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Broom AF, Kirby ER, Sibbritt DW, Adams J, Refshauge KM. Back pain amongst mid-age Australian women: A longitudinal analysis of provider use and self-prescribed treatments. Complement Ther Med 2012; 20:275-82. [DOI: 10.1016/j.ctim.2012.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/19/2012] [Accepted: 05/09/2012] [Indexed: 10/28/2022] Open
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Hübscher M, Refshauge KM. Neuromuscular training strategies for preventing lower limb injuries: what's new and what are the practical implications of what we already know?: Table 1. Br J Sports Med 2012; 47:939-40. [DOI: 10.1136/bjsports-2012-091253] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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van den Dolder PA, Ferreira PH, Refshauge KM. Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: a systematic review with meta-analysis. Br J Sports Med 2012; 48:1216-26. [PMID: 22844035 DOI: 10.1136/bjsports-2011-090553] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the effectiveness of exercise and soft tissue massage either in isolation or in combination for the treatment of non-specific shoulder problems. METHODS Database searches for articles from 1966 to December 2011 were performed. Studies were eligible if they investigated 'hands on' soft tissue massage performed locally to the shoulder or exercises aimed at improving strength, range of motion or coordination; non-surgical painful shoulder disorders; included participants aged 18-80 years and outcomes measured included pain, disability, range of motion, quality of life, work status, global perceived effect, adverse events or recurrence. RESULTS Twenty-three papers met the selection criteria representing 20 individual trials. We found low-quality evidence that soft tissue massage was effective for producing moderate improvements in active flexion and abduction range of motion, pain and functional scores compared with no treatment, immediately after the cessation of treatment. Exercise was shown by meta-analysis to produce greater improvements than placebo, minimal or no treatment in reported pain (weighted mean=9.8 of 100, 95% CI 0.6 to 19.0) but these changes were of a magnitude that was less than that considered clinically worthwhile. Exercise did not produce greater improvements in shoulder function than placebo, minimal or no treatment (weighted mean=5.7 of 100, 95% CI -3.3 to 14.7). CONCLUSION There is low-quality evidence that soft tissue massage is effective for improving pain, function and range of motion in patients with shoulder pain in the short term. Exercise therapy is effective for producing small improvements in pain but not in function or range of motion.
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Broom AF, Kirby ER, Sibbritt DW, Adams J, Refshauge KM. Use of complementary and alternative medicine by mid-age women with back pain: a national cross-sectional survey. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 12:98. [PMID: 22809262 PMCID: PMC3493383 DOI: 10.1186/1472-6882-12-98] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 07/08/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) has increased significantly in Australia over the past decade. Back pain represents a common context for CAM use, with increasing utilisation of a wide range of therapies provided within and outside conventional medical facilities. We examine the relationship between back pain and use of CAM and conventional medicine in a national cohort of mid-aged Australian women. METHODS Data is taken from a cross-sectional survey (n = 10492) of the mid-aged cohort of the Australian Longitudinal Study on Women's Health, surveyed in 2007. The main outcome measures were: incidence of back pain the previous 12 months, and frequency of use of conventional or CAM treatments in the previous 12 months. RESULTS Back pain was experienced by 77% (n = 8063) of the cohort in the previous twelve month period. The majority of women with back pain only consulted with a conventional care provider (51.3%), 44.2% of women with back pain consulted with both a conventional care provider and a CAM practitioner. Women with more frequent back pain were more likely to consult a CAM practitioner, as well as seek conventional care. The most commonly utilised CAM practitioners were massage therapy (26.5% of those with back pain) and chiropractic (16.1% of those with back pain). Only 1.7% of women with back pain consulted with a CAM practitioner exclusively. CONCLUSIONS Mid-aged women with back pain utilise a range of conventional and CAM treatments. Consultation with CAM practitioners or self-prescribed CAM was predominantly in addition to, rather than a replacement for, conventional care. It is important that health professionals are aware of potential multiple practitioner usage in the context of back pain and are prepared to discuss such behaviours and practices with their patients.
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Parkitny L, McAuley JH, Walton D, Pena Costa LO, Refshauge KM, Wand BM, Di Pietro F, Moseley GL. Rasch analysis supports the use of the Depression, Anxiety, and Stress Scales to measure mood in groups but not in individuals with chronic low back pain. J Clin Epidemiol 2012; 65:189-98. [DOI: 10.1016/j.jclinepi.2011.05.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 05/18/2011] [Accepted: 05/23/2011] [Indexed: 10/17/2022]
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Kilbreath SL, Refshauge KM, Beith JM, Ward LC, Lee M, Simpson JM, Hansen R. Upper limb progressive resistance training and stretching exercises following surgery for early breast cancer: a randomized controlled trial. Breast Cancer Res Treat 2012; 133:667-76. [DOI: 10.1007/s10549-012-1964-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 01/16/2012] [Indexed: 11/24/2022]
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Kilbreath S, Refshauge KM, Beith J, Ward L, Sawkins K, Paterson R, Clifton-Bligh P, Sambrook PN, Simpson JM, Nery L. Prevention of osteoporosis as a consequence of aromatase inhibitor therapy in postmenopausal women with early breast cancer: rationale and design of a randomized controlled trial. Contemp Clin Trials 2011; 32:704-9. [PMID: 21570487 DOI: 10.1016/j.cct.2011.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 04/12/2011] [Accepted: 04/27/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND Aromatase inhibitors (AIs) have improved the prognosis for breast cancer survivors and are now standard of care for postmenopausal women with hormone receptor positive early stage breast cancer. One side-effect, however, is a decrease in bone mineral density (BMD) and increased fracture risk. Since hormone replacement therapy (HRT) is contraindicated in these women, one prevention option is exercise combined with vitamin D and calcium. The effect of this intervention on drug-induced osteoporosis is unknown. METHODS A single-blind randomized controlled trial will be undertaken to test the hypothesis that exercise combined with vitamin D and calcium can prevent the decrease in BMD associated with the use of AIs. Sixty postmenopausal women prescribed an AI for the treatment of breast cancer will be randomized into either an exercise or control group. Participants randomized to the exercise group will undertake a 12-month gym-based exercise program, 3 times per week involving resistance and impact training. Participants in the control group will be advised on the benefits of exercise for preventing osteoporosis, but not prescribed exercise. Both groups will receive vitamin D and calcium supplements. The primary outcome will be total hip bone mineral density measured via dual energy X-ray absorptiometry (DXA). Study outcomes will be compared between groups at baseline, 6months and 12months. SUMMARY This study will investigate the effect of exercise in combination with vitamin D and calcium on prevention of drug-induced osteoporosis in postmenopausal women prescribed AIs for the treatment of breast cancer.
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Abstract
CONTEXT The Hertel model of chronic ankle instability (CAI) is commonly used in research but may not be sufficiently comprehensive. Mechanical instability and functional instability are considered part of a continuum, and recurrent sprain occurs when both conditions are present. A modification of the Hertel model is proposed whereby these 3 components can exist independently or in combination. OBJECTIVE To examine the fit of data from people with CAI to 2 CAI models and to explore whether the different subgroups display impairments when compared with a control group. DESIGN Cross-sectional study. PATIENTS OR OTHER PARTICIPANTS Community-dwelling adults and adolescent dancers were recruited: 137 ankles with ankle sprain for objective 1 and 81 with CAI and 43 controls for objective 2. INTERVENTION(S) Two balance tasks and time to recover from an inversion perturbation were assessed to determine if the subgroups demonstrated impairments when compared with a control group (objective 2). MAIN OUTCOME MEASURE(S) For objective 1 (fit to the 2 models), outcomes were Cumberland Ankle Instability Tool score, anterior drawer test results, and number of sprains. For objective 2, outcomes were 2 balance tasks (number of foot lifts in 30 seconds, ability to balance on the ball of the foot) and time to recover from an inversion perturbation. The Cohen d was calculated to compare each subgroup with the control group. RESULTS A total of 56.5% of ankles (n = 61) fit the Hertel model, whereas all ankles (n = 108) fit the proposed model. In the proposed model, 42.6% of ankles were classified as perceived instability, 30.5% as recurrent sprain and perceived instability, and 26.9% as among the remaining groups. All CAI subgroups performed more poorly on the balance and inversion-perturbation tasks than the control group. Subgroups with perceived instability had greater impairment in single-leg stance, whereas participants with recurrent sprain performed more poorly than the other subgroups when balancing on the ball of the foot. Only individuals with hypomobility appeared unimpaired when recovering from an inversion perturbation. CONCLUSIONS The new model of CAI is supported by the available data. Perceived instability alone and in combination characterized the majority of participants. Several impairments distinguished the sprain groups from the control group.
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Leaver AM, Refshauge KM, Maher CG, Herbert RD, Latimer J, McAuley JH, Jull G. The Authors Respond. Arch Phys Med Rehabil 2011. [DOI: 10.1016/j.apmr.2010.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Haggman SP, Sharpe LA, Nicholas MK, Refshauge KM. Attentional Biases Toward Sensory Pain Words in Acute and Chronic Pain Patients. THE JOURNAL OF PAIN 2010; 11:1136-45. [DOI: 10.1016/j.jpain.2010.02.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 10/28/2009] [Accepted: 02/12/2010] [Indexed: 12/22/2022]
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Leaver AM, Maher CG, Herbert RD, Latimer J, McAuley JH, Jull G, Refshauge KM. A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain. Arch Phys Med Rehabil 2010; 91:1313-8. [PMID: 20801246 DOI: 10.1016/j.apmr.2010.06.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/26/2010] [Accepted: 06/04/2010] [Indexed: 11/25/2022]
Abstract
UNLABELLED A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain. OBJECTIVE To determine whether neck manipulation is more effective for neck pain than mobilization. DESIGN Randomized controlled trial with blind assessment of outcome. SETTING Primary care physiotherapy, chiropractic, and osteopathy clinics in Sydney, Australia. PARTICIPANTS Patients (N=182) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner. INTERVENTIONS Participants were randomly assigned to receive treatment with neck manipulation (n=91) or mobilization (n=91). Patients in both groups received 4 treatments over 2 weeks. MAIN OUTCOME MEASURE The number of days taken to recover from the episode of neck pain. RESULTS The median number of days to recovery of pain was 47 in the manipulation group and 43 in the mobilization group. Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilization (hazard ratio=.98; 95% confidence interval, .66-1.46). CONCLUSIONS Neck manipulation is not appreciably more effective than mobilization. The use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.
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Leaver AM, Refshauge KM, Maher CG, McAuley JH. Conservative interventions provide short-term relief for non-specific neck pain: a systematic review. J Physiother 2010; 56:73-85. [PMID: 20482474 DOI: 10.1016/s1836-9553(10)70037-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
QUESTION Which interventions for non-specific neck pain are effective in reducing pain or disability? DESIGN Systematic review with meta-analysis of randomised controlled trials. PARTICIPANTS Adults with non-specific neck pain. INTERVENTION All interventions for neck pain that were evaluated in trials with a placebo, minimal- or no-intervention control. OUTCOME MEASURES Pain and disability outcomes (0-100 scale) at the conclusion of a course of treatment (short term), and in the medium (3 to 9 months) and long (> 9 months) term. RESULTS 33 trials were identified. The interventions with significant short-term effects on pain were manipulation (MD -22, 95% CI -32 to -11), multimodal intervention (MD -21, 95% CI -34 to -7), specific exercise (MD -12, 95% CI -22 to -2), combination orphenadrine/paracetamol (MD -17, 95% CI -32 to -2), and manual therapy (MD -12, 95% CI -16 to -7). There was a significant short-term effect on disability for acupuncture (MD -8, 95% CI -13 to -2) and manual therapy (MD -6, 95% CI -11 to -2). Treatment with laser therapy resulted in better pain outcomes at medium-term follow-up but not at short-term follow-up. No other intervention demonstrated medium- or long-term effects. CONCLUSION Some conservative interventions for neck pain are effective in the short term. Few interventions that have been investigated have shown longer term effects that are better than placebo or minimal intervention.
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Hush JM, Refshauge KM, Sullivan G, De Souza L, McAuley JH. Do Numerical Rating Scales and the Roland-Morris Disability Questionnaire capture changes that are meaningful to patients with persistent back pain? Clin Rehabil 2010; 24:648-57. [DOI: 10.1177/0269215510367975] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To investigate patients’ views about two common outcome measures used for back pain: Numerical Rating Scales for pain and the Roland-Morris Disability Questionnaire. Subjects: Thirty-six working adults who had previously sought primary care for back pain and who could speak and read English. Method: Eight focus groups were conducted to explore participants’ views about the 11-point Numerical Rating Scales and the 24-item Roland-Morris Disability Questionnaire. Each group was led by a facilitator and an interview topic guide was used. Audio recordings of focus groups were transcribed verbatim. Framework analysis was used to chart participants’ views and an interpretive analysis performed to explain the findings. Results: Participants reported that neither the Roland-Morris nor the Numerical Rating Scales captured the complex personal experience of pain or relevant changes in their condition. The time-frame of assessment was identified as particularly problematic and the Roland-Morris did not capture relevant functional domains. Conclusion: This study provides empirical data that working adults with persistent back pain consider these clinical outcome measures largely inadequate. These measures currently used for back pain may contribute to misleading conclusions about treatment efficacy and patient recovery.
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Czerniec SA, Ward LC, Lee MJ, Refshauge KM, Beith J, Kilbreath SL. Segmental measurement of breast cancer-related arm lymphoedema using perometry and bioimpedance spectroscopy. Support Care Cancer 2010; 19:703-10. [DOI: 10.1007/s00520-010-0896-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 04/23/2010] [Indexed: 01/16/2023]
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Hiller CE, Refshauge KM, Nightingale EJ, Raymond J, Burns J, Kilbreath SL. Prevalence And Impact Of Chronic Musculoskeletal Ankle Problems. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000386386.37056.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Czerniec SA, Ward LC, Refshauge KM, Beith J, Lee MJ, York S, Kilbreath SL. Assessment of breast cancer-related arm lymphedema--comparison of physical measurement methods and self-report. Cancer Invest 2010; 28:54-62. [PMID: 19916749 DOI: 10.3109/07357900902918494] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine the relationship between physical methods of measuring lymphedema and self-reported swelling, their reliability, and standard error of measurement. METHOD Lymphedema in each arm of women with (n = 33) and without (n = 18) unilateral arm lymphedema, secondary to breast cancer was measured by self-report, bioimpedance spectroscopy (BIS), perometer, and the truncated cone method. RESULTS The physical measurement tools were highly reliable (ICC((2,1)): 0.94 to 1.00) with high concordance (r(c): 0.89 to 0.99). Self-report correlated moderately with physical measurements (r = 0.65 to 0.71) and was moderately reliable (ICC((2,1)): 0.70). CONCLUSIONS Lymphedema assessment methods are concordant and reliable but not interchangeable.
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Lee TS, Kilbreath SL, Sullivan G, Refshauge KM, Beith JM. Patient Perceptions of Arm Care and Exercise Advice After Breast Cancer Surgery. Oncol Nurs Forum 2009; 37:85-91. [DOI: 10.1188/10.onf.85-91] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Costa LDCM, Maher CG, McAuley JH, Hancock MJ, Herbert RD, Refshauge KM, Henschke N. Prognosis for patients with chronic low back pain: inception cohort study. BMJ 2009; 339:b3829. [PMID: 19808766 PMCID: PMC2758336 DOI: 10.1136/bmj.b3829] [Citation(s) in RCA: 260] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2009] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To describe the course of chronic low back pain in an inception cohort and to identify prognostic markers at the onset of chronicity. DESIGN Inception cohort study with one year follow-up. SETTING Primary care clinics in Sydney, Australia. PARTICIPANTS The study sample was a subcohort of an inception cohort of 973 consecutive patients presenting to primary care with acute low back pain (<2 weeks' duration). 406 participants whose pain persisted for three months formed the inception cohort of patients with chronic low back pain. MAIN OUTCOME MEASURES Outcomes and putative predictors measured at initial presentation, onset of chronicity (study entry), and follow-up at nine and 12 months. Recovery was determined from measures of pain intensity, disability, and work status. The association between potential prognostic factors and time to recovery was modelled with Cox regression. RESULTS Completeness of follow-up was 97% of total person time for all outcomes. The cumulative probability of being pain-free was 35% at nine months and 42% at 12 months and for complete recovery was 35% at nine months and 41% at 12 months. Of the 259 participants who had not recovered from pain related disability at entry to the chronic study, 47% had recovered by 12 months. Previous sick leave due to low back pain, high disability levels or high pain intensity at onset of chronicity, low levels of education, greater perceived risk of persistent pain, and being born outside Australia were associated with delayed recovery. CONCLUSION More than one third of patients with recent onset, non-radicular chronic low back pain recover within 12 months. The prognosis is less favourable for those who have taken previous sick leave for low back pain, have high disability levels or high pain intensity at onset of chronic low back pain, have lower education, perceive themselves as having a high risk of persistent pain, and were born outside Australia.
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Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A, McAuley JH. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. ACTA ACUST UNITED AC 2009; 60:3072-80. [PMID: 19790051 DOI: 10.1002/art.24853] [Citation(s) in RCA: 252] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lin CWC, Moseley AM, Refshauge KM. Effects of rehabilitation after ankle fracture: a Cochrane systematic review. Eur J Phys Rehabil Med 2009; 45:431-441. [PMID: 19078904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Ankle fracture is one of the most common lower limb fractures. People experience limitations in activities after ankle fracture. OBJECTIVES The aim of this review was to evaluate the effects of rehabilitation interventions after ankle fracture in adults. METHODS Electronic databases, reference lists of included studies and relevant systematic reviews, and clinical trials registers were searched for randomised and quasi-randomised controlled trials with adults undergoing any interventions for rehabilitation after ankle fracture. The primary outcomes were activity limitation and adverse events. Two reviewers independently screened search results, assessed methodological quality, and extracted data. RESULTS Thirty-one studies were included. Clinical and statistical heterogeneity, or the low number of studies in the comparison, prevented meta-analyses in most instances. After surgical fixation, commencing exercise in a removable brace or splint significantly improved activity limitation but also led to a higher rate of adverse events (relative risk 2.61, 95% CI 1.72 to 3.97). Most other rehabilitation interventions did not show an effect in improving activity limitation. CONCLUSIONS There is limited evidence supporting the use of a removable type of immobilisation and exercise during the immobilisation period for improving activity limitation. Because of the potential increased risk, the patient's ability to comply with this treatment regimen is essential. More clinical trials that are well-designed and adequately-powered are required to strengthen current evidence.
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de Noronha M, Refshauge KM, Kilbreath SL, Figueiredo VG. Cross-cultural adaptation of the Brazilian-Portuguese version of the Cumberland Ankle Instability Tool (CAIT). Disabil Rehabil 2009; 30:1959-65. [DOI: 10.1080/09638280701809872] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lee TS, Kilbreath SL, Sullivan G, Refshauge KM, Beith JM, Harris LM. Factors That Affect Intention to Avoid Strenuous Arm Activity After Breast Cancer Surgery. Oncol Nurs Forum 2009; 36:454-62. [DOI: 10.1188/09.onf.454-462] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Merchant CR, Chapman T, Kilbreath SL, Refshauge KM, Krupa K. Decreased muscle strength following management of breast cancer. Disabil Rehabil 2009; 30:1098-105. [PMID: 19230221 DOI: 10.1080/09638280701478512] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess whether muscle strength, power and endurance at the affected shoulder were reduced in women treated for breast cancer. Secondly, we assessed whether muscle performance was explained by management or other symptoms. METHODS Participants were 40 women (mean +/- SD: 56.7 +/- 11.6 yr) who had completed all treatments for breast cancer at least 6 m previously. We measured dynamic concentric strength at one repetition maximum (1RM), endurance at 90% 1RM, and power through a range of 40-100% 1RM for shoulder protractors, extensors and retractors. Strength and endurance, but not power, were measured for shoulder flexors. Additionally, maximal grip strength, passive shoulder range of motion and arm circumference were measured. Self-reported symptoms were recorded using a questionnaire. RESULTS Shoulder protractors (p = 0.011), retractors (p = 0.007), and extensors (p = 0.009), but not flexors, were significantly weaker on the affected side compared to the unaffected side. Muscle power and endurance at the shoulder and grip strength were not impaired. Inter-limb differences in muscle strength were not explained by the surgical and medical management of the cancer. Self-reported weakness correlated poorly with our measures of muscle strength. CONCLUSIONS Long-term weakness occurs about the shoulder secondary to treatment for breast cancer. Strategies to prevent weakness need to be considered.
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Refshauge KM, Raymond J, Kilbreath SL, Pengel L, Heijnen I. The effect of ankle taping on detection of inversion-eversion movements in participants with recurrent ankle sprain. Am J Sports Med 2009; 37:371-5. [PMID: 18927252 DOI: 10.1177/0363546508324309] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Taping is often used to counter the proprioceptive deficit after joint injury such as ankle sprain. However, the effect of taping on proprioceptive acuity at the ankle is unclear, with conflicting findings. HYPOTHESIS Application of tape improves detection of inversion and eversion movements at the ankle. STUDY DESIGN Controlled laboratory study. METHODS The 70% threshold for movement detection was measured in 16 participants with recurrent ankle sprain under 2 conditions: with the ankle taped or untaped. The threshold for movement detection was examined at 3 velocities (0.1 deg/s, 0.5 deg/s, and 2.5 deg/s) and in 2 directions (inversion and eversion). RESULTS Application of tape significantly decreased the ability to detect movements at the ankle (P < .023). For example, at 0.5 deg/s, the 70% detection threshold was 3.40 degrees +/- 1.05 degrees in inversion and 3.49 degrees +/- 1.15 degrees in eversion at the untaped ankle, and 4.02 degrees +/- 0.86 degrees in inversion and 4.04 degrees +/- 0.89 degrees in eversion at the taped ankle. CONCLUSION Taping the ankle decreased the ability to detect movement in the inversion-eversion plane in participants with recurrent ankle sprain. CLINICAL RELEVANCE The findings suggest that the efficacy of taping is unlikely to be explained by an enhanced ability to detect inversion or eversion movements. However, because it has been found effective in reducing the incidence of ankle sprain, clinicians should continue taping to reduce the likelihood of resprain.
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Abstract
BACKGROUND Rehabilitation after ankle fracture can begin soon after the fracture has been treated by the use of different types of immobilisation which allow early commencement of weight-bearing or exercise. Alternatively, rehabilitation may start following the period of immobilisation, with physical or manual therapies. OBJECTIVES To compare the effectiveness of rehabilitation interventions following ankle fracture in adults. SEARCH STRATEGY We searched two Specialised Registers of The Cochrane Collaboration, electronic databases (including MEDLINE, EMBASE and CINAHL), reference lists of included studies and relevant systematic reviews, and clinical trials registers to September 2007. SELECTION CRITERIA Randomised and quasi-randomised controlled trials with adults undergoing any interventions for rehabilitation after ankle fracture were considered. The primary outcome was activity limitation. Secondary outcomes included impairments and adverse events. DATA COLLECTION AND ANALYSIS Two reviewers independently screened search results, assessed methodological quality, and extracted data. Relative risk and 95% confidence intervals (95% CI) were calculated for dichotomous variables, and weighted or standardised mean difference and 95% CI were calculated for continuous variables. A meta-analysis was performed where appropriate. MAIN RESULTS Thirty-one studies were included. Clinical and statistical heterogeneity prevented meta-analyses in most instances. After surgical fixation, commencing exercise in a removable brace or splint significantly improved activity limitation, pain and ankle range of motion, but also led to a higher rate of adverse events. Early commencement of weight-bearing during the immobilisation period improved ankle range of motion after surgical fixation. Where it was possible to avoid ankle range of motion after surgical fixation, the use of no immobilisation compared to cast immobilisation also improved ankle range of motion. After the immobilisation period, manual therapy was beneficial in increasing ankle range of motion. There was no evidence of effect for electrotherapy, hypnosis, or stretching. AUTHORS' CONCLUSIONS There is limited evidence supporting the use of a removable type of immobilisation and exercise during the immobilisation period, early commencement of weight-bearing during the immobilisation period, and no immobilisation after surgical fixation of ankle fracture. There is also limited evidence for manual therapy after the immobilisation period. Because of the potential increased risk, the patient's ability to comply with the use of a removable type of immobilisation and exercise is essential. More clinical trials that are well-designed and adequately-powered are required to strengthen current evidence.
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