Archives of Physical Medicine and Rehabilitation

A Randomized Controlled Trial Comparing Manipulation With Mobilization for Recent Onset Neck Pain

2010-09-01

Abstract: Leaver AM, Maher CG, Herbert RD, Latimer J, McAuley JH, Jull G, Refshauge KM. A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain.Objective: To determine whether neck manipulation is more effective for neck pain than mobilization.Design: Randomized controlled trial with blind assessment of outcome.Setting: Primary care physiotherapy, chiropractic, and osteopathy clinics in Sydney, Australia.Participants: Patients (N=182) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner.Interventions: Participants were randomly assigned to receive treatment with neck manipulation (n=91) or mobilization (n=91). Patients in both groups received 4 treatments over 2 weeks.Main Outcome Measure: The number of days taken to recover from the episode of neck pain.Results: The median number of days to recovery of pain was 47 in the manipulation group and 43 in the mobilization group. Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilization (hazard ratio=.98; 95% confidence interval, .66–1.46).Conclusions: Neck manipulation is not appreciably more effective than mobilization. The use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.

Forgoing Physician Visits Because of Cost: A Source of Health Disparities for Elderly People With Disabilities?

Jae Chul Lee, Allen W. Heinemann — 2010-09-01

Abstract: Lee JC, Heinemann AW. Forgoing physician visits because of cost: a source of health disparities for elderly people with disabilities?Objective: To examine disparities in having a usual source of care and forgoing physician visits because of cost between elderly people (age ≥65y) with and without disabilities after consecutively controlling for predisposing, enabling, and perceived and evaluated health need factors using the Andersen behavioral model, and to identify the determinants of such disparities.Design: Cross-sectional analysis.Setting: Community.Participants: Nationally representative sample of community-dwelling adults age 65 years or greater in the United States from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) (N=93,933).Interventions: Not applicable.Main Outcome Measures: Responses to 2 BRFSS questions: (1) whether the respondent had a health care provider, and (2) whether the respondent had forgone seeing a physician because of cost in the past 12 months.Results: After controlling for the aforementioned factors, elderly persons with disabilities were more likely than their counterparts without disabilities to have a usual source of care (adjusted odds ratio [AOR]=1.33; 95% confidence interval [CI], 1.08–1.64), and those with disabilities were more likely to forgo physician visits because of cost (AOR=1.64; 95% CI, 1.31–2.04). The unadjusted odds of forgoing physician visits (odds ratio [OR]=2.13; 95% CI, 1.87–2.43) did not decrease after controlling for predisposing factors (AOR=2.32; 95% CI, 1.96–2.75), whereas the odds were attenuated after controlling for enabling factors (AOR=2.18; 95% CI, 1.84–2.59), perceived health need (AOR=1.70; 95% CI, 1.37–2.12), and evaluated health need (AOR=1.64; 95% CI, 1.31–2.04).Conclusions: Although elderly people with disabilities were more likely than their counterparts without disabilities to have a usual source of care, those with disabilities were more likely to forgo physician visits because of cost. Elderly persons with greater perceived health needs were most likely to experience the disparity.

Comparison of Trunk Proprioception Between Patients With Low Back Pain and Healthy Controls

2010-09-01

Abstract: Lee AS, Cholewicki J, Reeves NP, Zazulak BT, Mysliwiec LW. Comparison of trunk proprioception between patients with low back pain and healthy controls.Objective: To determine whether proprioceptive impairments exist in patients with low back pain (LBP). We hypothesized that patients with LBP would exhibit larger trunk proprioception errors than healthy controls.Design: Case-control study.Setting: University laboratory.Participants: 24 patients with nonspecific LBP and 24 age-matched healthy controls.Interventions: Not applicable.Main Outcome Measures: We measured trunk proprioception in all 3 anatomical planes using motion perception threshold, active repositioning, and passive repositioning tests.Results: LBP patients had significantly greater motion perception threshold than controls (P<.001) (1.3±0.9° vs 0.8±0.6°). Furthermore, all subjects had the largest motion perception threshold in the transverse plane (P<.001) (1.2±0.7° vs 1.0±0.8° for all other planes averaged). There was no significant difference between LBP and healthy control groups in the repositioning tasks. Errors in the active repositioning test were significantly smaller than in the passive repositioning test (P=.032) (1.9±1.2° vs 2.3±1.4°).Conclusions: These findings suggest that impairments in proprioception may be detected in patients with LBP when assessed with a motion perception threshold measure.

Preparation for Compensatory Forward Stepping in Parkinson's Disease

2010-09-01

Abstract: King LA, St George RJ, Carlson-Kuhta P, Nutt JG, Horak FB. Preparation for compensatory forward stepping in Parkinson's disease.Objective: To characterize preparation for compensatory stepping in people with Parkinson's disease (PD) compared with healthy control subjects, and to determine whether levodopa medication improves preparation or the execution phases of the step.Design: Observational study.Setting: Outpatient neuroscience laboratory.Participants: Nineteen participants with idiopathic PD tested both in the on and off levodopa states and 17 healthy subjects.Intervention: Moveable platform with posterior translations of 24cm at 56cm/s.Main Outcome Measures: Compensatory steps forward, in response to a backward surface translation (24cm amplitude at 56cm/s), were categorized according to the presence of an anticipatory postural adjustment (APA) before stepping: no APA, single APA, or multiple APAs. The following step parameters were calculated: step latency, step length, center of mass (CoM) average velocity, and CoM displacement at the step initiation.Results: Lateral APAs were evident in 57% and 42% of trials for people with PD in the off and on medication states, respectively, compared with only 10% of trials for control subjects. Compared with subjects with PD who did not have APAs, those subjects with PD who did make an APA prior to stepping had significantly later (mean ± SEM, 356±16ms vs 305±8ms) and shorter (mean ± SEM, 251±27mm vs 300±16mm) steps, their CoM was significantly farther forward (185±7mm vs 171±5mm) at foot-off, and they took significantly more steps to regain equilibrium. Levodopa did not affect the preparation or execution phase of compensatory stepping. Poor axial scores and reports of freezing in the United Parkinson's Disease Rating Scale were associated with use of 1 or more APAs before compensatory stepping.Conclusions: Lateral postural preparation prior to compensatory stepping in subjects with PD was associated with inefficient balance recovery from external perturbations.

Case-Mix Adjustment and Enabled Reporting of the Health Care Experiences of Adults With Disabilities

2010-09-01

Abstract: Palsbo SE, Diao G, Palsbo GA, Tang L, Rosenberger WF, Mastal MF. Case-mix adjustment and enabled reporting of the health care experiences of adults with disabilities.Objectives: To develop activity limitation clusters for case-mix adjustment of health care ratings and as a population profiler, and to develop a cognitively accessible report of statistically reliable quality and access measures comparing the health care experiences of adults with and without disabilities, within and across health delivery organizations.Design: Observational study.Setting: Three California Medicaid health care organizations.Participants: Adults (N = 1086) of working age enrolled for at least 1 year in Medicaid because of disability.Interventions: Not applicable.Main Outcome Measures: Principal components analysis created 4 clusters of activity limitations that we used to characterize case mix. We indentified and calculated 28 quality measures using responses from a proposed enabled version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. We calculated scores for overall care as the weighted mean of the case-mix adjusted ratings.Results: Disability caused a greater bias on health plan ratings and specialist ratings than did demographic factors. Proxy respondents rated care the same as self-respondents. Telephone and mail administration were equivalent for service reports, but telephone respondents tended to offer more positive global ratings. Plan-level reliability estimates for new composites on shared decision making and advice on healthy living are .79 and .87, respectively. Plan-level reliability estimates for a new composite measure on family planning did not discriminate between health plans because respondents rated all health plans poorly. Approximately 125 respondents per site are necessary to detect group differences.Conclusions: Self-reported activity limitations incorporating standard questions from the American Community Survey can be used to create a disability case-mix index and to construct profiles of a population's activity limitations. The enabled comparative report, which we call the Assessment of Health Plans and Providers by People with Activity Limitations, is more cognitively accessible than typical CAHPS report templates for state Medicaid plans. The CAHPS Medicaid reporting tools may provide misleading ratings of health plan and physician quality by people with disabilities because the mean ratings do not account for systematic biases associated with disability. More testing on larger populations would help to quantify the strength of various reporting biases.

Development and Validation of Participation and Positive Psychologic Function Measures for Stroke Survivors

2010-09-01

Abstract: Bode RK, Heinemann AW, Butt Z, Stallings J, Taylor C, Rowe M, Roth EJ. Development and validation of participation and positive psychologic function measures for stroke survivors.Objective: To evaluate the reliability and validity of Neurologic Quality of Life (NeuroQOL) item banks that assess quality-of-life (QOL) domains not typically included in poststroke measures.Design: Secondary analysis of item responses to selected NeuroQOL domains.Setting: Community.Participants: Community-dwelling stroke survivors (n=111) who were at least 12 months poststroke.Interventions: Not applicable.Main Outcome Measures: Five measures developed for 3 NeuroQoL domains: ability to participate in social activities, satisfaction with participation in social activities, and positive psychologic function.Results: A single bank was developed for the positive psychologic function domain, but 2 banks each were developed for the ability-to-participate and satisfaction-with-participation domains. The resulting item banks showed good psychometric properties and external construct validity with correlations with the legacy instruments, ranging from .53 to .71. Using these measures, stroke survivors in this sample reported an overall high level of QOL.Conclusions: The NeuroQoL-derived measures are promising and valid methods for assessing aspects of QOL not typically measured in this population.

Impact of Traumatic Brain Injury on Participation in Leisure Activities

2010-09-01

Abstract: Wise EK, Mathews-Dalton C, Dikmen S, Temkin N, Machamer J, Bell K, Powell JM. Impact of traumatic brain injury on participation in leisure activities.Objective: To determine how participation in leisure activities for people with traumatic brain injury (TBI) changes from before injury to 1 year after injury.Design: Prospective evaluation of leisure participation at 1 year after TBI.Setting: Level I trauma center.Participants: Rehabilitation inpatients (mean age, 35.3 years; 77% male; 77% white) with moderate to severe TBI (N=160).Interventions: Not applicable.Main Outcome Measure: Functional Status Examination.Results: At 1 year after injury, 81% had not returned to preinjury levels of leisure participation. Activities most frequently discontinued included partying, drug and alcohol use, and various sports. The activity most often reported as new after injury was watching television. Of the small fraction who returned to preinjury levels, 70% did so within 4 months of injury. Sixty percent of those who did not return to preinjury levels were moderately to severely bothered by the changes.Conclusions: At 1 year after injury, many TBI survivors engage in a reduced number of leisure activities, which are more sedentary and less social, with a substantial fraction dissatisfied with these changes. While discontinuing some activities may be viewed as a positive change, there are few new ones to replace them.

Baseline Comorbidity Associated With the Short-Term Effects of Exercise Intervention on Quality of Life in the Japanese Older Population: An Observational Study

Kotaro Tamari — 2010-09-01

Abstract: Tamari K. Baseline comorbidity associated with the short-term effects of exercise intervention on quality of life in the Japanese older population: an observational study.Objective: To investigate predictors of responses to a class-based exercise program in terms of health-related quality of life (HRQOL).Design: A 3-month prospective cohort study.Setting: General community.Participants: A sample of community-dwelling Japanese volunteers (N=137; aged ≥65y) initially was included in the study. More than three fourths (76.6%) completed the follow-up examination.Interventions: Not applicable.Main Outcome Measures: Eight domains of the Medical Outcomes Study 36-Item Short-Form Health Survey, version 2, were used as main outcome measures. Candidate predictors included demographic variables, medical history of chronic diseases, and results of a set of physical performance tests at the baseline examination. Logistic regression models were used to detect predictors.Results: Bodily pain, vitality, social functioning, and mental health domains improved after the intervention (P<.01 vs baseline). The absence of diabetes mellitus showed an association with a good response in the identified domains, with an adjusted odds ratio (OR) of 2.88 (confidence interval [CI], .90–9.25). More than 20% of participants had negative changes in the physical functioning, physical role, general health, and emotional role domains at follow-up. The presence of osteoarthritis significantly predicted a poor response in these domains, with an adjusted OR of 6.75 (CI, 1.58–28.83).Conclusions: Three months of class-based exercise is effective in alleviating bodily pain and the mental components of HRQOL; however, the effect of exercise on the physical domains of HRQOL may be limited. The presence of osteoarthritis may moderate the effects of exercise on HRQOL physical components.

Suggestions for Refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): A Factor Analysis and Rasch Validation Study

2010-09-01

Abstract: Franchignoni F, Giordano A, Sartorio F, Vercelli S, Pascariello B, Ferriero G. Suggestions for refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): a factor analysis and Rasch validation study.Objective: To perform a comprehensive psychometric analysis of Disabilities of the Arm, Shoulder and Hand (DASH) to examine its properties and provide insights for an improved version.Design: Methodologic research on cross-sectional data from a convenience sample.Setting: A free-standing rehabilitation center.Participants: Outpatients and inpatients (N=238; 56% men; mean age, 52.2y) with upper-extremity musculoskeletal disorders.Main Outcome Measure: The official Italian version of DASH was analyzed by factor (both explorative and confirmatory) and Rasch analysis for evaluating dimensionality, functioning of rating scale categories, item fit, hierarchy of item difficulties, and reliability indices.Interventions: Not applicable.Results: Factor analysis established the presence of 3 underlying constructs related to manual functioning (items 1–5, 7–11, 16–18, 20, 21), shoulder range of motion (items 6, 12–15, 19), and symptoms and consequences (items 22–30). Rating scale diagnostics showed category malfunctioning. The fit to the Rasch model was good for all items except 4 (items 20, 21, 25, 26). Ten item pairs had high residual correlations after subtraction of the Rasch dimension (local dependency). A test model based on the 3 subscales suggested by factor analysis and corrected categories still showed misfitting in items 21 (“Sexual Activities”) and 26 (“Tingling”) and the presence of some dependent items.Conclusions: Unidimensionality and the key domains identified by the original developers as the theoretic framework of DASH were not confirmed by our analyses. The response categories showed misfunctioning. “Sexual Activities” and “Tingling” misfit the Rasch model. Further detailed investigations of DASH are warranted, both to confirm these results in different health conditions and cultures, and to reanalyze in-depth content validity issues regarding the questionnaire.

Electric Pulse Frequency and Magnitude of Perceived Sensation During Electrocutaneous Forearm Stimulation

Herbert F. Jelinek, Rowan McIntyre — 2010-09-01

Abstract: Jelinek HF, McIntyre R. Electric pulse frequency and magnitude of perceived sensation during electrocutaneous forearm stimulation.Objectives: To investigate the effect that electric pulse frequency has on the perceived magnitude of sensation and to quantify the relationship between electric pulse frequency and perceived magnitude of sensation during low-intensity electrocutaneous stimulation.Design: A repeated-measures research design was applied to evaluate the effect of electric pulse frequency on the perceived magnitude of electrocutaneous stimulation.Setting: Electrocutaneous agents laboratory.Participants: University students (N=26) with normal hearing and normal sensation were recruited for the study.Interventions: Electrocutaneous stimulation was applied to the forearm at 10 electric pulse frequencies.Main Outcome Measures: A cross-modality matching procedure was used in which stimulation intensity was matched with the level of loudness. Pairwise comparisons with 2 degrees of freedom at a power of 80% was performed. Statistical significance was set at P equal to .05.Results: Electric pulse frequency had a significant effect on the perceived magnitude of sensation, with the perceived sensation growing between 0 and 120Hz (F=36.02; P<.001). The relationship between the 2 variables was strong (r2=.99; P<.01).Conclusions: Increasing the electric pulse frequency of electrocutaneous stimulation increases the perceived magnitude of the resulting sensation. This has implications for the use of electrocutaneous stimulation for both analgesia and muscle stimulation.

Effect of Taping on Actual and Perceived Dynamic Postural Stability in Persons With Chronic Ankle Instability

Eamonn Delahunt, Angela McGrath, Naoise Doran, Garrett F. Coughlan — 2010-09-01

Abstract: Delahunt E, McGrath A, Doran N, Coughlan GF. Effect of taping on actual and perceived dynamic postural stability in persons with chronic ankle instability.Objective: To investigate whether 2 different mechanisms of ankle joint taping ([1] lateral subtalar sling or [2] fibular repositioning) can enhance actual and perceived dynamic postural stability in participants with chronic ankle instability (CAI).Design: Laboratory-based repeated-measures study.Setting: University biomechanics laboratory.Participants: Participants (n=16) with CAI.Interventions: Participants performed the Star Excursion Balance Test (SEBT) under 3 different conditions: (1) no tape, (2) lateral subtalar sling taping and (3) fibular repositioning taping.Main Outcome Measures: Reach distances in the anterior, posteromedial, and posterolateral directions on the SEBT. Participants' perceptions of stability, confidence, and reassurance when performing the SEBT under 2 different taping conditions.Results: Taping did not improve reach distance on the SEBT (P>.05). Feelings of confidence increased for 56% of participants (P=.002) under both tape conditions. Feelings of stability increased for 87.5% of participants (P<.001) using condition 2 (lateral subtalar sling taping) and 75% of participants (P=.001) using condition 3 (fibular repositioning taping). Feelings of reassurance increased for 68.75% of participants (P=.001) using condition 2 (lateral subtalar sling taping) and 50% of participants (P=.005) using condition 3 (fibular repositioning taping).Conclusions: No significant change in dynamic postural stability was observed after application of either taping mechanism; however, participants' perceptions of confidence, stability, and reassurance were significantly improved. Further research is necessary to fully elucidate the exact mechanisms by which taping may help reduce the incidence of repeated injury in subjects with CAI.

Differences in Preferred Walking Speeds in a Gait Laboratory Compared With the Real World After Total Hip Replacement

2010-09-01

Abstract: Foucher KC, Thorp LE, Orozco D, Hildebrand M, Wimmer MA. Differences in preferred walking speeds in a gait laboratory compared with the real world after total hip replacement.Objective: To evaluate the relation between walking speeds measured in a gait laboratory and those measured in real-world settings (habitual speed) in subjects with total hip replacements (THRs) and control subjects. The secondary objective is to determine whether the relationship between gait laboratory and habitual speeds was affected by recovery time or related to clinical indices.Design: Cohort study.Setting: Academic medical center.Participants: Experimental subjects (n=26) evaluated 3 weeks and 12 months after THR and control subjects (n=24).Interventions: None.Main Outcome Measures: Walking speed measured in the gait laboratory, walking speed measured in the field by using activity monitors, Harris Hip Score (HHS), and the Western Ontario and McMaster Osteoarthritis Index (WOMAC).Results: Laboratory speeds were significantly faster than habitual speeds in all groups (P<.001), but the 2 correlated significantly. The laboratory versus habitual-speed difference was unaffected by recovery time within the THR group (P=.180) but was larger for control subjects (.32±.21m/s) than for THR subjects (.19±.15m/s 1 year after surgery). Habitual speed significantly correlated with total WOMAC scores and with WOMAC stiffness and function subscores 3 weeks after THR. The HHS weakly correlated with 3-week laboratory speed. No speed and clinical correlations were seen 1 year after THR.Conclusions: Although subjects may exaggerate walking speeds in laboratory settings, laboratory-based data accurately reflect real-world activity. Setting affected speeds most in the control group. It is important to consider potential discrepancies between speeds walked in a laboratory versus in the real world when interpreting gait studies comparing 2 or more populations. Finally, analysis of these data suggests that clinical indices may more accurately reflect biomechanical function during early recovery after THR than after full recovery.

Construct Validity and Test-Retest Reliability of the Climbing Stairs Questionnaire in Lower-Limb Amputees

Fred A. de Laat, Gerardus M. Rommers, Jan H. Geertzen, Leo D. Roorda — 2010-09-01

Abstract: de Laat FA, Rommers GM, Geertzen JH, Roorda LD. Construct validity and test-retest reliability of the Climbing Stairs Questionnaire in lower-limb amputees.Objective: To investigate the construct validity and test-retest reliability of the Climbing Stairs Questionnaire, a patient-reported measure of activity limitations in climbing stairs, in lower-limb amputees.Design: A cross-sectional study.Setting: Outpatient department of a rehabilitation center.Participants: Lower-limb amputees (N=172; mean ± SD age, 65±12y; 71% men; 82% vascular cause) participated in the study; 33 participated in the reliability study.Interventions: Not applicable.Main Outcome Measure(s): Construct validity was investigated by testing 10 hypotheses: limitations in climbing stairs according to the Climbing Stairs Questionnaire will be greater in lower-limb amputees who: (1) are older, (2) have a vascular cause of amputation, (3) have a bilateral amputation, (4) have a higher level of amputation, (5) have more comorbid conditions, (6) had their rehabilitation treatment in a nursing home, and (7) climb fewer flights of stairs. Furthermore, limitations in climbing stairs will be related positively to activity limitations according to: (8) the Locomotor Capabilities Index, (9) the Questionnaire Rising and Sitting down, and (10) the Walking Questionnaire. Construct validity was quantified by using the Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation coefficient. Test-retest reliability was assessed with a 3-week interval and quantified using the intraclass correlation coefficient (ICC).Results: Construct validity (8 of 10 null hypotheses not rejected) and test-retest reliability were good (ICC=.79; 95% confidence interval, .57–.90).Conclusion: The Climbing Stairs Questionnaire has good construct validity and test-retest reliability in lower-limb amputees.

Exploratory Study on Oxygen Consumption On-kinetics During Treadmill Walking in Women With Systemic Lupus Erythematosus

Randall E. Keyser, Violeta Rus, Jamal A. Mikdashi, Barry S. Handwerger — 2010-09-01

Abstract: Keyser RE, Rus V, Mikdashi JA, Handwerger BS. Exploratory study on oxygen consumption on-kinetics during treadmill walking in women with systemic lupus erythematosus.Objective: To determine whether oxygen consumption (V˙o2) on-kinetics differed between groups of women with systemic lupus erythematosus (SLE) and sedentary but otherwise healthy controls.Design: Exploratory case-control study.Setting: Medical school exercise physiology laboratory.Participants: Convenience samples of women with SLE (n=12) and sedentary but otherwise healthy controls (n=10).Intervention: None.Main Outcome Measures: V˙o2 on-kinetics indices including time to steady state, rate constant, mean response time (MRT), transition constant, and oxygen deficit measured during bouts of treadmill walking at intensities of 3 and 5 metabolic equivalents (METs).Results: Time to steady state and oxygen deficit were increased and rate constant was decreased in the women with SLE compared with controls. At the 5-MET energy demand, the transition constant was lower and MRT was longer in the women with SLE than in controls. For a similar relative energy expenditure that was slightly lower than the anaerobic threshold, the transition constant was higher in controls than in women with SLE.Conclusion: V˙o2 on-kinetics was prolonged in women with SLE. The prolongation was concomitant with an increase in oxygen deficit and may underlie performance fatigability in women with SLE.

Predicting Exercise Capacity Through Submaximal Fitness Tests in Persons With Multiple Sclerosis

Ayse Kuspinar, Ross E. Andersen, Shang Yuan Teng, Miho Asano, Nancy E. Mayo — 2010-09-01

Abstract: Kuspinar A, Andersen RE, Teng SY, Asano M, Mayo NE. Predicting exercise capacity through submaximal fitness tests in persons with multiple sclerosis.Objective: To estimate, for persons with multiple sclerosis (MS), the extent to which peak oxygen consumption (Vo2peak) can be predicted by the results on submaximal tests.Design: Cross-sectional study.Setting: Three MS clinics in the Greater Montreal region, Canada.Participants: A center-stratified random sample of 135 women and 48 men was drawn (N=183). A subgroup of 59 subjects with MS, who were able to perform the step test, was selected from this sample to complete the maximal exercise test.Interventions: Not applicable.Main Outcome Measure: Vo2peak.Results: In this sample (mean age ± SD, 39 ± 9y; median Expanded Disability Status Scale=1.5), the mean Vo2peak ± SD was 27.6 ± 7.3mL·kg−1·min−1. This value is considerably low when compared with healthy persons, ranking below the 25th percentile for both men and women. In a multivariate regression analysis, the step test and grip strength were identified as the only significant predictors of Vo2peak. When combined with body weight, grip strength and the step test explained 74% of the variance in Vo2peak.Conclusions: Patients with MS with a mild degree of disability exhibit marked reductions in exercise capacity. Also, in persons with MS, submaximal tests are good predictors of exercise capacity. These measures may be used in clinical settings to help assess and monitor maximum oxygen consumption and in research to evaluate the effect of exercise-related interventions. Furthermore, they will allow people with MS to self-monitor their exercise capacity and be more actively engaged in taking charge of their fitness level.

Craniocervical Orientation Affects Muscle Activation When Exercising the Cervical Extensors in Healthy Subjects

2010-09-01

Abstract: Elliott JM, O'Leary SP, Cagnie B, Durbridge G, Danneels L, Jull G. Craniocervical orientation affects muscle activation when exercising the cervical extensors in healthy subjects.Objective: To evaluate the activity of neck extensor muscles during different extension exercises with muscle functional magnetic resonance imaging (mfMRI).Design: Cross-sectional.Setting: University laboratory.Participants: Healthy subjects (N=11; 7 men, mean age ± SD, 34±5.6y; 4 women, mean age ± SD, 23.3±5.2y; group mean age ± SD, 30.1±7.5y).Intervention: Not applicable.Main Outcome Measures: mfMRI measures of T2 relaxation were made for the multifidus (Mul), the semispinalis cervicis (SCe), the semispinalis capitis (SCa), and the splenius capitis (SpC) at C2-3, C5-6, and C7-T1 in response to 2 head/neck orientations: craniocervical neutral (CCN) and craniocervical extension (CCE). Subjects performed three 1-minute repetitions of each condition at 20% maximum voluntary contraction.Results: Significant shifts were observed in all muscle groups at the C5-6 and C7-T1 levels after both conditions (P=.04) except the SpC muscle at C5-6 with CCN (P=.17). T2 shifts in the SCa were significantly greater in response to CCE than CCN at C2-3 (P=.03) and C5-6 (P=.02). Similarly, CCE resulted in larger shifts than CCN in the Mul/SCe at C7-T1 (P=.003). No segmental differences were observed between exercises for SpC (P=.25).Conclusions: The results of this study provide some preliminary insight into the impact of craniocervical orientation on the differential response of the deep and superficial cervical extensor muscles during the performance of cervical extensor exercises.

Development of Romantic Relationships and Sexual Activity in Young Adults With Cerebral Palsy: A Longitudinal Study

2010-09-01

Abstract: Wiegerink DJ, Stam HJ, Gorter JW, Cohen-Kettenis PT, Roebroeck ME, Transition Research Group Southwest Netherlands. Development of romantic relationships and sexual activity in young adults with cerebral palsy: a longitudinal study.Objectives: To describe the development of romantic relationships and sexual activity of young adults with cerebral palsy (CP), to investigate whether this development is associated with demographic and physical characteristics, and to compare the sexual activity of this group with an age-appropriate Dutch reference population.Design: Prospective longitudinal study with 3 biannual assessments.Setting: Eight rehabilitation centers and departments in the southwestern regions of The Netherlands.Participants: Young adults (N=103; 61 men, 42 women) with CP without cognitive disabilities (age range at first assessment, 16–20y; 82% Gross Motor Function Classification System level I or II).Interventions: Not applicable.Main Outcome Measures: Sexual interest, romantic relationships, and sexual activity.Results: We observed a significant increase in dating in young adults with CP during the 4-year period; however, the experience in romantic relationships did not increase largely during this period. Young adults with a lower education level began dating later than those with higher levels. Significantly more women were in current romantic relationships than men. During the 4 years, participants' sexual experience increased significantly for all sexual milestones evaluated. Level of gross motor function was associated significantly with intercourse experience. Compared with an age-appropriate Dutch reference population, young adults with CP participated at a lower level in romantic relationships and sexual activities, but had equal sexual interest at the final assessment.Conclusions: Young ambulatory adults with CP had similar sexual interests and had increasing experiences with romantic relationships and sexual activities during the transition from late adolescence to young adulthood. However, the percentage of young adults with CP in current romantic relationships was low, especially for men.

Effects of Midodrine Hydrochloride on Blood Pressure and Cerebral Blood Flow During Orthostasis in Persons With Chronic Tetraplegia

2010-09-01

Abstract: Wecht JM, Rosado-Rivera D, Handrakis JP, Radulovic M, Bauman WA. Effects of midodrine hydrochloride on blood pressure and cerebral blood flow during orthostasis in persons with chronic tetraplegia.Objective: To determine the mean arterial pressure (MAP) and middle cerebral artery mean blood flow velocity (MFV) responses to 5 and 10mg midodrine during head-up tilt (HUT) in persons with tetraplegia.Design: Prospective dose-response trial.Setting: James J. Peters Veterans Administration Medical Center.Participants: Persons (N=10) with chronic tetraplegia (duration of injury=23±11y).Intervention: A dose titration study was performed over 3 testing days: control (no drug), 5mg midodrine (5mg), or 10mg midodrine (10mg) during 30 minutes of baseline (predrug/no drug), 30 minutes of supine rest postdrug/no drug, 15 minutes of progressive HUT (5 minutes at 15°, 25°, 35°), and 45 minutes of 45° HUT.Main Outcome Measures: MAP and MFV response to midodrine supine and during HUT.Results: Ten milligrams of midodrine significantly increased MAP while supine and during the HUT maneuver. Of note, the mean increase in MAP during HUT with 10mg was a result of a robust effect in 2 persons, with minimal change in the remaining 8 study subjects. The reduction in cerebral MFV during HUT was attenuated with 10mg.Conclusions: These findings suggest that midodrine 10mg may be efficacious for treatment of hypotension and orthostatic hypotension in select persons with tetraplegia. Although midodrine is routinely prescribed to treat orthostatic hypotension, the results of our work suggests limited efficacy of this agent, but additional studies in a larger sample of subjects with spinal cord injury should be performed.

Cognitive and Behavioral Impairment in Traumatic Brain Injury Related to Outcome and Return to Work

Marieke R. Benedictus, Jacoba M. Spikman, Joukje van der Naalt — 2010-09-01

Abstract: Benedictus MR, Spikman JM, van der Naalt J. Cognitive and behavioral impairment in traumatic brain injury related to outcome and return to work.Objective: To evaluate the cognitive and behavioral disturbances related to return to work (RTW) in patients with traumatic brain injury (TBI) with the application of a differentiated outcome scale.Design: Longitudinal cohort study.Setting: Level I trauma center.Participants: Adults (N=434) with TBI of various severity.Interventions: Not applicable.Main Outcome Measures: Extended Glasgow Outcome Scale (GOS-E), Differentiated Outcome Scale (DOS), and RTW.Results: Patients encountered problems in the physical (40%), cognitive (62%), behavioral (55%), and social domains (49%) of the DOS, with higher frequency related to severity of injury. Even those with mild TBI experienced cognitive (43%) and behavioral problems (33%). Patients with good recovery (58%) according to the GOS-E experienced problems in 1 or more domains of the DOS. Half the patients were able to resume previous vocational activities completely, although 1 in 3 experienced cognitive or behavioral problems. Using multivariate logistic regression analysis, the cognitive (odds ratio [OR], 10.548; confidence interval [CI], 5.99–18.67), behavioral (OR, 2.648; CI, 1.63–4.29), and physical domains (OR, 2.763; CI, 1.60–4.78) were significant (P<.01) predictors of RTW. For subcategories of TBI, the cognitive domain was predictive for RTW in those with moderate and severe TBI, whereas both the cognitive and behavioral domains were predictive for RTW in those with mild TBI.Conclusions: With application of a more detailed outcome scale, cognitive and behavioral impairments interfering with RTW were present in a substantial part of patients with TBI in the chronic phase after injury. More research is needed exploring the cognitive and behavioral outcome in different categories of injury severity separately.

Learning to Control Opening and Closing a Myoelectric Hand

Hanneke Bouwsema, Corry K. van der Sluis, Raoul M. Bongers — 2010-09-01

Abstract: Bouwsema H, van der Sluis CK, Bongers RM. Learning to control opening and closing a myoelectric hand.Objective: To compare 3 different types of myoelectric signal training.Design: A cohort analytic study.Setting: University laboratory.Participants: Able-bodied right-handed participants (N=34) randomly assigned to 1 of 3 groups.Interventions: Participants trained hand opening and closing on 3 consecutive days. One group trained with a virtual myoelectric hand presented on a computer screen, 1 group trained with an isolated prosthetic hand, and 1 group trained with a prosthetic simulator. One half of the participants trained with their dominant side, and the other half trained with their nondominant side. Before and after the training period, a test was administered to determine the improvement in skill. Participants were asked to open and close the hand on 3 different velocities at command.Main Outcome Measures: Peak velocity, mean velocity, and number of peaks in the myoelectric signal of hand opening and closing.Results: No differences were found for the different types of training; all participants learned to control the myoelectric hand. However, differences in learning abilities were revealed. After learning, a subgroup of the participants could produce clearly distinct myoelectric signals, which resulted in the ability to open and close the hand at 3 different speeds, whereas others could not produce distinct myoelectric signals.Conclusions: Acquired control of a myoelectric hand is irrespective of the type of training. Prosthetic users may differ in learning capacity; this should be taken into account when choosing the appropriate type of control for each patient.

Minimal Detectable Change in Quadriceps Strength and Voluntary Muscle Activation in Patients With Knee Osteoarthritis

2010-09-01

Abstract: Kean CO, Birmingham TB, Garland SJ, Bryant DM, Giffin JR. Minimal detectable change in quadriceps strength and voluntary muscle activation in patients with knee osteoarthritis.Objective: To examine the test-retest reliability and quantify the minimal detectable change (MDC) in quadriceps strength and voluntary activation in patients with knee osteoarthritis (OA).Design: Repeated measures over a 1-week interval.Setting: Tertiary care center.Participants: A convenience sample of patients (N=20) diagnosed with knee OA.Intervention: Isokinetic and isometric quadriceps strength testing and voluntary quadriceps activation testing using interpolated twitch technique.Main Outcome Measures: Peak isokinetic and isometric knee extension torque (Nm) and percentage of voluntary quadriceps activation (%).Results: The mean differences with 95% confidence intervals between the 2 test sessions for quadriceps isokinetic strength, isometric strength, and percent of voluntary activation were −4.34Nm (−14.01 to 5.34Nm), 1.56Nm (−5.56 to 8.68Nm), and 1.34% (−.53 to 3.22%), respectively. The intraclass correlation coefficients for all measures ranged from .93 to .98. The standard errors of measurement (SEMs) for quadriceps isokinetic and isometric strength were 14.57Nm and 10.76Nm, respectively. The SEM for percentage of voluntary activation was 2.84%. Based on these values, the MDCs were 33.90Nm, 25.02Nm, and 6.60% for quadriceps isokinetic strength, isometric strength, and percentage of voluntary activation, respectively.Conclusions: Maximal quadriceps isokinetic strength, isometric strength, and percentage of voluntary activation measures demonstrate excellent test-retest reliability in patients with knee OA. In addition to research applications, the present findings suggest these measures are appropriate for use when evaluating change in neuromuscular function of the quadriceps in individual patients.

Diagnostic Accuracy of History Taking and Physical Examination for Assessing Anterior Cruciate Ligament Lesions of the Knee in Primary Care

2010-09-01

Abstract: Wagemakers HP, Luijsterburg PA, Boks SS, Heintjes EM, Berger MY, Verhaar JA, Koes BK, Bierma-Zeinstra SM. Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care.Objective: To assess the diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament (ACL) lesions in primary care.Design: Cross-sectional diagnostic study.Setting: Primary care.Participants: Patients (N=134; age, 18–65y) who consulted their general practitioner (GP) within 5 weeks after injury.Interventions: Not applicable.Main Outcome Measures: Index tests were obtained with a questionnaire and physical examination. Magnetic resonance imaging (MRI) was used as the reference test. Logistic regression analysis was used to determine associations with ACL lesions. Diagnostic accuracy was determined by calculating sensitivity (Se), specificity (Sp), predictive values, and likelihood ratio (LR).Results: MRI showed an ACL lesion in 28 of 134 included patients. “Effusion,” “popping sensation,” “giving way,” and “anterior drawer test (ADT)” showed associations with an ACL lesion (P<.05). Popping sensation showed Se, Sp, positive predictive value (PPV), and positive LR (LR+) of .63, .73, .39, and 2.3, respectively. Combining determinants from history taking (2 of 3 positive results regarding effusion, popping sensation, and giving way) improved diagnostic accuracy (Se, .71; Sp, .71; PPV, .42; and LR+, 2.5). The ADT added diagnostic accuracy to these combinations (Se, .63; Sp, .85; PPV, .52; and LR+, 4.2).Conclusions: ACL lesions are seen frequently. Based on history taking (effusion, popping sensation, and/or giving way) and physical examination (ADT), GPs can screen for ACL lesions in primary care.

Effect of Pulmonary Rehabilitation on Balance in Persons With Chronic Obstructive Pulmonary Disease

Marla K. Beauchamp, Sachi O'Hoski, Roger S. Goldstein, Dina Brooks — 2010-09-01

Abstract: Beauchamp MK, O'Hoski S, Goldstein RS, Brooks D. Effect of pulmonary rehabilitation on balance in persons with chronic obstructive pulmonary disease.Objectives: To describe within-subject effects of pulmonary rehabilitation (PR) on balance in persons with chronic obstructive pulmonary disease (COPD) and to determine whether any observed changes in balance were associated with change in exercise tolerance or health-related quality of life.Design: Single-arm longitudinal study.Setting: Inpatient PR center.Participants: Subjects with COPD (N=29; mean ± SD age, 69.8±10.3y; forced expiratory volume in 1 second, 46.3%±22.3% predicted; 59% men [n=17]).Interventions: A standardized 6-week multidisciplinary PR program (exercise training, breathing exercises, education, and psychologic support).Main Outcome Measures: Balance was assessed using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and the Activities-Specific Balance Confidence (ABC) scale. Exercise tolerance was determined from the 6-minute walk test (6MWT), and health-related quality of life from the Chronic Respiratory Questionnaire (CRQ).Results: Subjects showed small improvements in BBS (2.8±2.8 points; P .05). There was a weak relationship between change in BBS and change in CRQ scores (r=.40; P=.045) and no relationship with change in 6MWT.Conclusions: PR contributed to minor improvements in balance and had no effect on balance confidence in subjects with COPD. Further work is warranted to determine the optimal intervention for improving balance in this population.

Inspiratory Muscle Training for Patients With Chronic Obstructive Pulmonary Disease: A Practical Guide for Clinicians

Kylie Hill, Nola M. Cecins, Peter R. Eastwood, Sue C. Jenkins — 2010-09-01

Abstract: Hill K, Cecins NM, Eastwood PR, Jenkins SC. Inspiratory muscle training for patients with chronic obstructive pulmonary disease: a practical guide for clinicians.Reduced inspiratory muscle strength is common in people with chronic obstructive pulmonary disease (COPD) and is associated with dyspnea and decreased exercise capacity. Most studies of inspiratory muscle training (IMT) in COPD have demonstrated increased inspiratory muscle strength. Many have also shown improvements in dyspnea and exercise capacity. However, a persisting challenge when translating and applying the findings of these studies in clinical practice is the disparity in training loads, modalities, and outcomes measures used in the different studies. This commentary summarizes our clinical and research experience with a threshold IMT device with the aim of providing clinicians interested in prescribing IMT in this population with practical recommendations regarding patient selection, assessment, and implementation of training. We propose using an interval-based high-intensity threshold IMT program for people who are unable to participate fully in whole-body exercise training because of comorbidities such as severe musculoskeletal problems. Initial training loads equivalent to at least 30% of a person's maximum inspiratory pressure (PImax) are required for all people undertaking IMT. Supervision, which includes monitoring of oxygen saturation throughout the first training session, is recommended, and patients are warned to expect transient delayed-onset muscle soreness, a consequence of muscle adaptation to an unaccustomed activity. We recommend training be undertaken 3 times a week for 8 weeks, with loads progressively increased as symptoms permit. It is prudent to exclude people at risk of pneumothorax or spontaneous rib fracture. Evaluation of IMT should include measures of PImax, dyspnea, health-related quality of life, and exercise capacity.

Adverse Events Reported in Progressive Resistance Strength Training Trials in Older Adults: 2 Sides of a Coin

Chiung-ju Liu, Nancy Latham — 2010-09-01

Abstract: Liu C, Latham N. Adverse events reported in progressive resistance strength training trials in older adults: 2 sides of a coin.Objectives: To summarize adverse events reported in randomized controlled trials that applied progressive resistance strength training in older adults and to examine factors that might be associated with these events.Design: After systematic searches of databases, 2 reviewers independently screened and extracted adverse event–related information from identified trials.Setting: Not applicable.Participants: Older adults 60 years of age and above (N = 6700).Intervention: Muscle strength training exercise that increases load gradually.Main Outcome Measures: Adverse events and reasons for dropout. Adverse events include any undesirable outcomes that may be directly related or unrelated to the intervention.Results: Among 121 trials identified, 53 trials provided no comments about adverse events, 25 trials reported no adverse events occurred, and 43 trials reported some types of adverse events. Most adverse events reported were musculoskeletal problems such as muscle strain or joint pain. Adverse events were reported more often in trials that recruited participants with certain health conditions, functional limitations, or sedentary lifestyle; in trials that applied high intensity; and in trials that were published after the 2001 Consolidated Standards of Reporting Trials statement had been published. Reasons reported for dropout in 58 trials might be related to adverse events. The most frequent reasons for dropout were illness or medical problems.Conclusions: Adverse events may be underreported because there is no consensus on the definition. Reporting adverse events associated with progressive resistance strength training in older adults is informative for practitioners to translate clinical research to clinical practice by knowing both the benefits and risks. Future trials should clearly define adverse events and report them in the published article.

No Effects of Whole-Body Vibration Training on Muscle Strength and Gait Performance in Persons With Late Effects of Polio: A Pilot Study

Christina Brogårdh, Ulla-Britt Flansbjer, Jan Lexell — 2010-09-01

Abstract: Brogårdh C, Flansbjer U-B, Lexell J. No effects of whole-body vibration training on muscle strength and gait performance in people with late effects of polio: a pilot study.Objective: To evaluate the feasibility and possible effects of whole-body vibration (WBV) training on muscle strength and gait performance in people with late effects of polio.Design: A case-controlled pilot study with assessments before and after training.Setting: A university hospital rehabilitation department.Participants: People (N=5; 3 men, 2 women; mean age, 64±6.7y; range, 55−71y) with clinically and electrophysiologically verified late effects of polio.Interventions: All participants underwent 10 sessions of supervised WBV training (standing with knees flexed 40°−55° up to 60 seconds per repetition and 10 repetitions per session twice weekly for 5 weeks).Main Outcome Measures: Isokinetic and isometric knee muscle strength (dynamometer), and gait performance (Timed Up & Go, Comfortable Gait Speed, Fast Gait Speed, and six-minute walk tests).Results: All participants completed the 5 weeks of WBV training, with no discernible discomfort. No significant changes in knee muscle strength or gait performance were found after the WBV training period.Conclusions: This pilot study did not show any significant improvements in knee muscle strength and gait performance following a standard protocol of WBV training. Thus, the results do not lend support to WBV training for people with late effects of polio.

The Trouble With “Body Weight Support” In Treadmill Training

Anton Wernig, Sabine Wernig — 2010-09-01

Kate L. Willoughby and colleagues are to be congratulated on the work done recently with children with cerebral palsy on the treadmill. Only those who have actually done it appreciate the amount of devotion necessary in training young children that way.

The authors respond

Kate L. Willoughby, Karen J. Dodd, Nora Shields, Sarah Foley — 2010-09-01

We thank Wernig and colleague for their comments and for generating important discussion around this topic. While treadmill training has been investigated in adult patient populations for some time, we have only recently begun to see rigorous investigation of the benefits of this intervention for children with cerebral palsy.

Correction

2010-09-01

In van Langeveld SA, Post MW, van Asbeck FW, ter Horst P, Leenders J, Postma K, Lindeman E. Reliability of a new classification system for mobility and self-care in spinal cord injury rehabilitation: the Spinal Cord Injury-Interventions Classification System. Arch Phys Med Rehabil 2009;90:1229-36, an error occurred in the reporting of data in . The original contained 3 panels: (1) the agreement between the researcher and participants (percentage of correct interventions) at the first measurement, (2) the intrarater reliability, presented as a percentage of agreement on correct interventions between the researcher and participants at the second measurement, and (3) the interrater reliability presented as a percentage of agreement on correct interventions between the first and second measurement.

New Books

2010-09-01

Warren PA, editor. Behavioral Health Disability: Innovations in Prevention and Management. ISBN: 9780387098135. Sep 2010. $129.95. Contact: Springer, 800-Springer, www.springer.com.

Indiana University School of Medicine - Accreditation Statement

2010-09-01

Journal Based CME Evaluation and Application

2010-09-01

CME Processing Fees and Application

2010-09-01

Masthead

2010-09-01

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

2010-09-01

Selections From This Month in the Archives

2010-09-01

Andrew M. Leaver, PhD Christopher G. Maher, PhD

Archives of Physical Medicine and Rehabilitation

A Randomized Controlled Trial Comparing Manipulation With Mobilization for Recent Onset Neck Pain

Forgoing Physician Visits Because of Cost: A Source of Health Disparities for Elderly People With Disabilities?

Comparison of Trunk Proprioception Between Patients With Low Back Pain and Healthy Controls

Preparation for Compensatory Forward Stepping in Parkinson's Disease

Case-Mix Adjustment and Enabled Reporting of the Health Care Experiences of Adults With Disabilities

Development and Validation of Participation and Positive Psychologic Function Measures for Stroke Survivors

Impact of Traumatic Brain Injury on Participation in Leisure Activities

Baseline Comorbidity Associated With the Short-Term Effects of Exercise Intervention on Quality of Life in the Japanese Older Population: An Observational Study

Suggestions for Refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): A Factor Analysis and Rasch Validation Study

Electric Pulse Frequency and Magnitude of Perceived Sensation During Electrocutaneous Forearm Stimulation

Effect of Taping on Actual and Perceived Dynamic Postural Stability in Persons With Chronic Ankle Instability

Differences in Preferred Walking Speeds in a Gait Laboratory Compared With the Real World After Total Hip Replacement

Construct Validity and Test-Retest Reliability of the Climbing Stairs Questionnaire in Lower-Limb Amputees

Exploratory Study on Oxygen Consumption On-kinetics During Treadmill Walking in Women With Systemic Lupus Erythematosus

Predicting Exercise Capacity Through Submaximal Fitness Tests in Persons With Multiple Sclerosis

Craniocervical Orientation Affects Muscle Activation When Exercising the Cervical Extensors in Healthy Subjects

Development of Romantic Relationships and Sexual Activity in Young Adults With Cerebral Palsy: A Longitudinal Study

Effects of Midodrine Hydrochloride on Blood Pressure and Cerebral Blood Flow During Orthostasis in Persons With Chronic Tetraplegia

Cognitive and Behavioral Impairment in Traumatic Brain Injury Related to Outcome and Return to Work

Learning to Control Opening and Closing a Myoelectric Hand

Minimal Detectable Change in Quadriceps Strength and Voluntary Muscle Activation in Patients With Knee Osteoarthritis

Diagnostic Accuracy of History Taking and Physical Examination for Assessing Anterior Cruciate Ligament Lesions of the Knee in Primary Care

Effect of Pulmonary Rehabilitation on Balance in Persons With Chronic Obstructive Pulmonary Disease

Inspiratory Muscle Training for Patients With Chronic Obstructive Pulmonary Disease: A Practical Guide for Clinicians

Adverse Events Reported in Progressive Resistance Strength Training Trials in Older Adults: 2 Sides of a Coin

No Effects of Whole-Body Vibration Training on Muscle Strength and Gait Performance in Persons With Late Effects of Polio: A Pilot Study

The Trouble With “Body Weight Support” In Treadmill Training

The authors respond

Correction

New Books

Indiana University School of Medicine - Accreditation Statement

Journal Based CME Evaluation and Application

CME Processing Fees and Application

Masthead

Editorial Board

Table of Contents

Selections From This Month in the Archives