Archives of Physical Medicine and Rehabilitation - Articles in Press

Jaw Opening Exercise for Insufficient Opening of Upper Esophageal Sphincter - Accepted Manuscript

2012-05-14

Abstract: Objective: To investigate the effects of the jaw opening exercise on decreased upper esophageal sphincter opening while swallowing. Study Design: Intervention study: before - after trial with four weeks follow-up evaluation. Setting: Nihon University School of Dentistry Dental Hospital Participants: Subjects were eight patients with dysphagia (seven men, one woman; average age, 70.5±11.3 years; age range, 54-86 years). Interventions: All patients performed a jaw-opening exercise to strengthen the suprahyoid muscles. The exercise involved opening the jaw to its maximum and maintaining this position for ten seconds. Each set of exercise consisted of five repetitions, and two sets were carried out daily for four weeks. The effectiveness of the exercise was evaluated by videofluorographic swallowing study (VFSS). Main outcome Measures: Hyoid elevation, UES opening, pharynx passage time, and pharyngeal residue after swallowing at pre and post exercise were compared by VFSS. Results: Compared to before starting the exercise, significant improvements were observed in the extent of upward movement of the hyoid bone (p<0.05), amount of UES opening (p<0.05), and time for pharynx passage (p<0.05) four weeks after initiating the exercise. Pharyngeal residue decreased in some subjects, and no increases were noted in any subjects. Conclusion: The jaw opening exercise is an effective treatment for dysphagia caused by dysfunction of hyoid elevation and UES opening.

Wolf Motor Function Test for Characterizing Moderate to Severe Hemiparesis in Stroke Patients - Accepted Manuscript

2012-05-14

Abstract: Objective: To extend the applicability of the Wolf Motor Function test (WMFT) to describe the residual functional abilities of moderate-to-severely affected stroke patients. The WMFT is a motor function test for mild to moderate upper extremity weakness in stroke patients, but it has not been routinely used for evaluation of more severe hemiparetic stroke patients due to its numerical characteristics. Design: Data was collected as part of two double-blind sham controlled randomized interventional studies, the Transcranial Direct Current Stimulation (tDCS) in Chronic Stroke Recovery and tDCS Enhanced Stroke Recovery and Cortical Reorganization. Stroke patients were evaluated with the upper-extremity Fugl-Meyer (UFM) and the WMFT in the same setting prior to treatment. Setting: University inpatient rehabilitation and outpatient clinic. Participants: 32 stroke patients with moderate-to-severe hemiparesis enrolled in the tDCS in Chronic Stroke Recovery and tDCS Enhanced Stroke Recovery and Cortical Reorganization studies. Intervention: Not applicable. Main Outcome Measures: WMFT scores were calculated using 1) median performance times, 2) new calculation using the mean rate of performance. We compared the distribution of values from the two methods and examined the WMFT-UFM correlation for the traditional and the new calculation. Results: WMFT rate values were more evenly distributed across their range than median WMFT time scores. The association between the WMFT rate and UFM was as good as the association between the median WMFT time scores and UFM (Spearman rs 0.84 vs -0.79). Conclusions: The new WMFT mean rate of performance is valid and a more sensitive measure in describing the functional activities of the moderate to severely affected upper extremity of stroke subjects and avoids the pitfalls of the median WMFT time calculations.

The Symptom Inventory Disability-Specific Short Forms for Multiple Sclerosis: Construct Validity, Responsiveness, and Interpretation - Uncorrected Proof

Carolyn E. Schwartz, Rita K. Bode, Brian R. Quaranto, Timothy Vollmer — 2012-05-11

Abstract: Schwartz CE, Bode RK, Quaranto BR, Vollmer T. The Symptom Inventory Disability-Specific Short Forms for multiple sclerosis: construct validity, responsiveness, and interpretation. Objectives: To test the cross-sectional and longitudinal construct validity of the disability-specific short forms of the Symptom Inventory for multiple sclerosis, to compare its internal consistency reliability and construct validity with those of the original (1999) 29-item short form of the Symptom Inventory, and to provide for the new disability-specific short forms interpretation metrics for use in sample size calculation for future research. Design: A Web-based longitudinal study, with data collected at baseline and 6 months after baseline. Correlations evaluated the overlap among disease-specific and generic patient-reported outcome measures. Responsiveness was assessed by using symptom transition scores and modified standardized response means. Interpretation guidelines were provided by using Cohen's effect size and crosswalks to the disease-specific and generic quality-of-life measures. Setting: National Multiple Sclerosis Registry. Participants: People with multiple sclerosis (N=1142) who participated in the North American Research Committee on Multiple Sclerosis Registry. Interventions: Not applicable. Main Outcome Measures: The Symptom Inventory; the disease-specific Performance Scales and the Patient-Determined Disease Steps; the generic Short Form 12. Results: The Symptom Inventory evidenced convergent and divergent validity, and the disability-specific short forms evidenced similar psychometric performance as the 1999 short form but had slightly better alpha reliability. They also evidenced moderate responsiveness to clinically important change, with more responsiveness among those with mild and moderate disabilities than among those with severe disabilities. Effect sizes were larger among patients who reported symptom improvement, rather than deterioration, suggesting that the tool would be more useful in clinical research focused on testing whether an intervention improves symptom experience, particularly for patients with mild and moderate disabilities. Crosswalks provided graphic and numeric links between the Symptom Inventory and other patient-reported outcomes. Conclusions: The Symptom Inventory can be useful for elucidating the patient's experience, but it varies considerably across and within disability groupings. Directions for future research are discussed.

Qualitative Study of Prosthetic Suspension Systems on Individuals with Transtibial Amputation’s Satisfaction and Perceived Problems with Their Prosthetic Devices - Accepted Manuscript

2012-05-11

Abstract: Objective: To investigate the effects of three dissimilar suspension systems on participant’s satisfaction and perceived problems with their prostheses. Design: Questionnaire survey. Setting: Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran and Department of Biomedical Engineering, Faculty of Engineering, University Malaya, Malaysia. Participants: A total of 243 persons with unilateral transtibial amputation, using prostheses with polyethylene foam liner, silicon liner with shuttle lock and seal-in liner. Intervention: Not applicable. Main Outcome Measure: Descriptive analyses were performed on the demographic information, satisfaction and prosthesis-related problems of the study participants. Results: The results showed significant differences between the three groups regarding the degree of satisfaction and perceived problems with the prosthetic device. Analyses of the individual items revealed that the study participants were more satisfied with the seal-in liner and experienced fewer problems with this liner. The silicon liner with shuttle lock and seal-in liner users reported significant differences in maintenance time compared with the polyethylene foam liner. Users of the silicon liner with shuttle lock experienced more sweating, while those who used the seal-in liner had greater problems with donning and doffing the device. Conclusion: The results of the survey provide a good indication that prosthetic suspension is improved with the seal-in liner as compared with the polyethylene foam liner and silicon liner with shuttle lock. However, further prospective studies are needed to investigate which system provides the most comfort and the least problems for participants.

Uncorrected Proof

2012-05-11

Active Video Game Play in Children With Cerebral Palsy: Potential for Physical Activity Promotion and Rehabilitation Therapies - Corrected Proof

2012-05-09

Abstract: Howcroft J, Klejman S, Fehlings D, Wright V, Zabjek K, Andrysek J, Biddiss E. Active video game play in children with cerebral palsy: potential for physical activity promotion and rehabilitation therapies. Objective: To evaluate the potential of active video game (AVG) play for physical activity promotion and rehabilitation therapies in children with cerebral palsy (CP) through a quantitative exploration of energy expenditure, muscle activation, and quality of movement. Design: Single-group, experimental study. Setting: Human movement laboratory in an urban rehabilitation hospital. Participants: Children (N=17; mean age ± SD, 9.43±1.51y) with CP. Intervention: Participants played 4 AVGs (bowling, tennis, boxing, and a dance game). Main Outcome Measures: Energy expenditure via a portable cardiopulmonary testing unit; upper limb muscle activations via single differential surface electrodes; upper limb kinematics via an optical motion capture system; and self-reported enjoyment via the Physical Activity Enjoyment Scale (PACES). Results: Moderate levels of physical activity were achieved during the dance (metabolic equivalent for task [MET]=3.20±1.04) and boxing (MET=3.36±1.50) games. Muscle activations did not exceed maximum voluntary exertions and were greatest for the boxing AVG and for the wrist extensor bundle. Angular velocities and accelerations were significantly larger in the dominant arm than in the hemiplegic arm during bilateral play. A high level of enjoyment was reported on the PACES (4.5±0.3 out of 5). Conclusions: AVG play via a low-cost, commercially available system can offer an enjoyable opportunity for light to moderate physical activity in children with CP. While all games may encourage motor learning to some extent, AVGs can be strategically selected to address specific therapeutic goals (eg, targeted joints, bilateral limb use). Future research is needed to address the challenge of individual variability in movement patterns/play styles. Likewise, further study exploring home use of AVGs for physical activity promotion and rehabilitation therapies, and its functional outcomes, is warranted.

Test-retest reliability of the six-minute walk test in individuals with Down syndrome - Accepted Manuscript

Amanda F. Casey, Xu Wang, Kristin Osterling — 2012-05-09

Abstract: Objective: To evaluate the reliability of the six-minute walk test in individuals with Down syndrome and explore factors affecting walking distance. Design: Four repeated walk tests in the span of two weeks including two practice walks. Setting: All tests were carried out in a 40m corridor at a university sport complex. Participants: Adolescents and young adults with Down syndrome (n=55) aged 11-26 yrs. Intervention: None Main outcome measure: Participants were instructed to walk as far as possible for the duration of six minutes. Distance walked, heart rate, blood pressure and perceived exertion were measured across four tests (t1, t2, t3, t4) Results: The walking distances for t1, t2, t3 and t4 averaged 395m, 428m, 433m and 436m respectively. The 6MWD during t1 and t2 was significantly different from that of t3 and t4 (t(54)= -6.475, P< 0.001). Repeated ANOVA showed no significant difference between distance walked in t3 and t4 (433±64m vs. 436±68m) (F(1,54)=2.439; P=0.124). BMI as well as levels of intellectual disability and physical activity all affected distance walked to different degrees. Conclusions: The 6MWT showed good test-retest reliability and increased walking distance after two practice walks emphasizing the need to account for a learning effect amongst people with Down syndrome. Reported 6MWD appears lower than that previously reported for individuals without Down syndrome.

Prevalence and impact of chronic musculoskeletal ankle disorders in the community - Accepted Manuscript

2012-05-09

Abstract: Objective: To determine the point prevalence of chronic musculoskeletal ankle disorders in the community. Design: Cross-sectional stratified (metropolitan vs regional) random sample. Setting: General community. Participants: Population-based computer aided telephone survey of people aged 18-65 in New South Wales (Australia). A total of 751 participants provided data from 2078 contacted. Interventions: Not applicable. Main outcome measures: Point prevalence for: no history of ankle injury or chronic ankle problems (no ankle problems), history of ankle injury without residual problems, and chronic ankle disorders. Chronic musculoskeletal ankle disorders due to ankle sprain, fracture, arthritis, or other disorder compared by chi-square for presence of pain, weakness, giving way, swelling and instability, activity limitation, and healthcare use in the past year. Results: There were 231 (30.8%) participants with no ankle problems, 342 (45.5%) with a history of ankle injury but no chronic problems, and 178 (23.7%) with chronic ankle disorders. The major component of chronic ankle disorders was musculoskeletal disorders (n=147, 19.6% of total sample) most of which were due to ankle injury (n=117, 15.6% of total). There was no difference among the arthritis, fracture, sprain and other groups in the prevalence of the specific complaints, or healthcare use. Significantly more participants with arthritis had to limit activity than in the sprain group (Fisher exact test p=.003). Conclusions: Chronic musculoskeletal ankle disorders affected almost 20% of the Australian community. The majority were due to a previous ankle injury and most people had to limit or change their physical activity due to the ankle disorder.

UW-SES: A new self-efficacy scale for people with disabilities - Accepted Manuscript

2012-05-09

Abstract: Objective: To develop a self-efficacy scale for people living with multiple sclerosis (MS) and spinal cord injury (SCI) that can be used across diagnostic conditions. Design: The scale was developed using modern psychometric methods including Item Response Theory. Items were administered at three time-points of a longitudinal survey of individuals with MS and SCI. Setting: Survey participants with MS were recruited from the National MS Society and participants with SCI were recruited from the Northwest Regional Spinal Cord Injury Model System and the Shepherd Center at the Virginia Crawford Research Institute in Atlanta, Georgia. Participants: Study participation was limited to eligible adults age 18 and over reporting a definitive diagnosis of MS or SCI. Interventions: None Main Outcome Measures: Evaluation of the new self-efficacy measure called the University of Washington Self-Efficacy Scale (UW-SES) included comparisons with the Chronic Disease Self-Efficacy Scale and other patient reported outcome measures. Results: UW-SES has excellent psychometric properties including well-functioning response categories, no floor effects and low ceiling effects. A long form (17 items) and short form (six items) are available. The correlation between the score on the newly developed scale and the Chronic Disease Self-Efficacy Scale was high (0.83), providing support for convergent validity. Higher self-efficacy scores were statistically significantly associated with better mental health, better physical health, less fatigue, less stress, less pain interference, less pain, fewer sleep problems and lower depressive symptoms. Conclusions: The UW-SES is a psychometrically sound instrument for measuring self-efficacy, validated in MS and SCI and can be used across both conditions. Both the long form and short form are available free of charge.

Factors Predicting Rehospitalization of Elderly Patients in a Postacute Skilled Nursing Facility Rehabilitation Program - Accepted Manuscript

Wen Dombrowski, Jessica L. Yoos, Richard Neufeld, Chaim Tarshish — 2012-05-02

Abstract: Many elderly patients are hospitalized and discharged to skilled nursing facilities (SNF) for rehabilitation. Objectives: To examine potential risk factors for rehospitalization of SNF rehabilitation patients. Design: Retrospective review of rehabilitation charts. Setting: 114 SNF rehabilitation beds at a 514 bed urban, academic nursing home that receives patients from tertiary care hospitals. Participants: 50 consecutive rehabilitation patients who were rehospitalized during days 4-30 of rehabilitation, compared to a matched group of 50 rehabilitation patients that were discharged without rehospitalization. Interventions: Not applicable. Main Outcome Measure: Data on potential risk factors were collected: demographics, medical history, conditions associated with preceding hospitalization, and initial rehabilitation exam and laboratory values. The clinical conditions precipitating rehospitalizations were noted. Results: 62% of rehospitalizations were related to complications or recurrence of the same medical condition that was treated during the preceding hospitalization. The rehospitalized group had significantly more comorbidities including anemia (P = 0.001) and malignant solid tumors (P < 0.001), index hospitalizations involving a gastrointestinal condition (P = 0.001), needed more assistance with eating (P = 0.001) and walking (P = 0.03), and had lower hemoglobin (P = 0.002) and albumin levels (P < 0.001). A logistic regression model found the strongest predictors for rehospitalization are history of malignant solid tumor (odds ratio (OR) = 10.10), recent hospitalization involving gastrointestinal conditions (OR = 4.62), and low albumin levels (with each unit decrease in albumin, the odds of rehospitalization is 4 times greater (OR = 0.24, P = 0.005)). Conclusions: Comorbid conditions, reasons for index hospitalization, and laboratory values are associated with increased risk for rehospitalization. Further studies are needed to identify high risk elderly patients and target interventions to minimize rehospitalizations.

Validity of the Patient Health Questionnaire-9 in assessing major depressive disorder during inpatient spinal cord injury rehabilitation - Accepted Manuscript

2012-05-02

Abstract: Objective: To investigate the validity of the Patient Health Questionnaire-9 (PHQ-9) depression screening measure in people undergoing acute inpatient rehabilitation for spinal cord injury (SCI) Design: We performed a blinded comparison of the PHQ-9 administered by research staff to the major depression module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-IV SCID) conducted by a mental health professional. Setting: Inpatient rehabilitation units in Seattle WA, Ann Arbor MI and Houston TX. Participants: Patients undergoing acute rehabilitation for traumatic SCI who were at least 18 years old, English speakers without severe cognitive, motor speech or psychotic disorders. We obtained the SCID on 173/204 (84%) of eligible patients. The final sample 142 (69%) consisted of those who underwent both assessments within 7 days of each other. Interventions: Not applicable. Main Outcome Measures: PHQ-9 and SCID major depression module. Results: Participants were on average 42.2 years old, 78.2% male, 81.7% Caucasian and 66.9% had cervical injuries. The optimal PHQ-9 cutoff (≥ 11) resulted in 35 (24.6%) positive screens. Key indices of criterion validity were: sensitivity = 1.00 (95% confidence interval [CI], 0.73-1.00), specificity = 0.84 (95% CI, 0.76-0.89), Youden Index = 0.84, positive predictive value = 0.40 (95% CI, 0.24-0.58) and negative predictive value = 1.00 (95% CI, 0.96-1.00). The area under the receiver operator curve was 0.92 and kappa was 0.50. Total PHQ-9 scores were inversely correlated with subjective health state and quality of life since SCI. Conclusion: The PHQ-9 meets criteria for good diagnostic accuracy compared to a structured diagnostic assessment for MDD even in the context of inpatient rehabilitation for acute traumatic SCI.

Fingertip-to-floor test and Straight leg raising test: Validity, responsiveness and predictive value in patients with acute/sub-acute low back pain - Accepted Manuscript

Harald Ekedahl, Bo Jönsson, Richard B. Frobell — 2012-05-02

Abstract: Objective: To investigated the validity over time of Fingertip-to-floor test (FTF) and Straight leg raising test (SLR) using Roland Morris disability Questionnaire (RMDQ) and correlation coefficient (r) and to assess the predictive value of factors related to the change in RMDQ over 12 months using multivariate regression analysis. Design: Longitudinal study. Setting: Out-patient physical therapy clinic. Participants: Sixty-five subjects with acute/sub-acute low back pain (≤13 weeks’ symptom duration). Thirty-eight (58%) had radicular pain as determined by the Slump test. Interventions: Not applicable Main Outcome Measures: Self-reported disability was used as reference variable and was measured using RMDQ at baseline and after 1 & 12 months. FTF and SLR were measured at baseline and after 1 month. Responsiveness and imprecision were assessed by using effect size (ES) and minimum detectable change (MDC). The sample was stratified by presence/absence of radicular pain (categorized by the Slump test). Results: The change in FTF was significantly correlated to the one-month-change in RMDQ, both in the entire sample (r=0.63) and in the group with radicular pain (r=0.66). Similar analysis for SLR showed a weak relationship to RMDQ. FTF showed adequate responsiveness (ES range 0.8-0.9) in contrast to SLR (ES range 0.2-0.5). MDC, for FTF and SLR were 4.5 cm and 5.7°, respectively. Change in FTF over one month was independently more strongly associated with the 12-month (R2=0.27-0.31) change in RMDQ than any of the other variables and multivariate combinations. Conclusions: Our results suggest that the FTF test has good validity in patients with acute/sub-acute LBP and even better validity in those with radicular pain. The change in FTF over the first month was a valid predictor of the change in self-reported disability over one year. In contrast, the validity of SLR can be questioned in the present group of patients.

Current Pain And Fear Of Pain Contribute To Reduced Maximum Voluntary Contraction Of Neck Muscles In Patients With Chronic Neck Pain - Accepted Manuscript

Rene Lindstrom, Thomas Graven-Nielsen, Deborah Falla — 2012-04-30

Abstract: Objective:: To assess a range of physical and psychological factors and determine which factors contribute the most to reduced strength in patients with neck pain. Design:: Regression Setting:: Laboratory Participants:: 34 women with chronic neck pain and 14 healthy controls. Interventions:: Not applicable. Main Outcome Measures:: Neck flexion, extension and lateral flexion MVCs were measured in patients and healthy controls. Additional parameters were collected for the patient group: 1) questionnaires measuring general health (SF-36), pain intensity (VAS), disability (Neck Disability Index, NDI; Patient Specific Functional Scale, PSFS) and fear of movement (Fear-avoidance beliefs questionnaire, FABQ), 2) pressure pain thresholds, 3) cross sectional area of selected neck muscles, and 4) surface electromyography from selected neck muscles during a multidirectional isometric task. Univariate and multivariate regression analyses were applied with average MVC (average of flexion, extension and lateral flexion MVC) as the dependent variable. Results:: The Average MVC was significantly lower in patients (mean ± SD: 130.0±6.0 N) compared to controls (166.9±11.7 N; P<0.01). Univariate regression of the Average MVC with FABQ, NDI or pain experienced during the MVC gave R²values of 13.4%, 13.8% and 21.1%, respectively. Collectively, FABQ and pain experienced during the MVC contractions resulted in an R²of 26.6% and FABQ, Contraction pain and NDI, an R²of 28.2%. Conclusion:: The average maximum voluntary force produced in neck flexion, extension and lateral flexion is inversely and moderately correlated to the pain experienced during the maximal contraction, to fear of movement and to aspects of neck disability in patients with chronic neck pain.

Pulmonary Function and Expiratory Flow Limitation in Acute Cervical Cord Injury - Accepted Manuscript

2012-04-30

Abstract: Objective: To identify the nature of the changes of respiratory mechanics in patients with middle cervical SCI and their correlation with posture. Design: Clinical trial Setting: Acute Spinal Cord Injury Unit Participants: Thirty four patients with SCI at C4-C5 level studied within 6 months of injury. Intervention: Patients were assessed by NEP test, maximal static respiratory pressure and standard spirometry. Main outcome measures: The following respiratory variables were recorded, both in semirecumbent and supine position: 1) Tidal expiratory flow limitation (TEFL); 2) airways resistances; 3) mouth occlusion pressure developed 0.1 second (P0.1) after occluded inspiration;4) maximum inspiratory (MIP) and maximum expiratory (MEP) pressure; 5) spirometric data. Results: a) TEFL was detected in 32% of the patients in supine and in 9% in semirecumbent position; b) Airway resistances and P0.1 were much higher compared to normal values whilst MIP and MEP were markedly reduced; e) FEV1/FVC was less than 70%, while the other spirometric data were reduced up to 30% of predicted values. Conclusion: Patients with middle cervical SCI can develop TEFL. The presence of TEFL, associated with increased airway resistance, could rise in work of breathing in presence of a reduced capacity of the respiratory muscles to face the increased load. The semirecumbent position and the use of CPAP can be helpful in order to 1) reduce the extent of TEFL and to avoid the opening/closure of the small airway; 2) decrease airway resistance; 3) maintain the expiratory flow as high as possible, favoring removal of secretions.

Work and Neuromuscular Diseases. Exploring Employment in Consultation Reports of Patients with Neuromuscular Diseases - Accepted Manuscript

2012-04-30

Abstract: Objectives: To explore consultation reports for patient- and employment characteristics and recommendations on employment regarding patients with Neuromuscular Diseases (NMDs) Design: Retrospective study of multidisciplinary reports. Setting: Radboud University Nijmegen Medical Centre, Neuromuscular Centre Nijmegen, the Netherlands. Participants: One hundred and two reports of patients with NMDs. Interventions: Based on one-off consultations by occupational therapists (OT), physical therapists (PT) and speech therapists (ST) and a multidisciplinary meeting, recommendations were developed regarding therapy content and volume in primary care or rehabilitation settings. Main outcome measures: A checklist has been developed to examine employment characteristics. A general questionnaire has been used including demographic variables and data on employment. Results: Of the 102 reports available, 86 were included for analysis. Sixty-nine reports contained information on employment. Thirty-seven (43%) patients with NMD were employed, the majority in white collar or moderately strenuous jobs. Of the 37 employed patients, 28 (76%) worked using adaptations. Thirty-two (87%) had employment problems, of these 15 (40%) needed improvement in one or more environmental factors. Twenty (54%) patients needed advice regarding participation in employment, of whom 19 were referred to primary care or rehabilitation settings for treatment to enhance employment participation. Conclusion: Eighty percent of the included consultation reports contained information on employment. Less than half the patients with NMD were employed, the majority in office related jobs, using some kind of adaptations. All 20 patients (except one) who agreed to recommendations regarding to therapy, were adequately referred by OTs and PTs for treatment of employment problems.

Functional Performance and Inflammatory Cytokines after Squat Exercises and Whole-Body Vibration in Elderly Individuals With Knee Osteoarthritis - Accepted Manuscript

2012-04-30

Abstract: Objective: To investigate the effects of squat exercises combined with whole-body vibration on the plasma concentration of inflammatory markers and the functional performance of elderly individuals with knee osteoarthritis. Design: Clinical, prospective, randomized, single-blinded study. Setting: Exercise Physiology Laboratory. Participants: Thirty-two elderly subjects with knee osteoarthritis were divided into three groups [i.e., squat exercises on a vibratory platform (platform group N= 11), squat exercises without vibration (squat group N= 10) and the control group (N=11)]. Interventions: The structured program of squat exercises in the platform and squat groups was conducted three times per week, on alternate days, for 12 weeks. Main Outcome Measures: Plasma sTNFR1 and sTNFR2 were measured using immunoassays (the ELISA method). The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire was used to evaluate self-reported physical function, pain and stiffness. The 6-minute walk test, the Berg balance scale, and gait speed were used to evaluate physical function. Results: In the group that performed squat exercises on a vibratory platform, there were significant reductions in the plasma concentrations of the inflammatory markers sTNFR1 and sTNFR2 (p<0.001 and p<0.05, respectively) and self-reported pain (p<0.05) compared with the control group; however, there was an increase in balance (p<0.05) and speed and distance walked (p<0.05 and p<0.001, respectively). In addition, the group that performed squat exercises on a vibratory platform walked faster than the group that only performed squat exercises (p<0.01). Conclusion: The results suggest that whole-body vibration training improves self-perception of pain, balance, gait quality and inflammatory markers in elderly subjects with knee osteoarthritis.

Mobility changes in individuals with dysvascular amputation from the pre-surgical period to 12 months post amputation - Accepted Manuscript

2012-04-26

Abstract: Objectives: To describe changes in ambulation among individuals with lower extremity amputation secondary to peripheral artery disease (PAD) and or diabetes, prior to surgery through 12 months after surgery. To compare differences in ambulation by amputation level, and to examine risk factors for change in ambulation over time. Design: Prospective cohort study Setting: Two VA medical centers, one University Hospital, and a Level 1 Trauma Center. Participants: Two-hundred and thirty-nine patients with PAD or diabetes undergoing a first unilateral major amputation were screened for participation between September 2005 and December 2008. Among these, 136 (57%) met study criteria and of these, 87 (64%) participated. Interventions: Standard of care at each facility Main Outcome Measures: Ambulatory function measured using the Locomotor Capability Index-5 Results: Seventy five of the 87 (86%) subjects enrolled finished their 12-month follow-up interview. Ambulatory mobility declined during the period immediately prior to surgery (pre-morbid) and remained low at 6-weeks post-surgery. On average, ambulation improved after surgery, but did not return to pre-morbid levels. In the final multivariate model, age and history of lower extremity arterial reconstruction were significantly associated with a poorer ambulatory trajectory over time, while other factors, such as amputation level, prior alcohol use, and length of disability prior to amputation were not. Conclusions: The findings highlight the importance of considering pre-morbid ambulatory function. Informing providers and patients about the trajectory and time course of changes in ambulation can be used to enhance patient education, patient expectations and treatment planning.

A Cross-Sectional Assessment of Stroke Rehabilitation in Nebraska Hospitals - Accepted Manuscript

2012-04-26

Abstract: Objective: To assess the structure and process of stroke rehabilitation in Nebraska hospitals. Design: Cross-sectional mail survey using the Dillman tailored-design method of administration. Setting: Hospitals in Nebraska. Participants: Approximately 77% of the 84 Nebraska hospitals that provide stroke rehabilitation are Critical Access Hospitals (CAHs) that are limited to 25 beds. Our study sample of 53 hospitals included the 19 hospitals licensed for 47–689 beds (non-CAHs) and a stratified random sample of 34 of the 65 CAHs. Interventions: Not applicable. Main Outcome Measures: Self-reported stroke rehabilitation team structure and processes, purposes of and barriers to use of evidence-based standardized assessments, specific assessments used, and access to specialized stroke rehabilitation services and community resources. Results: Thirty-six (68%) of the 53 hospitals responded to the survey. Approximately 61% of hospitals used an organized team to provide stroke rehabilitation; 8% of hospitals—all non-CAHs—had a team dedicated to stroke rehabilitation. After adjusting for hospital size, having an organized team was significantly associated with use of standardized assessments to improve communication, measure progress and outcomes, evaluate effectiveness of practice, and compare patient outcomes across conditions. Access to specialized stroke rehabilitation professionals and services was significantly greater in non-CAHs. Conclusions: Hospital size and presence of a team are determinants of the structure and process of stroke rehabilitation in Nebraska hospitals. Further research is needed to determine: (1) whether team structure is a determinant of stroke rehabilitation outcomes across the continuum of care settings, (2) the needs of rural stroke survivors, and (3) whether technology can facilitate use of stroke rehabilitation standardized assessments by rural healthcare professionals.

Long-Term Outcomes in Fibromyalgia Patients Treated with Noninvasive Cortical Electrostimulation - Accepted Manuscript

Jeffrey B. Hargrove, Robert M. Bennett, Daniel J. Clauw — 2012-04-23

Abstract: Objective: To evaluate long-term outcomes of Reduced Impedance Noninvasive Cortical Electrostimulation (RINCE) in the treatment of fibromyalgia. Design: After trial follow-up survey of subjects who had completed a randomized, controlled, double-blind study of RINCE therapy some 45 months previously. Setting: General community. Participants: Fibromyalgia (FM) patients who participated in the previous study. Interventions: Not applicable. Main Outcome Measure: Changes in the Fibromyalgia Impact Questionnaire (FIQ). Results: Sixty-nine originally studied subjects were eligible, 39 of which were mailed surveys. There was a 64% survey return rate. The total FIQ score was 52.6 at baseline, 35.7 at end-of-study and 31.8 at follow-up (P<0.001). Subjects reported symptom improvements lasting at least two-years, with a reduction or elimination of medicine use and need to see physicians for FM. Conclusion: A high percentage of FM patients treated with RINCE continued to experience worthwhile improvement at follow-up.

The Accuracy of Self-Reported Physical Activity as an Indicator of Cardiovascular Fitness Depends on Education Level - Accepted Manuscript

Paul Gerrard — 2012-04-23

Abstract: Objective: To determine if there is a relationship between level of education and the accuracy of self-reported physical activity as a proxy measure of aerobic fitness. Design: Data from the National Health and Nutrition Examination from the years 1999 - 2004 was used. Linear regression was performed for measured maximal oxygen uptake (VO2max) versus self-reported physical activity for five different levels of education. Setting: This was a national survey in the United States. ParticipantsParticipants included adults from the general United States population. Interventions: None. Main Outcome Measure: Coefficients of determination obtained from models for each education level were used to compare how well self-reported physical activity represents cardiovascular fitness. These coefficients were the main outcome measure. Results: Coefficients of determination for VO2max versus reported physical activity increased as level of education increased. Conclusions: In this preliminary study self-reported physical activity is a better proxy measure for aerobic fitness in highly educated than poorly educated individuals.

Activity and energy expenditure in older people playing active video games - Accepted Manuscript

2012-04-19

Abstract: Objective: To quantify energy expenditure in older adults playing interactive video games, while standing and seated. A secondary aim was to determine whether participants’ balance status influenced the energy cost associated with active video game play. Design: Cross-sectional study. Setting: University research center. Participants: Community dwelling adults (N=19) aged 70.7 ± 6.4 years. Intervention: Participants played 9 active video games, each for 5 minutes, in random order. Two games (boxing and bowling) were played in both seated and standing positions. Main outcome measures: Energy expenditure was assessed using indirect calorimetry while at rest and during game play. Energy expenditure was expressed in kJ·min-1 and metabolic equivalents (METs). Balance was assessed using the mini BESTest, the Activities-specific Balance Confidence (ABC) Scale, and the Timed Up and Go (TUG). Results: Mean (±SD) energy expenditure (EE) was significantly greater for all game conditions compared with rest (all P ≤ 0.01) and ranged from 1.46 ± 0.41 METs to 2.97 ± 1.16 METs. There was no significant difference in energy expenditure, activity counts, or perceived exertion between equivalent games played while standing and seated. No significant correlations were observed between energy expenditure or activity counts and balance status. Conclusions: Active video games provide light intensity exercise in community dwelling older people, whether played while seated or standing. People who are unable to stand may derive equivalent benefits from active video games played while seated. Further research is required to determine whether sustained use of active video games alters physical activity levels in community settings for this population.

Changes in balance and walking from stroke rehabilitation to the community: a follow-up observational study - Accepted Manuscript

Jannette M. Blennerhassett, Wayne Dite, Emily R. Ramage, Meagan E. Richmond — 2012-04-19

Abstract: Objective: To investigate: 1) if clinical test scores at discharge predict falls or limited community mobility after discharge from inpatient stroke rehabilitation; 2) how walking and dynamic standing balance change after discharge. Design: Follow-up observational study between 6 and 36-months after discharge. Setting: Rehabilitation setting Participants: Thirty community-dwelling stroke survivors who could walk unassisted when discharged from inpatient rehabilitation. Interventions: None Main outcome measures: 6-Minute Walk Test (6MWT), Four Square Step Test (FSST), Step Test (ST), Environmental Analysis of Mobility Questionnaire (EAMQ), Falls Efficacy Scale-International (FES-I) and self-reported falls. Results: Follow-up occurred at a median of 14.5-months post-discharge. Significant improvements occurred between discharge and follow-up for the 6MWT (MD=110.1m; 95%CI, 70.8-149.4, P<.001), ST (MD=1.8 steps; 95%CI .3-3.4, P=.03) and FSST (MD=4.3s; 95%CI -10.3-1.6, P=.05). Despite this, 40% of participants reported falling. The group who fell had lower clinical test scores at discharge and follow-up than non-fallers. Specific cut-off scores for the clinical tests accurately classified falls history in 70 to 78% of participants. The cut-off scores were: <250m for the 6MWT, <10 steps on the ST and a failure or ≥15 seconds to complete the FSST. Participants performing under the cut-off scores reported lower levels of community mobility (EAMQ, P<.01). Concern about falling was only higher for those classified at risk by the FSST (FES-I, P=.008). Conclusions: The FSST, Step Test and 6MWT scores at discharge had good falls prediction. People classified at risk of falls avoided more tasks in their home and community than those not classified at risk.

Different level, but a similar day pattern of physical activity in workers and sick-listed people with chronic nonspecific musculoskeletal pain - Accepted Manuscript

2012-04-18

Abstract: Objective: To investigate whether physical activity (PA) levels and day patterns of sick-listed workers with chronic nonspecific musculoskeletal pain (CMP) admitted for multidisciplinary rehabilitation are different from workers suffering from CMP. Design: cross-sectional. Setting: outpatient rehabilitation center and general community. Participants: a convenience sample of n=27 sick-listed patients with CMP referred for multidisciplinary pain rehabilitation and a volunteer sample of n=107 workers with CMP (<5% sick leave in year prior to participation). Interventions: participants wore an accelerometer for 5-7 consecutive days. Main Outcome Measure: PA, expressed as activity counts. All analyses were corrected for confounders. Results: PA levels of workers with CMP were higher than sick-listed patients (p=0.01). After correction for confounders, work status explained 3.5% of the variance observed in activity counts (Fchange=5.27, p=0.024). In the mornings group status significantly contributed to the variance in mean activity counts (Fchange=5.32, p=0.02). In afternoons (Fchange=3.29, p=0.07) and evenings (Fchange=2.41, p=0.12) the effect of group status on PA level was non-significant. No significant interaction was observed between time and group status (Wilks’ Lambda=0.92, F(14,104)=0.66, p=0.80. Conclusion: Workers with CMP have a higher PA level compared to sick-listed patients. The PA day pattern did not differ significantly between the two groups.

Changes in Torso Muscle Endurance Profiles in Children Aged 7 to 14 Years: Reference Values - Corrected Proof

Aleksandar Dejanovic, Erin P. Harvey, Stuart M. McGill — 2012-04-16

Abstract: Dejanovic A, Harvey EP, McGill SM. Changes in torso muscle endurance profiles in children aged 7 to 14 years: reference values. Objective: To establish torso muscle endurance values in children aged 7 to 14 years, as well as ratios between torso extensors, flexors, and lateral torso flexors, with applications in clinical assessment, rehabilitation, physical education targets, and athletic training program designs. It was hypothesized that boys and girls mature differently in terms of torso muscle endurance. Design: Measurements of torso muscle endurance were performed by using 4 tests in healthy children. Setting: Elementary school in Novi Sad, Province of Vojvodina, Republic of Serbia. Participants: Children from 1 elementary school (N=753, n=394 boys and n=359 girls) were grouped into 8 age strata. Interventions: Not applicable. Main Outcome Measures: Four tests established isometric physical endurance: Biering–Sørensen test for extensor endurance, flexor endurance test, and right- and left-side bridge tests. The mean, ratio, standard deviation, and 25th, 50th, and 75th percentile scores were determined for each sex/age stratum. Results: A 2-way analysis of variance indicated that girls had higher mean endurance times for torso extension and torso flexion than did boys. For example, times measured by using Biering–Sørensen and right-side bridge tests were significantly greater for girls than for boys across all age groups (P<.023). Boys can sustain the side torso test longer than can girls. Furthermore, 3-dimensional torso muscle endurance is under significant impact of age. Tukey Honestly Significant Difference post hoc tests confirmed that within and between sex exist significant differences in mean endurance times in all age strata at the significance level P=.05. Conclusion: Both age and sex influence differences in torso endurance in children aged 7 to 14 years. These data of endurance times, their ratios, and percentiles in healthy subjects form a database that may be useful for providing training and rehabilitation targets.

Minimal Detectable Changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up & Go” Test, Gait Speeds, and 2-Minute Walk Test in Individuals With Chronic Stroke With Different Degrees of Ankle Plantarflexor Tone - Corrected Proof

Vimonwan Hiengkaew, Khanitha Jitaree, Pakaratee Chaiyawat — 2012-04-16

Abstract: Hiengkaew V, Jitaree K, Chaiyawat P. Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up & Go,” gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone. Objective: To determine test-retest reliability and absolute and relative minimal detectable changes at the 95% confidence level (MDC95) of measures to detect postural balance and lower limb movements in individuals with chronic stroke who were able to walk and had differences in ankle plantarflexor tone. Design: Test-retest study. Data were collected on 2 occasions, about 6 days apart. Setting: Outpatient physical therapy clinics. Participants: Volunteers (N=61) with chronic stroke who were able to walk and had differences in ankle plantarflexor tone: no increase in ankle plantarflexor tone (n=12), a slight increase in ankle plantarflexor tone (n=32), and a marked increase in ankle plantarflexor tone (n=17). Intervention: Not applicable. Main Outcome Measures: Reliability and absolute and relative MDC95 of the Berg Balance Scale (BBS), the lower limb subscale of Fugl-Meyer Assessment (FMA-LE), the Timed “Up & Go” test (TUG), the comfortable gait speed (CGS), the fast gait speed (FGS), and the 2-minute walk test (2MWT). Results: Excellent reliability of the BBS, FMA-LE, TUG, CGS, FGS, and 2MWT for all the participants combined and for the subgroups was shown. All the participants combined showed the absolute and relative MDC95 in the BBS of 5 points and 10%, FMA-LE of 4 points and 16%, TUG of 8 seconds and 28%, CGS of 0.2m/s and 34%, FGS of 0.1m/s and 21%, and 2MWT of 13m and 23%. The absolute and relative MDC95 of the subgroups were varied based on ankle plantarflexor tone. Conclusions: The BBS, FMA-LE, TUG, CGS, FGS, and 2MWT are reliable measures to detect postural balance and lower limb movements in individuals with chronic stroke who have differences in ankle plantarflexor tone. The absolute and relative MDC95 of each measure are dissimilar in those with differences in ankle plantarflexor tone. The relative MDC95 seems more useful than the absolute MDC95 because the relative value can be used for a single individual.

A Prospective Study on Employment Outcome 3 Years After Moderate to Severe Traumatic Brain Injury - Corrected Proof

Erik Grauwmeijer, Majanka H. Heijenbrok-Kal, Ian K. Haitsma, Gerard M. Ribbers — 2012-04-16

Abstract: Grauwmeijer E, Heijenbrok-Kal MH, Haitsma IK, Ribbers GM. A prospective study on employment outcome 3 years after moderate to severe traumatic brain injury. Objectives: To evaluate the employment outcome in patients with moderate to severe traumatic brain injury (TBI) and to identify which patients are at risk of unemployment 3 years after injury. Design: Prospective cohort study. Setting: Patients with moderate and severe TBI discharged from the neurosurgery departments of 3 level 1 trauma centers in The Netherlands. Participants: Patients aged 18 to 65 years (N=113; mean age ± SD, 33.2±13.1y; 73% men) who were hospitalized with moderate (26% of patients) to severe (74% of patients) TBI. Interventions: Not applicable. Main Outcome Measures: The main outcome measure was employment status. Potential predictors included patient characteristics, injury severity factors, functional outcome measured at discharge from the acute hospital with the Glasgow Outcome Scale (GOS), Barthel Index (BI), and FIM, and cognitive functioning measured with the Functional Assessment Measure (FAM). Results: Ninety-four patients (83%) completed the 3-year follow-up. The employment rate dropped from 80% preinjury to 15% at 3 months postinjury and gradually increased to 55% after 3 years. The employment rate significantly increased from 3 months up to 1 year, but it did not change significantly from 1 to 3 years postinjury. Age, length of hospital stay, discharge to a nursing home (vs home), psychiatric symptoms, and BI, GOS, FIM, and FAM scores were found to be significant univariate determinants for employment status. By using multiple logistic regression analysis, the FAM score (adjusted odds ratio 1.1; P<.000) and psychiatric symptoms (adjusted odds ratio .08; P<.019) were selected as independent predictors for employment status. A FAM cutoff score of less than 65 to identify patients at risk of long-term unemployment had a good diagnostic value. Conclusions: Patients with TBI with psychiatric symptoms and impaired cognitive functioning at hospital discharge are at the highest risk of long-term unemployment. These factors should be the focus of vocational rehabilitation.

Effects of Ankle Proprioceptive Interference on Locomotion After Stroke - Corrected Proof

Sang-I. Lin, Li-Ju Hsu, Hui-Chung Wang — 2012-04-16

Abstract: Lin S-I, Hsu L-J, Wang H-C. Effects of ankle proprioceptive interference on locomotion after stroke. Objective: To examine the effects of vibration-induced ankle proprioceptive interference on the locomotion of patients with stroke with intact and impaired ankle joint position sense (JPS). Design: Cross-sectional. Setting: Rehabilitation department in a tertiary hospital. Participants: Ambulatory patients (N=35) with unilateral stroke received an ankle joint repositioning test and were classified into intact (n=16) or impaired (n=19) JPS group. Interventions: None. Main Outcome Measures: The plantar sensitivity and leg muscle strength were tested. Patients were instructed to walk at a self-selected pace on a computerized pressure sensor walkway under 3 conditions: no, affected, or unaffected Achilles' tendon vibration. The stride characteristics of the affected limb were analyzed. Results: Patients with intact and impaired JPS did not differ in their plantar sensitivity or leg muscle strength. The differences in the stride characteristics were nonsignificant between vibration and nonvibration conditions. Shorter single support and longer swing phase were found with the affected side vibration compared with the unaffected side vibration. Patients with intact and impaired JPS did not respond to the proprioceptive interference differently. Conclusions: After stroke, there could be changes in the central sensory regulation for locomotion control and vibration-induced afferent inputs from the ankle might be viewed as sensory disturbances. Further studies that manipulate other sensory inputs are needed to gain a better understanding of the central sensory integration for locomotion control after stroke.

Focal muscle vibration in the treatment of upper limb spasticity: a pilot randomized controlled trial in chronic stroke patients - Accepted Manuscript

2012-04-16

Abstract: Objective: To examine the clinical effect of Repetitive focal Muscle Vibration (rMV) on the motor function of the upper extremity 1 month after the treatment in patients with chronic stroke. Design: We performed a pilot randomised controlled trial using a double-blind parallel-group study design. Setting: Medical centre. Partecipants: Patients with chronic stroke (N=49) Interventions: Patients randomly assigned to the study group (SG) received rMV while patients in the control group (CG) received a placebo vibratory treatment. The patients and the clinical examiner were blind to the intervention. Main outcome measure: The primary endpoint was an improvement of more than 0.37 points at the functional ability scale of the Wolf Motor Function Test (WMFT-FAS). The Modified Ashworth Scale and the Visual Analogic Scale were the secondary outcome measures. All measures were administered before, one week (T1) and one month (T2) from the treatment. Results: Twenty-eight patients were allocated to the SG and twenty-one to the CG. The ANOVA for repeated measurements revealed a significant difference in the expression of the WMFT FAS score over time only in the SG (p: 0.006). The treatment was successful for 7 (33%) of 21 patients recruited in the SG, and for 2 (13%) of 15 patients recruited in the CG, the RR was 2.5 (95% CI: 0.60 – 10.39), the number needed to treat was 5. The Wilcoxon test showed a statistically significant difference between T0 and T2 in the SG (p:0.02). No adverse event was observed in the two groups. Conclusions: Our results suggest that the rMV treatment of the upper limb may add a functional improvement in chronic stroke patients but a larger, multicentre, randomized controlled study is needed.

A Structured Interview to Improve the Reliability and Psychometric Integrity of the Disability Rating Scale - Accepted Manuscript

James F. Malec, Flora M. Hammond, Joseph T. Giacino, John Whyte, Jerry Wright — 2012-04-16

Abstract: Objective: To (1) develop a standardized interview for telephone administration, (2) assess the psychometric properties of this interview format (DRS-PI) and (3) identify additional items to reduce skew. Design: Prospective cohort assessment study. Setting: Not applicable. Participants: 406 participants (287 individuals with traumatic brain injury (TBI); 119 caregivers) in the U.S. TBI Model System national database during 1-20 year telephone follow-up. Interventions: Not applicable. Main Outcome Measures: Original DRS and DRS-PI variations. DRS-PI questions were developed by consensus of the study investigators; item scores were derived from responses to questions by algorithm. Unnecessary questions were pruned. Results:: The DRS-PI correlated highly with the original DRS (intraclass correlation=.91) and demonstrated satisfactory construct validity and internal consistency (Person Separation/Reliability=2.51/.86; Item Separation/Reliability =16.72/1.00; Cronbach’s alpha=.83). Both versions showed substantial skew. For original DRS, 42% of scores were 0 or 1; for DRS-PI, 44%. Adding several items to the DRS-PI including actual employment status further improved its psychometric properties (Person Separation/ Reliability= 3.10/.91; Item Separation/Reliability=21.42/1.00; Cronbach’s alpha=.92) and reduced skew. For the Expanded DRS-PI, 18% of scores were 0 or 1. Conclusions: The DRS-PI provides an efficient method to assure standardized administration of and correlates highly with the original DRS. The addition of several new items including actual employment status mitigates skew in postacute samples.

Evidence of detraining after 12-week home-based exercise programs designed to reduce fall risk factors in older people recently discharged from hospital - Accepted Manuscript

2012-04-13

Abstract: Objective: To measure the extent to which improved sensorimotor function and balance resulting from a 12-week exercise intervention were retained 12 weeks after exercise cessation in older adults recently discharged from hospital. Design: Randomized-controlled trial with reassessment 12 weeks post exercise cessation Setting: Home-based exercises Participants: 180 adults aged 65 and older recently discharged from hospital (mean (±SD) length of stay: 12.3 ± 10.6 days) Interventions: Weight-Bearing (WB) exercises (n=60), Seated Resistance (SR) exercises (n=60) or social visits (n=60) Main outcome measures: Physiological Profile Assessment (PPA), a composite sensorimotor fall risk score and two measures of controlled leaning balance assessed at baseline, immediately after the intervention (12 weeks, 95% assessed) and again 12 weeks later (24 weeks, 92% assessed) Results: After the initial improvements in outcomes found at 12 weeks, both the SR and WB exercise groups showed detraining effects at 24 weeks. The PPA fall risk scores for both SR and WB groups returned to close to baseline values and there was no significant difference between groups at 24 weeks when controlling for baseline scores (p=0.924). WB exercise participants lost up to half of the improvement in the maximal balance range and coordinated stability tests. There was no difference between groups for the maximal balance range test at 24 weeks when controlling for baseline scores (p= 0.207) but between-group differences were maintained for the coordinated stability test (p=0.017). Conclusions: Balance improvements and fall risk reductions associated with a 12-week home-based exercise program in older adults were partially to totally lost 12 weeks after cessation of the intervention. These significant detraining effects suggest that sustained adherence to falls prevention exercise programs is required to reduce fall risk.

Underestimating Physical Function Gains: Comparing FIM Motor Subscale and interRAI Post Acute Care Activities of Daily Living Scale - Corrected Proof

Christine Glenny, Paul Stolee, Mary Thompson, Janice Husted, Katherine Berg — 2012-04-12

Abstract: Glenny C, Stolee P, Thompson M, Husted J, Berg K. Underestimating physical function gains: comparing FIM motor subscale and interRAI Post Acute Care activities of daily living scale. Objective: To investigate the construct validity of the activities of daily living (ADLs) sections of 2 major systems developed to measure functional ability in rehabilitation settings. Health assessment systems can inform care planning as well as policy decision-making on service effectiveness. Frailty, comorbidity, and heterogeneity make it difficult to accurately measure health outcomes for older adults. Objective investigation of the value of geriatric rehabilitation services requires assessment systems that are comprehensive, reliable, valid, and sensitive to clinically relevant changes in older patients. Design: Trained health care workers assessed patients with both tools at admission and discharge. We used Rasch analysis to compare the instruments' dimensionality, item difficulty, item fit, differential item function, and number of response options. Setting: Musculoskeletal and geriatric rehabilitation units in 2 Ontario hospitals. Participants: Older adults receiving rehabilitation (N=209; mean age ± SD, 78.5±9.3; 67% women). Interventions: Not applicable. Main Outcome Measures: FIM and the interRAI Post Acute Care (interRAI PAC) assessment. Results: For both the FIM motor and the interRAI PAC ADLs items, the difficulty level of the items was much lower than the participant's level of ability, resulting in a large ceiling effect. Also, on both scales, less actual change in functional ability was required to move between the midlevel response options. Conclusions: Both scales have limited ability to discriminate between subjects with higher functional ability, which indicates that they may underestimate the effectiveness of inpatient rehabilitation for this group of patients when used alone.

Efficacy and Retention of the French-Canadian Version of the Wheelchair Skills Training Program for Manual Wheelchair Users: A Randomized Controlled Trial - Corrected Proof

François Routhier, R. Lee Kirby, Louise Demers, Malgorzata Depa, Kara Thompson — 2012-04-12

Abstract: Routhier F, Kirby RL, Demers L, Depa M, Thompson K. Efficacy and retention of the French-Canadian version of the Wheelchair Skills Training Program for manual wheelchair users: a randomized controlled trial. Objectives: To test the hypotheses that, in comparison with a control group that received standard care, users of manual wheelchairs who also received the French-Canadian version of the Wheelchair Skills Training Program (WSTP) would significantly improve their wheelchair-skills capacity and that these improvements would be retained at 3 months. Design: Multicenter, single-blind, randomized controlled trial. Setting: Three rehabilitation centers in Montréal, Quebec, Canada. Participants: Manual wheelchair users (N=39), a sample of convenience. Intervention: Participants were randomly allocated to the WSTP or control groups. Participants in both groups received standard care. Participants in the WSTP group also received a mean of 5.9 training sessions (a mean total duration of 5h and 36min). Main Outcome Measures: The French-Canadian version of the Wheelchair Skills Test (WST) (Version 3.2) was administered at evaluation at first time period (baseline) (t1), evaluation at second time period (posttraining) (t2) (a mean of 47d after t1), and at evaluation at third time period (follow-up) (t3) (a mean of 101d after t2). Results: At t2, the mean ± SD total percentage WST capacity scores were 77.4%±13.8% for the WSTP group and 69.8%±18.4% for the control group (P=.030). Most of this difference was due to the community-level skills (P=.002). The total and subtotal Wheelchair Skills Test scores at t3 decreased by ≤0.5% from the t2 values, but differences between groups at t3, adjusting for t1, did not reach statistical significance (P≥.017 at a Bonferroni-adjusted α level of .005). Conclusion: WSTP training improves wheelchair skills immediately after training, particularly at the community-skills level, but this study did not show statistically significant differences between the groups at 3 months.

Feasibility of 2 Different Water-Based Exercise Training Programs in Patients With Parkinson's Disease: A Pilot Study - Uncorrected Proof

Carlos Ayán, José Cancela — 2012-04-12

Abstract: Ayán C, Cancela J. Feasibility of 2 different water-based exercise training programs in patients with Parkinson's disease: a pilot study. Objective: To compare the effects of 2 different water-based exercise training programs on functional mobility, motor symptoms, and quality of life (QOL) on patients with mild to moderate Parkinson's disease (PD). Design: Matched, controlled, pilot study. Setting: Outpatient, Parkinson's disease center. Participants: Patients (N=21) with PD (Hoehn and Yahr stage range, 1–3). Interventions: Participants were assigned to a low-intensity water exercise program (group 1) or a muscular resistance water exercise intervention (group 2). Group sessions were held for 12 weeks, twice a week for 60 minutes per session. Main Outcome Measures: Functional mobility was measured by means of the Five Times Sit-to-Stand Test, while the motor part of the Unified Parkinson's Disease Rating Scale was used to assess motor impairment. Patients' QOL was rated by means of the 39-item Parkinson's Disease Questionnaire. Results: Once the intervention ended, the participants' QOL improved significantly, regardless of the program undertaken (P=.02 for group 1; P=.005 for group 2). Only participants in group 2 showed a significant change in functional mobility (P=.001) and Parkinsonian motor symptoms (P=.012). Conclusions: Water-based exercise training programs are a helpful therapy in PD. Muscular resistance programs of this kind seem to be of value in improving functional mobility, motor symptoms, and QOL in patients with PD. Some of the methodologic aspects detailed here can be used to design larger controlled trials.

Development of a Measure of Skin Care Belief Scales for Persons with Spinal Cord Injury - Accepted Manuscript

2012-04-12

Abstract: Objective:: To develop and validate a measure of skin care beliefs and to describe the skin care behaviors of persons with spinal cord injury (SCI). Design:: A mixed methods design was used to develop the Skin Care Beliefs Scales. The Health Belief Model framed the hypotheses. Phase 1 included item development, content validity testing, and pilot testing. Phase 2 included testing the scale structure (principal components analysis), internal consistency reliability, test-retest reliability, and relationships between the belief scales and care behaviors. Setting:: Two acute rehabilitation hospitals and internet websites. Participants:: A total of 474 participants with SCI participated (qualitative/pilot N=56; psychometric study N=418). Interventions:: Not applicable. Main Outcome Measures:: The pilot and Phase 2 studies, respectively, used 146-item and 114-item versions of the SCBS. A Skin Care Activity Log was used to record skin care behaviors. Results:: Content validity indicated the items were relevant and clear. The analysis resulted in 11 independent scales reflecting three general beliefs (susceptibility, severity, self-efficacy) and barrier and benefit behavior-specific scales for skin checks, wheelchair pressure reliefs, and turning and sitting times. Excepting skin check barriers (ą= .65), scale Cronbach alphas ranged from .74 to .94. Test-Retest Intraclass correlations were fair to excellent (range .42 to .75). Construct validity was supported. Hierarchical linear regression indicated turning benefits, barriers, susceptibility, and self-efficacy were significant predictors of turning time. Benefits or barriers were correlated significantly with skin check and pressure relief adherence ( rho range, .17 to -.33). Self-efficacy was correlated with wheelchair pressure relief ( rho.18). Skin care behavior adherence varied widely, e.g., 0% to 100%. Conclusion:: The scales showed acceptable reliability and validity. Further testing with larger samples is desirable.

Effects of a multi-factorial falls prevention program for people with stroke returning home after rehabilitation: a randomized controlled trial - Accepted Manuscript

2012-04-12

Abstract: Objectives: To determine whether a multi-factorial falls prevention program reduces falls in people with stroke at risk of recurrent falls, and to determine whether this program leads to improvements in gait, balance, strength and fall-related efficacy. Design: A single blind, multi-center, randomized controlled trial with 12 month follow-up. Setting: Participants were recruited after discharge from rehabilitation and followed up in the community. Participants: Participants (N=156) were people with stroke at risk of recurrent falls being discharged home from rehabilitation. Interventions: Tailored multi-factorial falls prevention program and usual care, (N=71) or control (usual care, N=85). Main Outcome Measures: Primary outcomes were rate of falls and proportion of fallers. Secondary outcomes included injurious falls, falls risk, participation, activity, leg strength, gait speed, balance, and falls efficacy. Results: There was no significant difference in fall rate (intervention 1.89 falls/person-year, control 1.76 falls/person-year, IRR=1.10, P=0.74) or proportion of fallers between the groups (RR=0.83, 95%CI 0.60 – 1.14). There was no significant difference in injurious fall rate (intervention 0.74 injurious falls/person-year, control 0.49 injurious falls/person-year, IRR=1.57, P=0.25), and there were no significant differences between groups on any other secondary outcome. ConclusionsT: his multifactorial falls prevention program was not effective in reducing falls in people with stroke who are at risk of falls nor was it more effective than usual care in improving gait, balance and strength in people with stroke. Further research is required to identify effective interventions for this high risk group.

Depression and Neurocognitive Performance After Concussion Among Male and Female High School and Collegiate Athletes - Corrected Proof

Anthony P. Kontos, Tracey Covassin, R.J. Elbin, Tonya Parker — 2012-04-12

Abstract: Kontos AP, Covassin T, Elbin RJ, Parker T. Depression and neurocognitive performance after concussion among male and female high school and collegiate athletes. Objectives: To prospectively examine the relationship of sport-related concussion with depression and neurocognitive performance and symptoms among male and female high school and college athletes. A secondary objective was to explore age and sex differences. Design: Pretest, multiple posttest, repeated-measures design. Setting: Laboratory. Participants: High school and collegiate athletes (N=75) with a diagnosed concussion. Interventions: Not applicable. Main Outcome Measures: Beck Depression Inventory-II and computerized neurocognitive test battery (Immediate Post-concussion Assessment and Cognitive Test), which includes concussion symptoms (Post-concussion Symptom Scale) at baseline and at 2, 7, and 14 days postinjury. Results: Concussed athletes exhibited significantly higher levels of depression from baseline at 2 days (P≤.001), 7 days (P=.006), and 14 days postconcussion (P=.04). Collegiate athletes demonstrated a significant increase in depression at 14 days postconcussion than did high school athletes (P=.03). There were no sex differences in depression levels. Neurocognitive decrements at 14 days were supported for reaction time (P=.001) and visual memory (P=.001). Somatic depression at 7 days postconcussion was related to slower reaction time at 7 days postconcussion. Somatic depression at 14 days postinjury was related to lower visual memory scores at 14 days postinjury. Conclusions: Although not clinically significant, athletes experienced increased depression scores up to 14 days after concussion that coincided with neurocognitive decrements in reaction time and visual memory. Somatic depression appears to be most salient with regard to lower neurocognitive performance. Mood assessments after concussion are warranted to help monitor and enhance recovery.

Patients With Hemispatial Neglect Are More Prone to Limb Spasticity, but This Does Not Prolong Their Hospital Stay - Corrected Proof

David Wilkinson, Mohamed Sakel, Sarah-Jayne Camp, Lara Hammond — 2012-04-09

Abstract: Wilkinson D, Sakel M, Camp S-J, Hammond L. Patients with hemispatial neglect are more prone to limb spasticity, but this does not prolong their hospital stay. Objective: To determine whether stroke patients who suffer from hemispatial neglect tend to stay in hospitals longer because they are prone to limb spasticity. Design: Retrospective analysis of inpatient medical notes. Setting: Inpatient neurorehabilitation unit of a regional UK teaching hospital. Participants: All patients (N=106) admitted to the neurorehabilitation unit between 2008 and 2010 who had suffered a stroke, as confirmed by computed tomography or magnetic resonance imaging. Interventions: Not applicable. Main Outcome Measures: Statistical coincidence of hemispatial neglect and spasticity; length of hospital stay. Results: Chi-square analyses indicated that individuals with left neglect were nearly one third more likely to develop spasticity than those without neglect (87% vs 57%), while nearly one half of those with left-sided spasticity showed neglect (44% vs 13%). Individuals with neglect stayed in the hospital 45 days longer than those without neglect, but the presence or absence of spasticity did not affect length of stay. Conclusions: The results provide the first statistical evidence, to the best of our knowledge, that neglect and limb spasticity tend to co-occur poststroke, though it is only the former that significantly prolongs stay. Diagnostic value aside, these results are important because they tell us that the treatment of neglect should not be overshadowed by efforts to reduce comorbid spasticity. Despite its poor prognosis, hemispatial neglect continues to receive little targeted therapy in some units.

Home Accessibility, Living Circumstances, Stage of Activity Limitation, and Nursing Home Use - Accepted Manuscript

2012-04-09

Abstract: Objective: To explore the influence of the physical home and social environments, and disability patterns on nursing home (NH) use. Design: Longitudinal cohort study. Self- or proxy-reported perception of home environmental barriers accessibility, 5 stages expressing the severity and pattern of activity of daily living (ADL) limitations, and other characteristics at baseline were applied to predict NH use within 2 years or prior to death through logistic regression. Setting: General community. Participants: There were 7,836 population-based community-dwelling individuals (≥70 years old) from the second Longitudinal Study of Aging interviewed in 1994 with 2 year follow-up that was prospectively collected. Intervention: Not applicable. Main outcome measures: NH use within 2 years. Results: Perceptions of home environmental barriers and living alone were both associated with approximately 40% increased odds of NH use after adjustment for other factors. Compared to those with no limitations at ADL stage 0, the odds of NH use peaked for those with severe limitations at ADL stage III (odds ratio (OR) = 3.12, 95% confidence interval (CI), 2.20-4.41), then declined sharply for those with total limitations at ADL stage IV (OR=0.96, 95% CI, 0.33-2.81). Sensitivity analyses for missing NH use showed similar results. Conclusions: Accessibility of the home environment, living circumstance, and ADL stage represent potentially modifiable targets for rehabilitation interventions for decreasing NH use in the aging US population.

A Novel Splint for PIP Joint Contractures-a Case Report - Accepted Manuscript

2012-04-06

Abstract: Proximal interphalangeal joint (PIP) joint contractures are notoriously difficult to treat. Best results are obtained with early mobilization and splinting, though a high level of adherence is critical for a good outcome. We used a new roll-on splint that aims to increase motion with minimal difficulty. We describe a patient with moderate PIP joint contractures (30-60 degrees) that was treated successfully using this splint. The splint design and therapy protocol are described. The patient was treated for 12 weeks with good adherence to therapy and splinting. Total active motion (TAM) increased by 87% in the index finger and 108% in the ring. Grip, pinch and tip-pinch strengths increased. The Disabilities of the Arm, Shoulder and Hand (DASH) score improved from 26.7% to 2.5%. At three months, the patient returned to work. Though this case illustrates some of the advantages and disadvantages of the new splint, further study is necessary to evaluate the splint and compare it to other existing forms of treatment for PIP joint contractures.

Reliability and Validity of Step Test Scores in Subjects With Chronic Stroke - Corrected Proof

Sze-Jia Hong, Esther Y. Goh, Salan Y. Chua, Shamay S. Ng — 2012-04-05

Abstract: Hong S-J, Goh EY, Chua SY, Ng SS. Reliability and validity of step test scores in subjects with chronic stroke. Objectives: To establish (1) the intrarater and interrater reliabilities of step test (ST) scores in subjects with chronic stroke, (2) the ST's known-groups validity and cutoff scores for distinguishing subjects with chronic stroke from healthy adults older than 50 years, and (3) the convergent validity of ST scores with lower-limb muscle strength, coordination, balance performance, and walking speed. Design: Cross-sectional study. Setting: University-based rehabilitation center. Participants: Convenience sample of subjects (N=30): community-dwelling subjects with chronic stroke (n=15) and healthy adults older than 50 years (n=15). Interventions: Not applicable. Main Outcome Measures: ST scores; handheld dynamometer measurements of bilateral lower-limb muscle strength; lower-extremity motor coordination test (LEMOCOT) scores; Berg Balance Scale scores; walking speed as measured by a 5-meter walk test. Results: ST scores showed excellent intrarater reliability, with intraclass correlation coefficients ranging from .981 to .995 and interrater reliability ranging from .996 to .999. A cutoff score of 13 on the paretic side was found to distinguish the healthy adults older than 50 years from subjects with stroke at a sensitivity of 87% and a specificity of 87%. A cutoff score of 11 on the nonparetic side was found to distinguish the healthy adults from subjects with stroke at a sensitivity of 100% and a specificity of 67%. ST scores of the paretic limb demonstrated a significant correlation with muscle strength, the LEMOCOT scores of the paretic leg, and walking speed. ST scores of the nonparetic limb demonstrated a significant correlation with muscle strength and the LEMOCOT scores of the paretic leg. Conclusions: The ST is a reliable measurement tool when the number of steps is counted by either experienced or inexperienced examiners by viewing videotapes. ST scores with both the paretic limb and the nonparetic limb are sensitive in distinguishing subjects with chronic stroke from healthy adults older than 50 years.

From “Wheelchair Circuit” to “Wheelchair Assessment Instrument for People with Multiple Sclerosis”: Reliability and Validity Analysis of a Test to Assess Driving Skills in Manual Wheelchair Users With Multiple Sclerosis - Corrected Proof

Monia Vereecken, Guy Vanderstraeten, Stephan Ilsbroukx — 2012-04-05

Abstract: Vereecken M, Vanderstraeten G, Ilsbroukx S. From “Wheelchair Circuit” to “Wheelchair Assessment Instrument for people with Multiple Sclerosis”: reliability and validity analysis of a test to assess driving skills in manual wheelchair users with multiple sclerosis. Objectives: To assess the reliability and validity of the Wheelchair Assessment Instrument for people with Multiple Sclerosis (WAIMS), a test to measure driving skills in manual wheelchair users with multiple sclerosis (MS). Design: Three test trials per subject were conducted by 2 raters to examine reliability (inter- and intrarater) and validity (concurrent and construct). Setting: A national multiple sclerosis rehabilitation center. Participants: Convenience sample of manual wheelchair users with MS (n=50), participating in an inpatient or outpatient rehabilitation program in a national multiple sclerosis center. Interventions: Not applicable. Main Outcome Measures: The WAIMS consists of 8 items and results in 3 final test scores: ability sum score, performance time sum score, and covered distance. These 3 scores are used to calculate inter- and intrarater reliability, concurrent validity, and construct validity. Concerning validity, the test scores on the WAIMS are compared with (1) the Belgian medical prescription of a wheelchair on the item d445 (hand and arm use), based on the International Classification of Functioning, Disability and Health, (2) the Expanded Disability Status Scale, and (3) the mobility (wheelchair) item of the FIM. Results: Intrarater reliability was found to be higher than interrater reliability. Except for the interrater reliability of the ability sum score, all intraclass correlation coefficients met our standard of 0.80. Concurrent validity was rather low, but construct validity showed that the WAIMS is a valid instrument to assess driving skills in manual wheelchair users with MS. Conclusions: The WAIMS is a promising tool to assess driving skills in manual wheelchair users with MS, but it needs some refinements and future studies to confirm this statement.

Age Differences in Expectations and Readiness Regarding Lifestyle Modifications in Individuals at High Risk of Diabetes - Corrected Proof

2012-04-05

Abstract: Bouchard DR, Langlois M-F, Domingue M-E, Brown C, LeBrun V, Baillargeon J-P. Age differences in expectations and readiness regarding lifestyle modifications in individuals at high risk of diabetes. Objective: The main objective of this study was to determine whether expectations and readiness to modify eating habits and physical activity (PA) level are different between young and older individuals with prediabetes who agreed to participate in a lifestyle modification program. Design: Cross-sectional analysis. Setting: Primary care or referral center. Participants: Adults between ages 27 and 78 years (N=74) were tested before starting a 12-month lifestyle intervention. Interventions: Not applicable. Main Outcome Measures: The visual analog scale questionnaire was used to assess expectations and readiness (ie, intentions, conviction, and self-confidence) to modify the PA level and eating habits. The PA level was assessed with a pedometer and eating habits with a questionnaire. Analyses were stratified by the age group: <60 years old versus ≥60 years old. Results: Body mass loss expectations in terms of goal (−22.9% vs −17.9% of the current body mass; P=.04), acceptable (−15.6% vs −9.4%; P=.01), and failure (−7.6% vs −3.8%; P=.05) in future body mass loss were all greater for the younger group. Despite no significant age group difference in the initial PA level and eating habits, the youngest group had a greater intention to increase the PA level (89% vs 81%; P=.004) and to eat healthier (90% vs 85%; P=.001). Finally, the PA level and the consumption of fruits and vegetables, but not body mass, were associated with intentions or self-confidence to make some lifestyle modifications within age groups. Conclusions: In individuals at high risk for diabetes, increasing age is associated with lower expectations and reduced readiness with regard to lifestyle modifications. Thus, age should be considered when planning a lifestyle modification program.

Adherence to Clinical Guidelines Improves Patient Outcomes in Australian Audit of Stroke Rehabilitation Practice - Corrected Proof

2012-04-05

Abstract: Hubbard IJ, Harris D, Kilkenny MF, Faux SG, Pollack MR, Cadilhac DA. Adherence to clinical guidelines improves patient outcomes in Australian audit of stroke rehabilitation practice. Objective: To study the correlation between adherence to recommended management and good recovery outcomes in an Australian cohort of inpatients receiving rehabilitation. Design: Processes of care were audited and included those recommended in the Australian Clinical Guidelines for Stroke Rehabilitation and Recovery. Setting: National audit data from 68 rehabilitation units were used, with each hospital contributing up to 40 consecutive cases. Participants: Not applicable. Interventions: Not applicable. Main Outcome Measures: Discharged home or an increase of greater than or equal to 22 in FIM scores between admission and discharge. Multivariable logistic regression models controlling for patient clustering were used to assess the associations between adherence to recommended management and recovery outcomes (dependent variables). Results: Hospitals contributed 2119 patients (median age 75y, 53% men). We found that rehabilitation units providing evidence-based management (eg, treatment for sensorimotor impairment 38%, hypertonicity 56%, mobility 94%, and home assessments 71%) were more likely to provide better recovery outcomes for people with stroke. A discharge FIM score of 100 was clinically relevant and was strongly correlated with whether or not a patient was discharged home. We found very good correlation between admission and discharge FIM scores in stroke rehabilitation. Conclusions: This is one of the first study comparing adherence to recommended management in Australian rehabilitation units and stroke recovery outcomes based on national audit data. Novel findings include the significance of an FIM score between 80 and 100 and the clinical significance of various management processes.

Smallest Real Difference of 2 Instrumental Activities of Daily Living Measures in Patients With Chronic Stroke - Corrected Proof

Wen-Shian Lu, Christine C. Chen, Sheau-Ling Huang, Ching-Lin Hsieh — 2012-04-05

Abstract: Lu W-S, Chen CC, Huang S-L, Hsieh C-L. Smallest real difference of 2 instrumental activities of daily living measures in patients with chronic stroke. Objective: To estimate the smallest real difference (SRD) values of 2 instrumental activities of daily living measures (the Nottingham Extended Activities of Daily Living [NEADL] and the Frenchay Activities Index [FAI]) in patients with chronic stroke. Design: Test-retest reliability study. Setting: Physical rehabilitation units of 5 hospitals. Participants: Chronic stroke patients (N=52; 37 men, 15 women) who were discharged from the hospital for more than 6 months. Interventions: Not applicable. Main Outcome Measures: Both measures were administered twice about 2 weeks apart to participants. The SRD was calculated on the basis of standard error of measurement: SRD = 1.96 × √2 × Standard error of measurement. SRD% (the value of SRD divided by total score of a measure) was used to compare measurement errors across both measures. Reproducibility between successive measurements of the measures was investigated with intraclass correlation coefficients (ICCs). Results: The SRD (SRD%) values of the NEADL and the FAI were 12.0 (21.1%) and 6.7 (14.9%), respectively. Test-retest reproducibility of both measures was high (ICC: NEADL=.89, FAI=.89). Conclusions: Because of substantial SRD values of the NEADL and the FAI, prospective users should be cautious in using both measures to detect real change for a single subject.

Changes in Gait Pattern and Hip Muscle Strength After Open Reduction and Internal Fixation of Acetabular Fracture - Corrected Proof

2012-04-05

Abstract: Kubota M, Uchida K, Kokubo Y, Shimada S, Matsuo H, Yayama T, Miyazaki T, Takeura N, Yoshida A, Baba H. Changes in gait pattern and hip muscle strength after open reduction and internal fixation of acetabular fracture. Objectives: To characterize changes in the gait pattern at 3 and 12 months after surgery for acetabular fracture, to assess the relationship between various gait parameters and hip muscle strength, and to determine the factors associated with gait disorders that correlate with gait parameters measured at 12 months after surgery. Design: Prospective cohort study. Setting: University hospital. Participants: Patients (N=19) with acetabular fractures were treated by open reduction and internal fixation (ORIF) and examined at 3 and 12 months postoperatively. The study also included a similar number of sex- and age-matched control subjects. Interventions: Postoperative rehabilitation program. Main Outcome Measures: Spatiotemporal, kinematic, and kinetic variables of gait and strength of hip flexor, adductor, and abductor muscles at 3 and 12 months after ORIF. Results: Walking velocity at 3 months after ORIF was slower in the patients than in the control subjects; however, walking velocity at 12 months was similar in the 2 groups. Although most of the kinematic and kinetic variables showed recovery to control levels at 3 and 12 months after ORIF, recovery was incomplete for pelvic forward tilt and hip abduction moment even at 12 months after ORIF. The greatest loss of muscle strength was noted in the hip abductors, where the average deficit was 35.4% at 3 months and 24.6% at 12 months. There was a significant relationship between hip abductor muscle strength and hip abduction moment at 3 months (R2=.63); however, this relationship diminished at 12 months (R2=.14). The presence of associated injuries correlated with lack of recovery of the peak hip abduction moment. Conclusions: Pelvic forward tilt and peak hip abduction moment showed incomplete recovery at 12 months after ORIF with subsequent conventional and home exercise rehabilitation programs. Our results suggest that improvement of hip abductor muscle strength in the early postoperative period could improve the peak hip abduction moment.

Validity of the Life Satisfaction questions, the Life Satisfaction Questionnaire (LiSat-9), and the Satisfaction With Life Scale (SWLS) in persons with spinal cord injury - Accepted Manuscript

2012-04-05

Abstract: Objective: To assess and compare the validity of three life satisfaction instruments in persons with spinal cord injury (SCI). Design: Cross-sectional study five years after discharge from inpatient rehabilitation. Setting: Eight Dutch rehabilitation centres with specialised SCI units. Participants: Persons (n=225) with recently acquired SCI between 18 to 65 years of age were included in a cohort study. Data were available for 145 persons 5 years after discharge. Interventions: Not applicable Main outcome measures: the Life Satisfaction questions (LS questions), the Life Satisfaction Questionnaire (LiSat-9), and the Satisfaction With Life Scale (SWLS). Results: There were no floor or ceiling effects. Cronbach’s alpha was questionable for the LS questions (0.60), satisfactory for the LiSat-9 (0.75), and good for the SWLS (0.83). Concurrent validity was shown by strong and significant Spearman correlations (0.59-0-60) between all three life satisfaction instruments. Correlations with measures of mental health and participation were 0.52-0.56 for the LS questions, 0.45-0.52 for the LiSat-9, and 0.41-0.48 for the SWLS. Divergent validity was shown by weak and in part non-significant correlations between the three life satisfaction measures and measures of functional independence and lesion characteristics. Conclusion: Overall, the validity of all three life satisfaction measures was supported. Despite questionable internal consistency, the concurrent and divergent validity of the LS questions were at least as good as the validity of the LiSat-9 and the SWLS.

Retrospective Study of the Effects of Inpatient Rehabilitation on Improving and Maintaining Functional Independence in People With Friedreich Ataxia - Corrected Proof

2012-04-05

Abstract: Milne SC, Campagna EJ, Corben LA, Delatycki MB, Teo K, Churchyard AJ, Haines TP. Retrospective study of the effects of inpatient rehabilitation on improving and maintaining functional independence in people with Friedreich ataxia. Objectives: To determine the effects of inpatient intervention for people with Friedreich ataxia (FRDA), and to identify whether improvements gained were sustained postdischarge. Design: This retrospective observational cohort study comprised people with FRDA admitted to inpatient rehabilitation. Setting: All participants in the study were referred by a specialist multidisciplinary FRDA clinic to inpatient rehabilitation. Participants: From 2003 until 2010, people (N=29; men, n=17; women, n=12) with FRDA were admitted to rehabilitation, representing 42 admissions. On admission, 9 participants were ambulant and 33 participants were nonambulant. Interventions: Each participant was prescribed goal-related therapy on an individual basis by the multidisciplinary team, and this consisted of a range of treatment approaches. Main Outcome Measure: The FIM was used to determine the efficacy of inpatient rehabilitation. Results: Consistent with the progressive nature of the condition, FIM scores, as measured on an annual basis preintervention, declined over time. However, FIM scores increased by a mean of 8.5 points during periods of inpatient rehabilitation and continued to increase by a mean of 2.0 points during the period immediately after rehabilitation. Results demonstrate these increases during and immediately after inpatient rehabilitation were significant (P<.001). Conclusions: To the best of our knowledge, this study provides the first evidence that a period of inpatient rehabilitation reverses or halts the downward decline in function for people with FRDA. The benefits from this intervention continued during the period immediately after inpatient rehabilitation, indicating that these gains are more than just short-term achievements. Further exploration of intensity, type, and length of rehabilitation is required to ensure that the most appropriate rehabilitation is provided.

Comparative Study of Short Forms of the Tampa Scale for Kinesiophobia: Fear of Movement in a Surgical Spine Population - Corrected Proof

2012-04-04

Abstract: Archer KR, Phelps KD, Seebach CL, Song Y, Riley LH III, Wegener ST. Comparative study of short forms of the Tampa Scale for Kinesiophobia: fear of movement in a surgical spine population. Objective: To compare the factor structure of 6 short forms of the Tampa Scale for Kinesiophobia (TSK) by means of confirmatory factor analysis in patients after spinal surgery for degenerative conditions. Design: A cross-sectional survey study. Setting: University-based surgical clinic. Participants: Adults (N=137) treated by spinal surgery for a degenerative condition (ie, spinal stenosis, spondylosis with or without myelopathy, and spondylolisthesis). Interventions: Not applicable. Main Outcome Measure: Patients completed the TSK within 3 months of hospital discharge. Results: Confirmatory factor analysis demonstrated that the 2-factor models of the TSK-13 and TSK-11 had a reasonable fit for the data, with internal consistency values >.70. A 1-factor TSK-4 (items 3, 6, 7, and 11) demonstrated an excellent fit for the data, but an adequate internal consistency was not maintained. A poor fit was noted for the 1-factor models of the TSK-13 and TSK-11, and a 4-item TSK (items 1, 2, 9, and 11). Conclusions: The current study provides further evidence that specific short-form versions of the TSK may be useful for assessing fear of movement in surgical populations. Results support the measurement of fear of movement using the 2-factor, 13- and 11-item versions of the TSK in patients after spinal surgery. A TSK-4 (items 3, 6, 7, and 11) offers a promising alternative to the TSK-13 and TSK-11. However, further research is needed to test the validity and reliability of the TSK-4 in patients undergoing spinal surgery in order to support its use in a clinical environment. Researchers and clinicians interested in a shorter measure of fear of movement should consider using the TSK-11.

Effect of Shoulder Pain on Shoulder Kinematics during Weight Bearing Tasks in Persons with Spinal Cord Injury - Accepted Manuscript

2012-04-04

Abstract: Objective: To assess three-dimensional scapulothoracic and glenohumeral kinematics between subjects with spinal cord injury and disease (SCI/D) with, and without shoulder pain during a weight-relief raise and transfer task. Design: Case-Control, repeated-measures analysis of variance Setting: Movement Analysis Laboratory Participants: 43 subjects (23 with clinical signs of impingement and 20 without) between 21-65 years, at least one year post SCI/D (range 1-43 years) resulting in AIS T2 motor neurological level or below, and requiring the full time use of a manual wheelchair. Interventions: Weight-relief raises and transfer tasks. Main Outcome Measures: An electromagnetic tracking system acquired three dimensional position and orientation of the thorax, scapula and humerus. Dependent variables included angular values for scapular upward and downward rotation, posterior and anterior tilt and internal and external rotation relative to the thorax and glenohumeral internal and external rotation relative to the scapula. The mean of three trials were collected and angular values were compared at three distinct phases of the weight-relief raise and transfer activity. Comparisons were also made between transfer direction (lead versus trail arm), and across groups. Results: Key findings include significantly increased scapular upward rotation for the pain group during transfer (p=.03). Significant group differences were found for the trailing arm at the lift pivot (phase 2) of the transfer with the pain group having greater anterior tilt (mean difference 5.7°, SE 2.8°). The direction of transfer also influenced kinematics at the different phases of the activity. conclusions: Potentially detrimentalmagnitude and direction of scapular and glenohumeral kinematics duringweight bearing tasks may pose increased risk for shoulder pain or injury in persons with SCI/D. Consideration should be given to rehabilitation strategies that promote favorable scapular kinematics and glenohumeral external rotation.

Workshop on Personal Motion Technologies for Healthy Independent Living: Executive Summary - Corrected Proof

2012-04-02

Abstract: Rodgers MM, Cohen ZA, Joseph L, Rossi W, for the Workshop on Personal Motion Technologies for Healthy Independent Living Presenters. Workshop on personal motion technologies for healthy independent living: executive summary. The objective of the June 2010 “Workshop on Personal Motions Technologies for Healthy Independent Living” was to discuss personal motion technologies that might enable older adults and individuals with disability to live independently for longer periods. The 60 participants included clinicians, academic researchers, engineers, patient advocates, caregivers, members of the public, and federal representatives. The workshop was divided into 6 sessions that addressed the following: (1) use of technologies in identifying early indicators of disease or adverse events; (2) monitoring daily activities; (3) coping with impairment; (4) managing mild cognitive impairment; (5) rehabilitation and exercise in the home; and (6) caregiver support. Presentations and discussion focused on clinical needs, the health impact of addressing those needs, state-of-the-art technologies, and challenges to adoption of those technologies. Conclusions included the following: (1) Involvement of end-users in research and development will increase the likelihood that technologies will be adopted. (2) Integration of differing types of technology into a system that includes clinical measures is required for independent living. (3) Seniors are willing to sacrifice some privacy for an effective technology that keeps them in their homes as long as they control who receives their data. (4) Multilevel and multiscale models are needed to understand motion in the context of the environment and to design effective systems.