: Community-residing people with SCI (N=244; 77% men, 61% white; mean age, 43.1y; 43% with tetraplegia) who were at least 1 month postinjury. Interventions: Not applicable. Main Outcome Measures: Depression severity (Patient Health Questionnaire-9 [PHQ-9]), physical activity (International Physical Activity Questionnaire [IPAQ]), pleasant and rewarding activities (Environment Rewards Observation Scale [EROS]), and self-efficacy to manage the effects of SCI (Modified Lorig Chronic Disease Self-Management Scale). Results: Greater depression severity was associated with being 20 to 29 years of age, not completing high school, not working or attending school, and being ≤4 years post-SCI. After controlling for demographic and injury characteristics (adjusted R2=.13), lower EROS scores (change in adjusted R2=.34) and lower self-efficacy (change in R2=.13) were independent predictors of higher PHQ-9 scores. Contrary to predictions, physical activity as measured by the IPAQ did not predict depression severity. Conclusions: Our findings suggest that having fewer rewarding activities, and to a lesser extent, having less confidence in one's ability to manage the effects of SCI are independent predictors of greater depression severity after SCI. Interventions such as behavior activation, designed to increase rewarding activities, may represent an especially promising approach to treating depression in this population.

Robotic Resistance Treadmill Training Improves Locomotor Function in Human Spinal Cord Injury: A Pilot Study

Ming Wu, Jill M. Landry, Brian D. Schmit, T. George Hornby, Sheng-Che Yen — 2012-03-29

Abstract: Wu M, Landry JM, Schmit BD, Hornby TG, Yen S-C. Robotic resistance treadmill training improves locomotor function in human spinal cord injury: a pilot study. Objective: To determine whether cable-driven robotic resistance treadmill training can improve locomotor function in humans with incomplete spinal cord injury (SCI). Design: Repeated assessment of the same patients with crossover design. Setting: Research units of rehabilitation hospitals in Chicago. Participants: Patients with chronic incomplete SCI (N=10) were recruited to participate in this study. Interventions: Subjects were randomly assigned to 1 of 2 groups. One group received 4 weeks of assistance training followed by 4 weeks of resistance training, while the other group received 4 weeks of resistance training followed by 4 weeks of assistance training. Locomotor training was provided by using a cable-driven robotic locomotor training system, which is highly backdrivable and compliant, allowing patients the freedom to voluntarily move their legs in a natural gait pattern during body weight supported treadmill training (BWSTT), while providing controlled assistance/resistance forces to the leg during the swing phase of gait. Main Outcome Measures: Primary outcome measures were evaluated for each participant before training and after 4 and 8 weeks of training. Primary measures were self-selected and fast overground walking velocity and 6-minute walking distance. Secondary measures included clinical assessments of balance, muscle tone, and strength. Results: A significant improvement in walking speed and balance in humans with SCI was observed after robotic treadmill training using the cable-driven robotic locomotor trainer. There was no significant difference in walking functional gains after resistance versus assistance training, although resistance training was more effective for higher functioning patients. Conclusions: Cable-driven robotic resistance training may be used as an adjunct to BWSTT for improving overground walking function in humans with incomplete SCI, particularly for those patients with relatively high function.

Increased Aerobic Fitness After Neuromuscular Electrical Stimulation Training in Adults With Spinal Cord Injury

2012-03-26

Abstract: Carty A, McCormack K, Coughlan GF, Crowe L, Caulfield B. Increased aerobic fitness after neuromuscular electrical stimulation training in adults with spinal cord injury. Objectives: To evaluate the efficacy of a novel neuromuscular electrical stimulation (NMES) system for improving aerobic fitness in individuals with spinal cord injury (SCI). It was hypothesized that training with this NMES system would increase peak oxygen consumption (Vo2peak) and peak heart rate (HRpeak) in a sedentary adult SCI population. Design: Prospective cohort study. Setting: All testing took place at a university human performance laboratory. Participants: Volunteer participants with SCI (N=16; T4-11 American Spinal Injury Association Impairment Scale grades A and B) were recruited from the national SCI outpatient and outreach service databases. All completed the training program, but results from 2 participants were excluded because posttraining tests were invalid. Therefore, 14 participants (11 men, 3 women) completed the program and testing. Interventions: Four electrodes (175cm2) were placed bilaterally on the quadriceps and hamstrings muscle groups, and subtetanic contractions were elicited using an NMES device. Training was undertaken unsupervised at home for 1 hour, 5d/wk for 8 weeks. Main Outcome Measures: An incremental treadmill wheelchair propulsion exercise test with simultaneous cardiopulmonary gas exchange analysis was used to determine Vo2peak and HRpeak. Results: A statistically significant increase in Vo2peak (P=.001) and HRpeak (P=.032) between baseline and follow-up was observed. Conclusions: This novel form of NMES is an effective method of improving aerobic fitness in an SCI population. Results are comparable to those with current functional electrical stimulation exercise systems.

Curve Walking Is Not Better Than Straight Walking in Estimating Ambulation-Related Domains After Incomplete Spinal Cord Injury

Rob Labruyère, Hubertus J. van Hedel — 2012-03-05

Abstract: Labruyère R, van Hedel HJ. Curve walking is not better than straight walking in estimating ambulation-related domains after incomplete spinal cord injury. Objectives: To investigate whether a figure-of-8–shaped walking test can estimate various domains of walking in subjects with incomplete spinal cord injury (iSCI) better than the 10-meter walk test (10MWT), and to explore similarities and differences between the 2 tests and between subjects with iSCI and age-matched, healthy controls. Design: Case-control study. Setting: Spinal cord injury center of a university hospital. Participants: A convenience sample of subjects with iSCI (n=15; mean age, 50y; 40% women; neurologic level from C3 to L5; median time since injury, 5mo) was compared with an age-matched control group (47% women). Interventions: Not applicable. Main Outcome Measures: The figure-of-8 test (FET) included 6 conditions to test the subjects' ability to adapt their gait to several circumstances. These conditions covered normal and maximal walking speed, constrained vision, obstacles, foamed soles, and a dual task. Additionally, subjects were tested for lower extremity muscle strength, gait capacity (10MWT) and balance, independence, and fear of falling. Results: (1) Preferred straight-walking speed correlated with the different FET conditions in both groups; (2) if normalized to preferred straight-walking speed, FET conditions showed significant differences between both groups; (3) if normalized to preferred curve-walking speed, these differences seemed to disappear; and (4) the 10MWT appeared superior to the different conditions of the FET in estimating various walking-related functions. Conclusions: Subjects with iSCI seem to have difficulties with curve walking compared with straight walking. We therefore recommend the implementation of curve walking into rehabilitation training programs. However, the FET did not provide a better estimate of functional ambulation performance after an iSCI compared with the 10MWT.

Contributions of Cognitive Function to Straight- and Curved-Path Walking in Older Adults

2012-05-01

Abstract: Lowry KA, Brach JS, Nebes RD, Studenski SA, VanSwearingen JM. Contributions of cognitive function to straight- and curved-path walking in older adults. Objective: To determine whether the cognitive function contribution to straight- and curved-path walking differs for older adults. Design: Cross-sectional observational study. Setting: Ambulatory clinical research training center. Participants: People (N=106) aged 65 to 92 years, able to walk household distances independently with or without an assistive device, and who scored 24 or greater on the Mini-Mental State Examination. Interventions: Not applicable. Main Outcome Measures: Cognitive function was assessed using the Digit Symbol Substitution Test (DSST) as a measure of psychomotor speed, and Trail Making Test Parts A and B (TMT-A and TMT-B) and the Trail Making Test difference score (TMT-B-A) as executive function measures of complex visual scanning and set shifting. Gait speed recorded over an instrumented walkway was used as the measure of straight-path walking. Curved-path walking was assessed using the Figure-of-8 Walk Test (F8W) and recorded as the total time and number of steps for completion. Results: Both DSST and TMT-A independently contributed to usual gait speed (P<.001). TMT-A performance contributed to F8W time (P<.001). Neither TMT-B nor TMT-B-A contributed to usual gait speed or time to complete the F8W. For the number of steps taken to complete the F8W, TMT-A, TMT-B, and TMT-B-A (all P<.001) were independent contributors, while DSST performance was not. Conclusions: Curved-path walking, as measured by the F8W, involves different cognitive processes compared with straight-path walking. Cognitive flexibility and set-shifting processes uniquely contributed to how individuals navigated curved paths. The measure of curved-path walking provides different and meaningful information about daily life walking ability than usual gait speed alone.

Evaluating Intense Rehabilitative Therapies With and Without Acupuncture for Children With Cerebral Palsy: A Randomized Controlled Trial

2012-05-01

Abstract: Duncan B, Shen K, Zou L-P, Han T-L, Lu Z-L, Zheng H, Walsh M, Venker C, Su Y, Schnyer R, Caspi O. Evaluating intense rehabilitative therapies with and without acupuncture for children with cerebral palsy: a randomized controlled trial. Objective: To compare the outcomes of conventional therapies (physical, occupational, and hydrotherapies) plus acupuncture with those without acupuncture when administered intensely in the management of children with spastic cerebral palsy (CP). Design: Evaluation-blind, prospective randomized controlled trial. Setting: Therapies and video-recorded assessments at a children’s hospital in Beijing, China, and blind scoring and data analyses at a university in the United States. Participants: Children (N=75), 12 to 72 months of age, with spastic CP. Interventions: Intensely administered (5 times per week for 12wk) physical therapy, occupational therapy, and hydrotherapy either with acupuncture (group 1) or without acupuncture (group 2). To satisfy standard of care, group 2 subsequently received acupuncture (weeks 16–28). Main Outcome Measures: The Gross Motor Function Measure (GMFM)-66 and the Pediatric Evaluation of Disability Inventory (PEDI) assessments at 0, 4, 8, 12, 16, and 28 weeks. Results: At the end of 12 weeks, there was no statistically significant difference between the 2 groups, but when group 2 received acupuncture (16–28wk) there was a shift toward improvement in the GMFM-66 and the PEDI-Functional Skills Self-Care and Mobility domain. When groups were combined, statistically significant improvements after intense therapies occurred from baseline to 12 weeks for each outcome measure at each Gross Motor Function Classification System (GMFCS) level. After adjusting for expected normative maturational gains based on age, the GMFM gains for children with GMFCS II level was statistically significant (P<.05) with a mean gain of 6.5 versus a predicted gain of 3.4. Conclusions: Intense early administered rehabilitation improves function in children with spastic CP. The contribution from acupuncture was unclear. Children's response varied widely, suggesting the importance of defining clinical profiles that identify which children might benefit most. Further research should explore how this approach might apply in the U.S.

Predictors of Cardiometabolic Risk Among Adults With Cerebral Palsy

Mark D. Peterson, Heidi J. Haapala, Edward A. Hurvitz — 2012-05-01

Abstract: Peterson MD, Haapala HJ, Hurvitz EA. Predictors of cardiometabolic risk among adults with cerebral palsy. Objective: To examine the independent association between various anthropometric indicators and standard clinical markers of cardiometabolic health risk among adults with cerebral palsy (CP). Design: Cross-sectional study. Setting: Clinical center for CP treatment and rehabilitation. Participants: Adults with CP (N=43) with a mean age ± SD of 37.3±13.2 years, and Gross Motor Function Classification System (GMFCS) levels of I−V. Interventions: Not applicable. Main Outcome Measures: Adults with CP were assessed for body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), waist-to-height ratio (WtHR), and serum lipid profiles. Data were analyzed with multiple regression analysis and general linear models, and are reported as means ± SDs. Results: Mean BMI was 29.1±7.8kg/m2. BMI was not associated with any measures of cardiometabolic risk. Using GMFCS categories (2 groups: GMFCS levels I–III and IV–V), BMI was significantly lower among GMFCS levels IV–V (24.2±6.2kg/m2) versus GMFCS levels I–III (30.1±7.6kg/m2). WC and WtHR were not correlated with any cardiometabolic outcomes. Conversely, measures of WHR were independently associated with various indices of risk, including total cholesterol to high-density lipoprotein (HDL) cholesterol ratio (r=.45; P<.05), HDL cholesterol (r=–.51; P<.01), and triglycerides (r=.40; P<.05), suggesting that greater WHR was indicative of elevated risk. Conclusions: It is likely that WHR represents a stronger predictor of risk, because this measure was robustly and independently associated with 3 primary clinical markers of cardiometabolic health in adults with CP.

Gait Differs Between Unilateral and Bilateral Knee Osteoarthritis

Mark W. Creaby, Kim L. Bennell, Michael A. Hunt — 2012-03-05

Abstract: Creaby MW, Bennell KL, Hunt MA. Gait differs between unilateral and bilateral knee osteoarthritis. Objectives: To compare walking biomechanics in the most painful leg, and symmetry in biomechanics between legs, in individuals with (1) unilateral pain and structural osteoarthritis (OA), (2) unilateral pain, but bilateral structural OA, and (3) bilateral pain and structural OA and in (4) an asymptomatic control group. Design: Cohort study. Setting: Laboratory based. Participants: Participants with symptomatic and/or radiographic medial tibiofemoral OA in one or both knees (n=91), and asymptomatic control participants (n=31). Interventions: Not applicable. Main Outcome Measure: The peak knee adduction moment, peak knee flexion moment, knee varus-valgus angle, peak knee flexion angle, toe-out, and trunk lean were computed from 3-dimensional analysis of walking at a self-selected speed. Results: After controlling for walking speed, greater trunk lean toward the more painful knee and reduced flexion in the more painful knee were observed in all OA groups compared with the control group. Between-knee asymmetries indicating greater varus angle and a lower external flexion moment in the painful knee were present in those with unilateral pain and either unilateral or bilateral structural OA. Knee biomechanics were symmetrical in those with bilateral pain and structural OA and in the pain free control group. Conclusions: The presence of pain unilaterally appears to be associated with asymmetries in knee biomechanics. Contrary to this, bilateral pain is associated with symmetry. This suggests that the symptomatic status of both knees should be considered when contemplating unilateral or bilateral biomechanical interventions for medial knee OA.

Motor Imagery Ability in Patients With Traumatic Brain Injury

2012-02-27

Abstract: Oostra KM, Vereecke A, Jones K, Vanderstraeten G, Vingerhoets G. Motor imagery ability in patients with traumatic brain injury. Objective: To assess motor imagery (MI) ability in patients with moderate to severe traumatic brain injury (TBI). Design: Prospective, cohort study. Setting: University hospital rehabilitation unit. Participants: Patients with traumatic brain injury (mean coma duration, 18d) undergoing rehabilitation (n=20) and healthy controls (n=17) matched for age and education level. Interventions: Not applicable. Main Outcome Measures: The vividness of MI was assessed using a revised version of the Movement Imagery Questionnaire—Revised second version (MIQ-RS); the temporal features were assessed using the time-dependent motor imagery (TDMI) screening test, the temporal congruence test, and a walking trajectory imagery test; and the accuracy of MI was assessed using a mental rotation test. Results: The MIQ-RS revealed a decrease of MI vividness in the TBI group. An increasing number of stepping movements was observed with increasing time periods in both groups during the TDMI screening test. The TBI group performed a significantly smaller number of imagery movements in the same movement time. The temporal congruence test revealed a significant correlation between imagery and actual stepping time in both groups. The walking trajectory test revealed an increase of the imagery and actual walking time with increasing path length in both groups, but the ratio of imaginary walking over actual walking time was significantly greater than 1 in the TBI group. Results of the hand mental rotation test indicated significant effects of rotation angles on imagery movement times in both groups, but rotation time was significantly slower in the TBI group. Conclusions: Our patients with TBI demonstrated a relatively preserved MI ability indicating that MI could be used to aid rehabilitation and subsequent functional recovery.

Respite Care After Acquired Brain Injury: The Well-Being of Caregivers and Patients

2012-03-09

Abstract: Smeets SM, van Heugten CM, Geboers JF, Visser-Meily JM, Schepers VP. Respite care after acquired brain injury: the well-being of caregivers and patients. Objective: To investigate satisfaction with respite care, the well-being of informal caregivers and patients with acquired brain injury (ABI) who receive respite care by day-care activity centers, and factors related to caregiver well-being. Design: Cross-sectional cohort study. Setting: Adult day-care activity centers. Participants: A sample of caregivers and patients (N=108) with ABI (mean of 8y since injury) enrolled in 1 of 7 day-care activity centers. The sample consisted predominantly (70%) of stroke patients. Intervention: Respite care by adult day-care activity centers. Main Outcome Measures: Well-being was defined in terms of life satisfaction (Life Satisfaction Questionnaire [LiSat-9]), emotional functioning (Hospital Anxiety and Depression Scale [HADS]), and caregiver burden (Caregiver Strain Index [CSI]). Factors related to well-being were personal, injury related, and psychological. Results: Satisfaction with day-care activity center care was high for caregivers (7.8) and patients (8.1). Caregiver satisfaction with care was unrelated to caregiver well-being. Most caregivers (61%) showed low life satisfaction and high subjective burden (69%), and 33% of caregivers and 42% of the patients reported depressive symptoms. Caregiver well-being was positively correlated with a high sense of mastery of caregivers and patients and low passive coping of the patient (LiSat-9 R2=.32; HADS R2=.55; CSI R2=.35). Conclusions: This study emphasizes the need for care for both caregivers and patients in the chronic phase after ABI. Although respite care is highly appreciated, it is not sufficient for caregivers to attain a healthy level of well-being. Results indicate that caregiver well-being might improve by targeting passive coping and mastery skills of caregivers and patients. Continuous support for both caregivers and patients is needed.

Relationship of Caregiver and Family Functioning to Participation Outcomes After Postacute Rehabilitation for Traumatic Brain Injury: A Multicenter Investigation

2012-03-14

Abstract: Sander AM, Maestas KL, Sherer M, Malec JF, Nakase-Richardson R. Relationship of caregiver and family functioning to participation outcomes after postacute rehabilitation for traumatic brain injury: a multicenter investigation. Objective: To investigate the contribution of caregiver emotional functioning and family functioning to participation outcomes after postacute rehabilitation for traumatic brain injury (TBI). Design: Prospective cohort study. Setting: Three postacute comprehensive-integrated postacute rehabilitation programs associated with National Institute on Disability and Rehabilitation Research–funded TBI Model Systems Centers. Participants: Persons with medically documented TBI (N=136; 57% with severe TBI, 12% moderate, 31% mild), primarily men and 69% white. Interventions: Not applicable. Main Outcome Measures: Community Integration Questionnaire and Craig Handicap Assessment and Reporting Technique (CHART). Results: After accounting for age, education, sex, and race/ethnicity, there was a significant interaction between caregiver emotional functioning and time since injury for CHART Occupation and Social Integration Scale scores. Better emotional functioning in caregivers was associated with greater occupation and social integration outcomes for persons who entered the postacute rehabilitation program within 6 months of injury, but not for those >6 months postinjury. There was no relationship of family functioning to participation outcomes, and no interaction between family functioning and time since injury. Conclusions: Caregiver distress should be accounted for in studies investigating the effectiveness of postacute rehabilitation after TBI. Screening of caregivers early during postacute rehabilitation can target those who need assistance to improve their support of the person with TBI.

Standardized Measurement of Recovery From Nonspecific Back Pain

2012-03-26

Abstract: Hush JM, Kamper SJ, Stanton TR, Ostelo R, Refshauge KM. Standardized measurement of recovery from nonspecific back pain. Objective: To propose standardized, patient-centered measures of recovery from nonspecific low back pain (LBP) in research, underpinned by an empirically derived concept of recovery and informed by expert opinion. Design: Synthesis of literature reviews and expert panel opinion. Setting: Primary care centers for the management of nonspecific LBP. Participants: Persons with nonspecific LBP. Interventions: Conservative treatments for nonspecific LBP. Main Outcome Measures: Three phases of research were conducted. First, qualitative research that explored patients' perspectives of recovery from nonspecific LBP was reviewed. Second, measures of recovery used in LBP clinical trials during the past decade were investigated in a systematic review. Third, opinion was sought from an expert panel of clinicians and researchers about how to measure recovery from nonspecific LBP, in a workshop at the 10th International Forum for Primary Care Research in Low Back Pain. Results: An empirically derived and patient-centered concept of recovery from nonspecific LBP was developed from the qualitative research phase. The systematic review conducted in the second study phase revealed that researchers have used vastly heterogeneous measures of LBP recovery in clinical trials during the past decade. Finally, the key conclusions of the LBP Forum workshop were (1) that appropriate patient-centered instruments to measure recovery include global measures and patient-specific measures; and (2) that the benefits of implementing the same recovery measures for acute and chronic LBP outweigh the disadvantages of using different measures. Conclusions: The results were synthesized to inform our recommendation that researchers consider adopting 2 instruments as standardized measures of recovery from nonspecific LBP, as an adjunct to the existing core set of LBP outcome measures. These instruments are an 11-point Global Back Recovery Scale, for a simple measure of global recovery, and the Patient-Generated Index of Quality of Life–Back Pain, to evaluate specific relevant dimensions of recovery. This recommendation has majority endorsement by members of the Australian National Health and Medical Research Council Acute Low Back Pain Review Group.

Musculoskeletal Comorbidities in Cardiac Patients: Prevalence, Predictors, and Health Services Utilization

2012-03-15

Abstract: Marzolini S, Oh PI, Alter D, Stewart DE, Grace SL; on behalf of the Cardiac Rehab: Care Continuity through Automatic Referral Evaluation Investigators. Musculoskeletal comorbidities in cardiac patients: prevalence, predictors, and health services utilization. Objectives: To describe the prevalence of musculoskeletal conditions (MSKC) in patients with coronary artery disease (CAD); to examine the sociodemographic, clinical, and psychosocial predictors of these comorbidities; and to describe health care utilization by musculoskeletal comorbidity status. Design: This was a cross-sectional, observational study in which patients were administered a questionnaire in the hospital and 1 year later. Setting: Eleven hospitals in Ontario, Canada. Participants: CAD patients (N=1803). Interventions: Not applicable. Main Outcome Measures: Sociodemographic, MSKC, clinical, and psychosocial factors were ascertained via questionnaire and in-hospital chart extraction. A health care utilization questionnaire was mailed 1 year later. Results: Over half (56%) of the patients with CAD had MSKCs, with arthritis/joint pain accounting for 64.4% of these MSKCs. Patients who were older (odds ratio [OR]=1.03), women (OR=1.87), white (OR=1.80), with higher body mass index (OR=1.05), depressive symptoms (OR=1.92), and lower family income (OR=1.46) were more likely to present with MSKCs. One year posthospitalization, a greater proportion of those with MSKCs reported ≥1 cardiac-related emergency department visit (33.2% vs 28.3%, P=.03), hospital admission (30.7% vs 22%, P=.006), more primary care physician visits (6.6±5.6 vs 5.7±4.6, P<.001), and fewer cardiac rehabilitation referrals (61.5% vs 70%, P<.001). After adjusting for depressive symptoms, body mass index, age, income, ethnicity, and sex, MSKCs predicted only hospital readmissions. Conclusions: Over half of the patients hospitalized for CAD have MSKCs. Those with MSKCs have a physical and psychosocial profile that places them at greater cardiovascular risk than those with CAD only, explaining, in part, their greater health care utilization. Despite a greater need for comprehensive risk factor management in patients with MSKCs, fewer were referred to cardiac rehabilitation.

Computer-Aided Design of Customized Foot Orthoses: Reproducibility and Effect of Method Used to Obtain Foot Shape

2012-05-01

Abstract: Telfer S, Gibson KS, Hennessy K, Steultjens MP, Woodburn J. Computer-aided design of customized foot orthoses: reproducibility and effect of method used to obtain foot shape. Objective: To determine, for a number of techniques used to obtain foot shape based around plaster casting, foam box impressions, and 3-dimensional scanning, (1) the effect the technique has on the overall reproducibility of custom foot orthoses (FOs) in terms of inter- and intracaster reliability and (2) the reproducibility of FO design by using computer-aided design (CAD) software in terms of inter- and intra-CAD operator reliability for all these techniques. Design: Cross-sectional study. Setting: University laboratory. Participants: Convenience sample of individuals (N=22) with noncavus foot types. Interventions: Not applicable. Main Outcome Measures: Parameters of the FO design (length, width at forefoot, width at rearfoot, and peak medial arch height), the forefoot to rearfoot angle of the foot shape, and overall volume match between device designs. Results: For intra- and intercaster reliability of the different methods of obtaining the foot shape, all methods fell below the reproducibility quality threshold for the medial arch height of the device, and volume matching was <80% for all methods. The more experienced CAD operator was able to achieve excellent reliability (intraclass correlation coefficients >0.75) for all variables with the exception of forefoot to rearfoot angle, with overall volume matches of >87% of the devices. Conclusions: None of the techniques for obtaining foot shape met all the criteria for excellent reproducibility, with the peak arch height being particularly variable. Additional variability is added at the CAD stage of the FO design process, although with adequate operator experience good to excellent reproducibility may be achieved at this stage. Taking only basic linear or angular measurement parameters from the device may fail to fully capture the variability in FO design.

Impact of Cerebral Palsy on Health-Related Physical Fitness in Adults: Systematic Review

2012-05-01

Abstract: Hombergen SP, Huisstede BM, Streur MF, Stam HJ, Slaman J, Bussmann JB, van den Berg-Emons RJ. Impact of cerebral palsy on health-related physical fitness in adults: systematic review. Objective: To conduct a systematic review of the impact of cerebral palsy (CP) on the level of health-related physical fitness (body composition, cardiorespiratory endurance, flexibility, muscular endurance, and strength) in adults with CP compared with able-bodied adults. Data Sources: The Cochrane Library, MEDLINE, CINAHL, EMBASE, and PEDro were searched up to December 2010 for relevant comparative studies. Study Selection: Two reviewers independently applied the inclusion criteria (adults, comparative design, components of physical fitness) to select potential relevant studies. Data Extraction: Two reviewers independently extracted the data and assessed the methodological quality. A consensus method was used to solve disagreements. Data Synthesis: Pooling data was not possible, but a best-evidence synthesis was conducted. Also, a description of the level of health-related physical fitness in CP was given (expressed as a percentage of able-bodied controls). Nine case-control studies were included (average age ± SD of subjects with CP, 21±3y): 3 investigated body composition; 5, cardiorespiratory endurance; 3, muscular strength; and 1, muscular endurance. Two of the studies investigated multiple fitness components. No studies on flexibility were found. Muscular strength (34%–60%), muscular endurance (27%–52%), and cardiorespiratory endurance (14%) showed significantly lower values in adults with CP compared with able-bodied controls. Studies on body composition reported conflicting results on the impact of CP. Conclusions: The results of this review point to a reduction in 3 components of health-related physical fitness in young adults with CP compared with controls: muscular strength, muscular endurance, and cardiorespiratory endurance. However, the level of evidence varies from moderate (muscular strength) to limited (muscular endurance and cardiorespiratory endurance). Additional studies of high methodological quality are recommended before firm conclusions can be made.

Feasibility and Test-Retest Reliability of an Electroencephalography-Based Brain Mapping System in Children With Cerebral Palsy: A Preliminary Investigation

2012-03-12

Abstract: Lee NG, Kang SK, Lee DR, Hwang HJ, Jung JH, You JH, Im CH, Kim DA, Lee JA, Kim KS. Feasibility and test-retest reliability of an electroencephalography-based brain mapping system in children with cerebral palsy: a preliminary investigation. Objective: To investigate the feasibility and test-retest reliability of a novel electroencephalography (EEG)-based brain mapping system in healthy children and children with cerebral palsy (CP). Design: Correlation statistics. Setting: University brain mapping and neurorehabilitation laboratory. Participants: A convenience sample of children (N=12; 5 healthy children, mean ± SD, 12.6±0.89y; 7 children with CP, mean ± SD, 9.71±1.1y) participated in the study. Interventions: Not applicable. Main Outcome Measures: Mu band (8–12Hz) power values in event-related spectral perturbation maps during reach and grasp hand movements were repeatedly measured on 2 separate occasions (2h apart). Intraclass correlation coefficient (ICC1,2) tests were computed to determine test-retest reliability at the standard level of significance (P<.004). In addition, the feasibility of the system was determined by evaluating potential differences in the cortical activation areas obtained from topographical maps during actual reach and grasp motor tasks between healthy children and children with CP. Results: The test-retest reliability results showed excellent reliability between the repeated measures, ranging from .93 (P=.000) to .99 (P=.000). Our EEG brain mapping system was capable of distinguishing differences in the cortical activity power (mu band power spectra) between healthy children and children with CP. Conclusions: To our knowledge, this study is the first evidence demonstrating the feasibility and reliability of the EEG brain mapping system. Clinically, this system provides important insights into neuroplasticity associated with motor recovery after treatment and can also be used as real-time neurofeedback or noninvasive neuromodulation in the course of neurologic rehabilitation.

Self-Reported Fatigue and Energy Cost During Walking Are Not Related in Patients With Multiple Sclerosis

2012-03-22

Abstract: Kempen JCE, de Groot V, Knol DL, Lankhorst GJ, Beckerman H. Self-reported fatigue and energy cost during walking are not related in patients with multiple sclerosis. Objectives: To determine whether there is a relationship between self-reported fatigue and the energy cost of walking (ECw), and how self-reported fatigue and ECw relate to physical functioning in patients with multiple sclerosis (MS). Design: Cross-sectional cohort study, using structural equation modeling. Setting: Home environment and at a university medical center. Participants: Patients (N=75) were obtained from a longitudinal study on outcome measurement and functional prognosis in early MS. Patients were included if they were able to walk for 6 minutes without being assisted by a person. The age range was between 28.0 and 69.7 years and the median Expanded Disability Status Scale was 2.5 (range, 1.0–6.5). Interventions: Not applicable. Main Outcome Measures: Self-reported fatigue was measured with the Fatigue Severity Scale, the vitality subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and a visual analog scale. Physical functioning was determined with the physical functioning subscale of the SF-36, fast walking speed, and comfortable walking speed. The ECw (J·kg−1·m−1) was measured with the energy cost of the walking test. Results: The relationship between ECw and latent variable fatigue had a β=−.188 (P=.236), that between ECw and physical functioning (SF-36 physical functioning) had a β=−.344 (P=.001), and that between fatigue and physical functioning had a β=−.448 (P=.000). Conclusions: Fatigue and ECw are not related in patients with MS with mild to moderate walking problems. ECw and fatigue are independent determinants of physical functioning.

Longitudinal Performance of a Surgically Implanted Neuroprosthesis for Lower-Extremity Exercise, Standing, and Transfers After Spinal Cord Injury

2012-05-01

Abstract: Triolo RJ, Bailey SN, Miller ME, Rohde LM, Anderson JS, Davis JA Jr, Abbas JJ, DiPonio LA, Forrest GP, Gater DR Jr, Yang LJ. Longitudinal performance of a surgically implanted neuroprosthesis for lower-extremity exercise, standing, and transfers after spinal cord injury. Objective: To investigate the longitudinal performance of a surgically implanted neuroprosthesis for lower-extremity exercise, standing, and transfers after spinal cord injury. Design: Case series. Setting: Research or outpatient physical therapy departments of 4 academic hospitals. Participants: Subjects (N=15) with thoracic or low cervical level spinal cord injuries who had received the 8-channel neuroprosthesis for exercise and standing. Intervention: After completing rehabilitation with the device, the subjects were discharged to unrestricted home use of the system. A series of assessments were performed before discharge and at a follow-up appointment approximately 1 year later. Main Outcome Measures: Neuroprosthesis usage, maximum standing time, body weight support, knee strength, knee fatigue index, electrode stability, and component survivability. Results: Levels of maximum standing time, body weight support, knee strength, and knee fatigue index were not statistically different from discharge to follow-up (P>.05). Additionally, neuroprosthesis usage was consistent with subjects choosing to use the system on approximately half of the days during each monitoring period. Although the number of hours using the neuroprosthesis remained constant, subjects shifted their usage to more functional standing versus more maintenance exercise, suggesting that the subjects incorporated the neuroprosthesis into their lives. Safety and reliability of the system were demonstrated by electrode stability and a high component survivability rate (>90%). Conclusions: This group of 15 subjects is the largest cohort of implanted lower-extremity neuroprosthetic exercise and standing system users. The safety and efficiency data from this group, and acceptance of the neuroprosthesis as demonstrated by continued usage, indicate that future efforts toward commercialization of a similar device may be warranted.

Functional Motor Preservation Below the Level of Injury in Subjects With American Spinal Injury Association Impairment Scale Grade A Spinal Cord Injuries

José Zariffa, Armin Curt, John D. Steeves, EMSCI Study Group — 2012-02-24

Abstract: Zariffa J, Curt A, for the EMSCI Study Group, Steeves JD. Functional motor preservation below the level of injury in subjects with American Spinal Injury Association Impairment Scale grade A spinal cord injuries. Objective: To assess how frequently subjects with spinal cord injuries (SCIs) classified as American Spinal Injury Association Impairment Scale (AIS) grade A have substantial preserved motor function below the neurologic level of injury, despite having no preserved sensory or motor function at the S4-5 spinal cord segment. Design: Analysis of the European Multicenter Study about Spinal Cord Injury database to determine how frequently subjects assessed as AIS A would have been AIS D based on motor scores alone (ie, had scores of ≥3 in at least half of the International Standards for Neurological Classification of Spinal Cord Injury [ISNCSCI] key muscles below the neurologic level of injury, despite having no sacral sparing). Setting: Eighteen European centers. Participants: Individuals with traumatic SCI at any level (total of 2557 assessments). Interventions: Not applicable. Main Outcome Measure: ISNCSCI assessments. Results: Over the first year after SCI (with assessments at approximately 1, 4, 12, 24, and 48wk) and for all rostrocaudal levels of injury, only 3.2% of AIS A assessments were found to meet the AIS D motor score criteria. The percentage was highest for lumbar (16.3%) and lower thoracic (4.4%) SCI. No trends were observed across time points. Conclusions: These results suggest that the low frequency of individuals with an AIS A classification and high levels of motor function are not a significant concern in subject recruitment for clinical trials, unless the level of SCI is within the lumbar cord.

Three-Year Follow-Up Results of a Residential Community Reintegration Program for Patients With Chronic Acquired Brain Injury

2012-03-22

Abstract: Geurtsen GJ, van Heugten CM, Martina JD, Rietveld AC, Meijer R, Geurts AC. Three-year follow-up results of a residential community reintegration program for patients with chronic acquired brain injury. Objective: To evaluate outcomes of a residential community reintegration program 3 years after treatment on independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation. Design: A follow-up assessment 3 years after treatment was compared with the 1-year follow-up assessment in a prospective cohort study. Setting: A tertiary rehabilitation center for acquired brain injury. Participants: Of the 67 patients assessed at the 1-year follow-up, 63 subjects (94%; 42 men; mean age at admission to treatment 24.7y; mean time postonset 5.1y) were available at the 3-year follow-up and taken into account in the analyses. Intervention: A structured residential treatment program directed at improving independence in domestic life, work, leisure time, and social interactions. Main Outcome Measures: Community Integration Questionnaire, Employability Rating Scale, living situation, school, work situation, work hours, Center for Epidemiological Studies-Depression scale, and the World Health Organization Quality of Life Scale Abbreviated (5 scales). Results: There were no significant differences for any of the outcome measures between the 1-year and 3-year follow-up assessment. Conclusions: These results indicate that the established significant and clinically relevant improvements after a residential community reintegration program remain stable in the long term.

Systematic Reviews for Informing Rehabilitation Practice: An Introduction

2012-05-01

Abstract: Dijkers MP, Bushnik T, Heinemann AW, Heller T, Libin AV, Starks J, Sherer M, Vandergoot D. Systematic reviews for informing rehabilitation practice: an introduction. The research literature that rehabilitation clinicians need to be familiar with has become too large for anyone to read, and numerous published studies are too complex for many practitioners to understand and fruitfully use. One method to keep up with new findings is through systematic reviews. Systematic reviews can be effective tools that help guide rehabilitation practice by identifying the best research that provides the evidence for enhanced clinical decision-making. This article describes how systematic reviews are created, indicates where rehabilitation clinicians may find them, and refers to a resource that may be of use in evaluating their quality and applicability.

Quasi-Experimental Study of Weight-Supported Treadmill Training for Myelopathy

Bruce H. Dobkin, Robert Elashoff — 2012-05-01

In their exploratory, cohort report using body weight–supported treadmill training (BWSTT) in persons with nonprogressive spinal cord injury (SCI), Harkema et al state, “There is a need to evaluate the effectiveness of locomotor training by using a standardized protocol and outcomes with a large sample of participants with upper motor neuron, incomplete SCI.” For this rationale, the Reeve Foundation funded 7 sites (NeuroRecovery Network [NRN]) to treat 196 patients graded C and D on the American Spinal Injury Association Impairment Scale (AIS). The investigators did not use any of the design features needed to scientifically test the impact of their training. They acknowledge limitations but did nothing to mitigate them. The protocol did not randomize to a comparison intervention, specify number of treatments, obtain blinded outcomes, or assess outcomes at standard posttreatment times or examine their sustainability. No measures of home-based walking practice, lower limb strength, physical functioning, and quality of life were obtained. Instead, they conjectured about the possible impact of their findings based on unrelated studies. No statistical correction for multiple outcome tests was performed. Indeed, the cohort's high variability of baseline and change scores, which the authors decry as a problem of past studies, is a contraindication for their use of the Wilcoxon statistic for 2-group outcome studies. Lack of a standard protocol, with high baseline variability (eg, time from onset was 32d to 25y; participants trained for 20–251 sessions over 28–649d), made it unlikely, a priori, that they could generalize about impact or establish an effect size.

The Authors Respond: Balance and Ambulation Improvements in Individuals With Chronic Incomplete Spinal Cord Injury Using Locomotor Training-Based Rehabilitation

2012-05-01

Dobkin and Elashoff raise a number of points about our article that recently appeared in the Archives that will benefit from some discussion, and we will address them below. Their editorial comments are essentially based on the assumption that the objective of our study was to scientifically test the impact of locomotor training, and thus a randomized controlled trial was required. Although the former is desirable, it is not the only type of study that can provide valuable information that can be used to improve clinical practice. Important insight can be gained even from a case study, and clinically relevant outcomes can be missed if only a sole primary outcome measure is considered.

Effect of Vacuum-Assisted Socket and Pin Suspensions on Socket Fit

Hossein Gholizadeh, Noor Azuan Abu Osman, Arezoo Eshraghi — 2012-05-01

We read the article by Klute et al with interest; however, we identified a number of issues with the article. The authors compared the socket fit, activity level, and limb volume of 2 different prosthetic suspension systems, namely a vacuum-assisted suspension system (VASS) and a pin suspension. Because limited literature is available on the effect of vacuum-assisted suspension as a means of controlling residual limb volume and pistoning, the article would have been more clinically helpful if some ambiguities were clarified.

The Authors Respond: Vacuum-Assisted Socket Suspension Systems for Lower Extremity Amputees: Effect on Fit, Activity, and Limb Volume

2012-05-01

The accompanying letter (by Gholizadeh et al) asks several interesting questions about our study comparing the fit and function of 2 different, but widely prescribed, socket and suspension systems for lower limb amputees. We are thankful for the opportunity to address them.

American Board of Physical Medicine and Rehabilitation 2011 Certification Examinations

2012-05-01

On October 1, 2011, the American Board of Physical Medicine and Rehabilitation, in conjunction with the American Board of Anesthesiology and the American Board of Psychiatry and Neurology, administered the eighth examination for subspecialization in Pain Medicine. Effective October 1, 2011, the following individuals were certified.

Request for Proposals 2014 Archives Supplement 2

2012-05-01

Masthead

2012-05-01

Archives of Physical Medicine and Rehabilitation (ISSN 0003-9993) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010-1710. Periodicals postage paid at New York, NY and additional mailing offices.

Editorial Board

2012-05-01

Editors' Selections From This Issue

2012-05-01

Steve Tumilty, PhD Suzanne McDonough, PhD

Archives of Physical Medicine and Rehabilitation

Clinical Effectiveness of Low-Level Laser Therapy as an Adjunct to Eccentric Exercise for the Treatment of Achilles' Tendinopathy: A Randomized Controlled Trial

Effectiveness of Supported Employment for Veterans With Spinal Cord Injuries: Results From a Randomized Multisite Study

Comparison of the Efficacy of Transcutaneous Electrical Nerve Stimulation, Interferential Currents, and Shortwave Diathermy in Knee Osteoarthritis: A Double-Blind, Randomized, Controlled, Multicenter Study

Short-Term Effects of 890-Nanometer Radiation on Pain, Physical Activity, and Postural Stability in Patients With Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Study

The Trajectory of Physical and Mental Health From Injury to 5 Years After Multiple Trauma: A Prospective, Longitudinal Cohort Study

An Exploration of Modifiable Risk Factors for Depression After Spinal Cord Injury: Which Factors Should We Target?

Robotic Resistance Treadmill Training Improves Locomotor Function in Human Spinal Cord Injury: A Pilot Study

Increased Aerobic Fitness After Neuromuscular Electrical Stimulation Training in Adults With Spinal Cord Injury

Curve Walking Is Not Better Than Straight Walking in Estimating Ambulation-Related Domains After Incomplete Spinal Cord Injury

Contributions of Cognitive Function to Straight- and Curved-Path Walking in Older Adults

Evaluating Intense Rehabilitative Therapies With and Without Acupuncture for Children With Cerebral Palsy: A Randomized Controlled Trial

Predictors of Cardiometabolic Risk Among Adults With Cerebral Palsy

Gait Differs Between Unilateral and Bilateral Knee Osteoarthritis

Motor Imagery Ability in Patients With Traumatic Brain Injury

Respite Care After Acquired Brain Injury: The Well-Being of Caregivers and Patients

Relationship of Caregiver and Family Functioning to Participation Outcomes After Postacute Rehabilitation for Traumatic Brain Injury: A Multicenter Investigation

Standardized Measurement of Recovery From Nonspecific Back Pain

Musculoskeletal Comorbidities in Cardiac Patients: Prevalence, Predictors, and Health Services Utilization

Computer-Aided Design of Customized Foot Orthoses: Reproducibility and Effect of Method Used to Obtain Foot Shape

Impact of Cerebral Palsy on Health-Related Physical Fitness in Adults: Systematic Review

Feasibility and Test-Retest Reliability of an Electroencephalography-Based Brain Mapping System in Children With Cerebral Palsy: A Preliminary Investigation

Self-Reported Fatigue and Energy Cost During Walking Are Not Related in Patients With Multiple Sclerosis

Longitudinal Performance of a Surgically Implanted Neuroprosthesis for Lower-Extremity Exercise, Standing, and Transfers After Spinal Cord Injury

Functional Motor Preservation Below the Level of Injury in Subjects With American Spinal Injury Association Impairment Scale Grade A Spinal Cord Injuries

Three-Year Follow-Up Results of a Residential Community Reintegration Program for Patients With Chronic Acquired Brain Injury

Systematic Reviews for Informing Rehabilitation Practice: An Introduction

Quasi-Experimental Study of Weight-Supported Treadmill Training for Myelopathy

The Authors Respond: Balance and Ambulation Improvements in Individuals With Chronic Incomplete Spinal Cord Injury Using Locomotor Training-Based Rehabilitation

Effect of Vacuum-Assisted Socket and Pin Suspensions on Socket Fit

The Authors Respond: Vacuum-Assisted Socket Suspension Systems for Lower Extremity Amputees: Effect on Fit, Activity, and Limb Volume

American Board of Physical Medicine and Rehabilitation 2011 Certification Examinations

Request for Proposals 2014 Archives Supplement 2

Masthead

Editorial Board

Table of Contents

Editors' Selections From This Issue