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Kondo Y, Ariake Y, Suzuki I, Kato T, Furukawa K, Bando K, Nakashiba A, Watabe T, Miyazaki Y, Mukai Y, Hara T, Takahashi Y. Two-minute standing endurance test for axial postural abnormalities in patients with Parkinson's disease. Gait Posture 2024; 112:81-87. [PMID: 38749293 DOI: 10.1016/j.gaitpost.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/06/2024] [Accepted: 05/01/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Photo-based measurement methods are used to assess axial postural abnormalities (PA) in Parkinson's disease (PD). However, they capture only moments in time. We developed the 2-minute standing endurance test (2 M-SET), which specifically captures temporal changes in posture, as a novel dynamic method for measuring axial PA in patients with PD. RESEARCH QUESTION This study aimed to verify the effectiveness and validity of the 2 M-SET for capturing temporal changes in axial PA in patients with PD. METHODS Twenty-eight patients with PD participated. The participants attempted to maintain an upright posture for 2 minutes during three tasks: standing, stepping in place, and walking. The rate of change in postural angle was recorded at 10-second intervals. Based on the results, the 2 M-SET was developed. Therapists evaluated the 2 M-SET using the NeuroPostureApp© to measure anterior trunk flexion (ATF) angles and lateral trunk flexion (LTF) angles at 0, 10, 30, 60, and 120 seconds. To assess reliability, the congruence between the measurements obtained by the therapists and those obtained using a three-dimensional motion-analysis system was examined. For validity, we assessed whether the ATF and LTF angles measured by the therapists could accurately capture postural changes at regular intervals over time. RESULTS The average postural changes over 2 minutes for the standing, stepping in place, and gait tasks were 59.2±83.5%, 37.6±30.7%, and 45.4±50.6%, respectively. The intraclass correlation coefficients showed high reliability, with values of 0.985 and 0.970 for the ATF and LTF angles, respectively. SIGNIFICANCE The results of our proposed 2 M-SET method, which uses temporal photo-based measurements to assess the patient's ability to maintain an upright standing position for 2 minutes, demonstrate the potential to capture temporal changes in axial PA. DATA AVAILABILITY STATEMENT The data supporting the findings of this study are available upon reasonable request and approval from the local ethics committee.
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Affiliation(s)
- Yuki Kondo
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Yosuke Ariake
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ippei Suzuki
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Taro Kato
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kota Furukawa
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kyota Bando
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Atsushi Nakashiba
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takuya Watabe
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuta Miyazaki
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yohei Mukai
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takatoshi Hara
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
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Highsmith MJ, Miro RM, Kartel M, Ramrattan A, Courtade A, Heckman JT, Phillips SL, Wurdeman SR, DiBello TV, England DL, Stevens PM, Campbell JH, Hyre MJ, Maikos JT, Hill OT, Carey SL. Functional and perceptive differences between conventional and advanced ankle foot orthoses in community ambulators post-limb trauma: the injuries managed with advanced bracing of the lower extremity (IM ABLE) study. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1277509. [PMID: 39011087 PMCID: PMC11246986 DOI: 10.3389/fresc.2024.1277509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/15/2024] [Indexed: 07/17/2024]
Abstract
Introduction Many military service members and civilians suffer from lower extremity trauma. Despite recent advancements in lower limb bracing technology, it remains unclear whether these newer advanced braces offer improved comfort and functionality compared to conventional options. The IDEO (Intrepid Dynamic Exoskeletal Orthosis), a type of "advanced" orthosis was developed to assist in maintaining high functional performance in patients who have experienced high-energy lower extremity trauma and underwent limb salvage surgeries. Methods A cross-sector multi-site initiative was completed to study the efficacy of advanced ankle foot orthoses (AFO) for lower limb trauma and injury compared to a conventional AFO. Following fitting, training, and accommodation, the subjects were assessed in each AFO system for mobility, self-reported function, safety and pain, and preference. Results They preferred the advanced over the conventional AFO and the mobility and exertion perception improved with the advanced AFO with no difference in pain or overall health status scores. Discussion Thus, an advanced AFO is an option for trauma affecting the lower limb. Long-term studies are required to better understand the accommodation and learning process of using an advanced AFO.
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Affiliation(s)
- M. Jason Highsmith
- School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Orthotic, Prosthetic & Pedorthic Clinical Services (OPPCS) Program Office, Rehabilitation & Prosthetic Services, (12RPS4) US Department of Veterans Affairs, Washington, DC, United States
| | - Rebecca M. Miro
- School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Michael Kartel
- Orthotic, Prosthetic & Pedorthic Clinical Services (OPPCS), Physical Medicine & Rehabilitation, James A. Haley Veterans' Hospital, US Department of Veterans Affairs, Tampa, FL, United States
| | - Anita Ramrattan
- Research and Development Services, James A. Haley Veterans' Hospital, US Department of Veterans Affairs, Tampa, FL, United States
| | - Angela Courtade
- Southeastern Regional Amputation System of Care, (ASoC) Physical Medicine & Rehabilitation, James A. Haley Veterans' Hospital, US Department of Veterans Affairs, Tampa, FL, United States
| | - Jeffrey T. Heckman
- Southeastern Regional Amputation System of Care, (ASoC) Physical Medicine & Rehabilitation, James A. Haley Veterans' Hospital, US Department of Veterans Affairs, Tampa, FL, United States
- Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Samuel L. Phillips
- Research and Development Services, James A. Haley Veterans' Hospital, US Department of Veterans Affairs, Tampa, FL, United States
| | - Shane R. Wurdeman
- Hanger Institute for Clinical Research and Education, Austin, TX, United States
| | - Thomas V. DiBello
- Hanger Institute for Clinical Research and Education, Austin, TX, United States
| | - Dwiesha L. England
- Hanger Institute for Clinical Research and Education, Austin, TX, United States
| | - Phillip M. Stevens
- Hanger Institute for Clinical Research and Education, Austin, TX, United States
| | - James H. Campbell
- Hanger Institute for Clinical Research and Education, Austin, TX, United States
| | - Michael J. Hyre
- Narrows Institute for Biomedical Research and Education, New York, NY, United States
| | - Jason T. Maikos
- Prosthetics and Sensory Aids Services, (PSAS) New York Harbor Healthcare System, US Department of Veterans Affairs, New York, NY, United States
| | - Owen T. Hill
- School of Health Professions, College of Medicine, Health Science Center, University of Texas, San Antonio, TX, United States
| | - Stephanie L. Carey
- Department of Mechanical Engineering, College of Engineering, University of South Florida, Tampa, FL, United States
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Kho ME, Berney S, Pastva AM, Kelly L, Reid JC, Burns KEA, Seely AJ, D'Aragon F, Rochwerg B, Ball I, Fox-Robichaud AE, Karachi T, Lamontagne F, Archambault PM, Tsang JL, Duan EH, Muscedere J, Verceles AC, Serri K, English SW, Reeve BK, Mehta S, Rudkowski JC, Heels-Ansdell D, O'Grady HK, Strong G, Obrovac K, Ajami D, Camposilvan L, Tarride JE, Thabane L, Herridge MS, Cook DJ. Early In-Bed Cycle Ergometry in Mechanically Ventilated Patients. NEJM EVIDENCE 2024; 3:EVIDoa2400137. [PMID: 38865147 DOI: 10.1056/evidoa2400137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
BACKGROUND Critical illness requiring invasive mechanical ventilation can precipitate important functional disability, contributing to multidimensional morbidity following admission to an intensive care unit (ICU). Early in-bed cycle ergometry added to usual physiotherapy may mitigate ICU-acquired physical function impairment. METHODS We randomly assigned 360 adult ICU patients undergoing invasive mechanical ventilation to receive 30 minutes of early in-bed Cycling + Usual physiotherapy (n=178) or Usual physiotherapy alone (n=182). The primary outcome was the Physical Function ICU Test-scored (PFIT-s) at 3 days after discharge from the ICU (the score ranges from 0 to 10, with higher scores indicating better function). RESULTS Cycling began within a median (interquartile range) of 2 (1 to 3) days of starting mechanical ventilation; patients received 3 (2 to 5) cycling sessions for a mean (±standard deviation) of 27.2 ± 6.6 minutes. In both groups, patients started Usual physiotherapy within 2 (2 to 4) days of mechanical ventilation and received 4 (2 to 7) Usual physiotherapy sessions. The duration of Usual physiotherapy was 23.7 ± 15.1 minutes in the Cycling + Usual physiotherapy group and 29.1 ± 13.2 minutes in the Usual physiotherapy group. No serious adverse events occurred in either group. Among survivors, the PFIT-s at 3 days after discharge from the ICU was 7.7 ± 1.7 in the Cycling + Usual physiotherapy group and 7.5 ± 1.7 in the Usual physiotherapy group (absolute difference, 0.23 points; 95% confidence interval, -0.19 to 0.65; P=0.29). CONCLUSIONS Among adults receiving mechanical ventilation in the ICU, adding early in-bed Cycling to usual physiotherapy did not improve physical function at 3 days after discharge from the ICU compared with Usual physiotherapy alone. Cycling did not cause any serious adverse events. (Funded by the Canadian Institutes of Health Research and others; ClinicalTrials.gov numbers, NCT03471247 [full randomized clinical trial] and NCT02377830 [CYCLE Vanguard 46-patient internal pilot].).
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Affiliation(s)
- Michelle E Kho
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Susan Berney
- Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, VIC, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
| | - Amy M Pastva
- Department of Orthopedic Surgery, Physical Therapy Division, Duke University School of Medicine, Durham, NC
| | - Laurel Kelly
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Julie C Reid
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care, University of Toronto, Toronto
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto-St. Michael's Hospital, Toronto
| | - Andrew J Seely
- Department of Surgery, University of Ottawa, Ottawa
- Critical Care Medicine, Ottawa Hospital Research Institute, Ottawa
| | - Frédérick D'Aragon
- Department of Anesthesiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Bram Rochwerg
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ian Ball
- Department of Medicine, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Alison E Fox-Robichaud
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Tim Karachi
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Francois Lamontagne
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Département de Médecine, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Patrick M Archambault
- Centre de Recherche Intégrée pour un Système Apprenant en Santé et Services Sociaux, Centre Intégré de Santé et Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
| | - Jennifer L Tsang
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Niagara Health Knowledge Institute, Niagara Health, St. Catharines, ON, Canada
| | - Erick H Duan
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - John Muscedere
- Queen's University, Kingston, ON, Canada
- Department of Critical Care Medicine, Kingston, ON, Canada
| | - Avelino C Verceles
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Maryland, Baltimore
| | - Karim Serri
- Critical Care Division, Department of Medicine, Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal, Hôpital Sacré-Coeur de Montréal, Faculté de Médecine, Université de Montréal, Montreal
| | - Shane W English
- Department of Medicine (Critical Care), University of Ottawa, Ottawa
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa
| | - Brenda K Reeve
- Department of Medicine, Brantford General Hospital, Brantford, ON, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto
- Department of Medicine, Sinai Health System, Toronto
| | - Jill C Rudkowski
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Heather K O'Grady
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Geoff Strong
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kristy Obrovac
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Daana Ajami
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Laura Camposilvan
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Research Institute of St. Joe's, Hamilton, ON, Canada
| | - Margaret S Herridge
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto
| | - Deborah J Cook
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Bergmann J, Egger M, Müller F, Jahn K. Outcome, predictors and longitudinal trajectories of subjects with critical illness polyneuropathy and myopathy (CINAMOPS): study protocol of an observational cohort study in a clinical and post-clinical setting. BMJ Open 2024; 14:e083553. [PMID: 38670603 PMCID: PMC11057271 DOI: 10.1136/bmjopen-2023-083553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Critical illness polyneuropathy and myopathy (CIP/CIM) are frequent complications in the intensive care unit (ICU) with major consequences for the progress and outcome of subjects. CIP/CIM delays the weaning process, prolongs the hospital stay and increases the mortality rate. Additionally, it may have long-term consequences beyond the hospitalisation phase with prolonged disability. Even though there is growing interest in CIP/CIM, research about the clinical and post-clinical course as well as the middle-term and long-term outcomes of subjects with CIP/CIM is scarce. A large prospective study of critically ill subjects is needed with accurate diagnosis during the acute stage and comprehensive assessment during long-term follow-up. METHODS AND ANALYSIS This prospective observational cohort study aims to compare the clinical and post-clinical course of chronically critically ill subjects with and without the diagnosis of CIP/CIM and to determine predictors for the middle-term and long-term outcomes of subjects with CIP/CIM. In addition, the influence of the preclinical health status and the preclinical frailty on the long-term outcome of subjects with CIP/CIM will be investigated.This single-centre study will include 250 critically ill patients who were invasively ventilated for at least 5 days at the ICU and show reduced motor strength. At five study visits at admission and discharge to neurological rehabilitation, and 12, 18 and 24 months after disease onset, a comprehensive test battery will be applied including assessments of functioning and impairment, independence, health-related quality of life, activity and participation, cognition, gait and balance, fatigue, mental health and frailty.Secondary objectives are the documentation of therapy goals, therapy content and achieved milestones during the rehabilitation, to evaluate the clinimetric properties of the Mini-BESTest in critically ill patients, and to evaluate the time course and outcome of subjects with CIP/CIM after SARS-CoV-2 infection. ETHICS AND DISSEMINATION The study was approved by the ethical committee of the Ludwig-Maximilians University Munich. Participants will be included in the study after having signed informed consent.Results will be published in scientific, peer-reviewed journals and at national and international conferences. TRIAL REGISTRATION NUMBER German Clinical Trial Register (DRKS00021753).
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Affiliation(s)
- Jeannine Bergmann
- Department of Neurology, Schoen Clinic Bad Aibling Harthausen, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marion Egger
- Department of Neurology, Schoen Clinic Bad Aibling Harthausen, Bad Aibling, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Friedemann Müller
- Department of Neurology, Schoen Clinic Bad Aibling Harthausen, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Klaus Jahn
- Department of Neurology, Schoen Clinic Bad Aibling Harthausen, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität München, Munich, Germany
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Feyzioğlu Ö, Dinçer S, Özdemir AE, Öztürk Ö. Physical performance tests have excellent reliability in frail and non-frail patients with prostate cancer. Disabil Rehabil 2024:1-8. [PMID: 38613370 DOI: 10.1080/09638288.2024.2340703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE Our aim was to investigate the test-retest reliability of the 2-min walk test (2MWT), timed up and go test (TUG), and five times sit-to-stand test (FTSST) in prostate cancer (PC) patients. METHODS This study was conducted with 73 patients who were classified into two groups as frail and non-frail determined by the Geriatric-8 questionnaire. Patients performed the 2MWT, TUG, and FTSST tests for two times. The test-retest reliability of the 2MWT, TUG, and FTSST was assessed by calculating the intraclass correlation coefficient (ICC). The standard error of measurement (SEM95) and minimal detectable change (MDC95) values were calculated. RESULTS All tests showed excellent test-retest reliability for both groups (ICC(2.1) > 0.90). The SEM95 and MDC95 values of 2MWT were 3.09, 8.57, and 3.15 m, 8.73 m for frail and non-frail groups. The SEM95 and MDC95 values of TUG for the frail group were 0.6 and 1.66 and 0.43 and 1.19 for the non-frail group, respectively. The SEM95 and MDC95 values of FTST for the frail group were 0.68 and 1.88 and for the non-frail group 0.86 and 2.38. CONCLUSIONS The 2MWT, TUG, and FTSST showed excellent reliability in frail and non-frail older adults with PC which can be used to assess physical performance.
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Affiliation(s)
- Özlem Feyzioğlu
- Department of Physiotherapy and Rehabilitation, Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Istanbul, Turkey
| | - Selvi Dinçer
- Department of Radiation Oncology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Ayşem Ecem Özdemir
- Department of Physiotherapy and Rehabilitation, Gelisim University, Faculty of Health Sciences, Istanbul, Turkey
| | - Özgül Öztürk
- Department of Physiotherapy and Rehabilitation, Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Istanbul, Turkey
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Hansen A, Nim CG, O'Sullivan K, O'Neill S. Testing walking performance in patients with low back pain: will two minutes do instead of six minutes? Disabil Rehabil 2024; 46:1173-1177. [PMID: 37026438 DOI: 10.1080/09638288.2023.2194683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/18/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE The six-minute walk test (6MWT) can assess walking function but is time-consuming. We investigate the correlation of performance over the first two minutes of the 6MWT (2MWT#) and the 6MWT. We also evaluate the 2MWT#'s ability to predict 6MWT results, assess correlations to secondary explanatory outcomes, and assess the ability to discriminate between clinical subgroups. MATERIAL AND METHODS A cross-sectional study of 124 participants with LBP. Correlations between the 2MWT# and 6MWT and secondary outcomes were evaluated using the Pearson product-moment correlation coefficient. The predictive ability of the 2MWT# was defined as the residual distance between the observed 6MWT and three times the 2MWT#. Differences between clinical subgroups were evaluated using the Wilcoxon rank test. RESULTS The 2MWT# and 6MWT correlated highly (r = 83, 95% CI 0.76 - 0.87). The 2MWT# overestimated 6MWT results with 46.8 meters (SD 67.0). Both tests correlated with secondary outcomes and discriminated similarly between clinical subgroups. CONCLUSIONS The 2MWT# correlates highly with 6MWT but overestimates the observed 6MWT by 9%. Because it is shorter, possibly less burdensome, and with little or no loss of discriminatory ability, we consider it a legitimate alternative to the 6MWT in patients with LBP.Implications for rehabilitationWalking function is often affected in patients with low back pain (LBP).The six-minute walk test (6MWT) is frequently used to assess walking function but is time-consuming.A shorter two-minute walk test is a legitimate alternative in patients with LBP as it correlates highly with the 6MWT and has little or no loss of discriminatory ability between clinical subgroups.
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Affiliation(s)
- Anders Hansen
- Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Casper Glissmann Nim
- Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Sports Science and Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Sports and Human Performance Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Søren O'Neill
- Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Cristina da Silva L, Danielli Coelho de Moraes Faria C, da Cruz Peniche P, Ayessa Ferreira de Brito S, Tavares Aguiar L. Validity of the two-minute walk test to assess exercise capacity and estimate cardiorespiratory fitness in individuals after stroke: a cross-sectional study. Top Stroke Rehabil 2024; 31:125-134. [PMID: 37243679 DOI: 10.1080/10749357.2023.2217639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the construct validity of the 2-minute walk test (2MWT) to assess the exercise capacity and the criterion-concurrent validity of the 2MWT and the 6-minute walk test (6MWT) to estimate the cardiorespiratory fitness of ambulatory individuals with chronic stroke. In addition, to provide an equation to predict the distance covered in the 6MWT and another to predict the peak oxygen consumption (VO2peak) for these individuals. METHODS This is a cross-sectional and prospective study. A convenience sample with 57 individuals with chronic stroke was recruited. The 2MWT, the 6MWT and the cardiopulmonary exercise test (CPET) were performed in a laboratory. The Spearman's correlation coefficient was used to investigate the validity. To develop the equations, stepwise multiple linear regression analysis was used. RESULTS A significant correlation of very high magnitude between the distance covered in the 2MWT and the 6MWT was found (rs = 0.93; p < 0.001). A significant correlation of moderate magnitude between the distance covered in the 2MWT and the VO2peak (rs = 0.53; p < 0.001) similar to the correlation between the 6MWT and the VO2peak (rs = 0.55; p < 0,001) were found. Furthermore, an equation was developed to predict the VO2peak (R2 = 0.690; p < 0.001; VO2peak = 13.532 + 0.078*distance walked in the 2MWT +4.509*sex-0.172*age), and another to predict the distance covered in the 6MWT (R2 = 0.827; p < 0.001; MWT = -1.867 + 3.008*distance walked in the 2MWT). CONCLUSION 2MWT showed adequate construct and concurrent validity. Furthermore, it is possible to use the prediction equations developed to estimate the VO2peak or the distance covered in the 6MWT.
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Affiliation(s)
| | | | - Paula da Cruz Peniche
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Larissa Tavares Aguiar
- Department of Physiotherapy, Universidade Federal de Minas Gerais; Faculdade Ciências Médicas de Minas Gerais (FCM-MG), Belo Horizonte, Brazil
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Kanetzke NA, Westerdahl JE, Cho CC, Durham AN, Moerchen VA. Feasibility of a Child-Friendly 2-Minute Walk Test: A Crossover Randomized Controlled Trial. Phys Occup Ther Pediatr 2024; 44:526-541. [PMID: 38247299 DOI: 10.1080/01942638.2024.2304765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024]
Abstract
AIMS Most studies that use the NIH Toolbox 2-Minute Walk Test with young children, modify the protocol, compromising the generalizability of outcomes. A standardizable protocol is needed. The purpose of this study was to compare the 2MWT performance of children ages 3-6 years on the standard NIH Toolbox protocol and on a modified protocol designed to support young children. METHODS Cross-over randomized controlled trial. Fifteen typically developing children ages 3-6 years were randomly assigned to the performance order of the NIH toolbox 2MWT protocol and the Modified Accessibility Path (MAP) 2MWT protocol. Outcome variables and statistical analyses included test completion (McNemar test), distance walked (Wilcoxon signed-rank test), and accuracy (general estimating equation model with Poisson distribution). RESULTS All children completed 2 min of walking with the MAP protocol. Only 40% of children completed the NIH Toolbox protocol, with 83% of these NIH completers bolstered by previous exposure to the MAP protocol. Collapsed across the order, children also had significantly fewer errors per lap with the MAP protocol (p < 0.0001), despite walking a significantly greater distance (p = 0.006). CONCLUSIONS These findings lend preliminary support for standardized application of a 2MWT with young children when the protocol is designed to be child-friendly.
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Affiliation(s)
- Nicholas A Kanetzke
- College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jacqueline E Westerdahl
- College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Chris C Cho
- College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Adané N Durham
- College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Victoria A Moerchen
- College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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9
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Gacto-Sánchez M, Lozano-Meca JA, Lozano-Guadalajara JV, Montilla-Herrador J. Concurrent validity of the 2-and 6-minute walk test in knee osteoarthritis. Knee 2023; 43:34-41. [PMID: 37269795 DOI: 10.1016/j.knee.2023.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/14/2023] [Accepted: 05/11/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND The 6-Minute Walk Test (6MWT) is frequently used for the assessment of walking distances in several conditions, as knee osteoarthritis, but it can be both time-consuming for the researcher or clinician, and exhausting of painful for the subject suffering from this condition. The objective of our study was to analyze the concurrent validity of the 2-Minute Walk Test (2MWT) for patients with knee osteoarthritis compared to the 6-Minute Walk Test (6MWT). METHODS Cross-sectional validation study. Scores from the 6MWT of 42 ambulatory patients affected by knee osteoarthritis were compared to those from the shorter 2MWT. An initial correlation test was used to assess correlation between both measures, and a subsequent univariate regression analysis was performed with the aim of comparing the estimated outcomes of the 6MWT versus the actual 6MWT. RESULTS The scores from the 2MWT and 6MWT showed excellent correlation (Pearson's correlation coefficient r = 0.976; p-value < 0.001); the predictive equation based on the scores from the 2MWT (R2 = 0.952, p-value < 0.001) estimates the 6MWT scores with a relative error of 3.23%. CONCLUSIONS The 2MWT may be a practical assessment tool in replacement for the 6MWT in clinical assessment due to its low burden on patients and as a means of improving efficiency in a timely manner.
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Affiliation(s)
- Mariano Gacto-Sánchez
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.
| | - José Antonio Lozano-Meca
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.
| | | | - Joaquina Montilla-Herrador
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.
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10
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Kho ME, Reid J, Molloy AJ, Herridge MS, Seely AJ, Rudkowski JC, Buckingham L, Heels-Ansdell D, Karachi T, Fox-Robichaud A, Ball IM, Burns KEA, Pellizzari JR, Farley C, Berney S, Pastva AM, Rochwerg B, D'Aragon F, Lamontagne F, Duan EH, Tsang JLY, Archambault P, English SW, Muscedere J, Serri K, Tarride JE, Mehta S, Verceles AC, Reeve B, O'Grady H, Kelly L, Strong G, Hurd AH, Thabane L, Cook DJ. Critical Care C ycling to Improve Lower Extremity Strength (CYCLE): protocol for an international, multicentre randomised clinical trial of early in-bed cycling for mechanically ventilated patients. BMJ Open 2023; 13:e075685. [PMID: 37355270 PMCID: PMC10314658 DOI: 10.1136/bmjopen-2023-075685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/26/2023] Open
Abstract
INTRODUCTION In-bed leg cycling with critically ill patients is a promising intervention aimed at minimising immobility, thus improving physical function following intensive care unit (ICU) discharge. We previously completed a pilot randomised controlled trial (RCT) which supported the feasibility of a large RCT. In this report, we describe the protocol for an international, multicentre RCT to determine the effectiveness of early in-bed cycling versus routine physiotherapy (PT) in critically ill, mechanically ventilated adults. METHODS AND ANALYSIS We report a parallel group RCT of 360 patients in 17 medical-surgical ICUs and three countries. We include adults (≥18 years old), who could ambulate independently before their critical illness (with or without a gait aid), ≤4 days of invasive mechanical ventilation and ≤7 days ICU length of stay, and an expected additional 2-day ICU stay, and who do not fulfil any of the exclusion criteria. After obtaining informed consent, patients are randomised using a web-based, centralised system to either 30 min of in-bed cycling in addition to routine PT, 5 days per week, up to 28 days maximum, or routine PT alone. The primary outcome is the Physical Function ICU Test-scored (PFIT-s) at 3 days post-ICU discharge measured by assessors blinded to treatment allocation. Participants, ICU clinicians and research coordinators are not blinded to group assignment. Our sample size estimate was based on the identification of a 1-point mean difference in PFIT-s between groups. ETHICS AND DISSEMINATION Critical Care Cycling to improve Lower Extremity (CYCLE) is approved by the Research Ethics Boards of all participating centres and Clinical Trials Ontario (Project 1345). We will disseminate trial results through publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03471247 (Full RCT); NCT02377830 (CYCLE Vanguard 46 patient internal pilot).
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Affiliation(s)
- Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Physiotherapy, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Research Institute of St. Joe's, Hamilton, Ontario, Canada
| | - Julie Reid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alexander J Molloy
- Physiotherapy, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Research Institute of St. Joe's, Hamilton, Ontario, Canada
| | - Margaret S Herridge
- University Health Network, Toronto General Research Institute, Toronto, Ontario, Canada
| | - Andrew J Seely
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jill C Rudkowski
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Medicine, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Lisa Buckingham
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Diane Heels-Ansdell
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tim Karachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Ian M Ball
- Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Karen E A Burns
- Li Sha King Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, Unity Health Toronto, Toronto, Ontario, Canada
| | - Joseph R Pellizzari
- Consultation-Liaison Psychiatry Service, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Christopher Farley
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Sue Berney
- Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amy M Pastva
- Departments of Medicine and Orthopedic Surgery, Duke University, Durham, North Carolina, USA
| | - Bram Rochwerg
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Sherbrooke, Quebec, Canada
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Francois Lamontagne
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Erick H Duan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Medicine, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Division of Critical Care Medicine, Niagara Health System, St Catharines, Ontario, Canada
| | - Jennifer L Y Tsang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care Medicine, Niagara Health System, St Catharines, Ontario, Canada
| | - Patrick Archambault
- Anesthesiology and Intensive Care, Faculty of Medicine, Université Laval, Quebec, Québec, Canada
- Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Québec, Canada
| | - Shane W English
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Karim Serri
- Critical Care Division, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
| | - Jean-Eric Tarride
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Programs for the Assessment of Technology in Health, Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | - Avelino C Verceles
- Department of Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Brenda Reeve
- Medicine, Brantford General Hospital, Brantford, Ontario, Canada
| | - Heather O'Grady
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Laurel Kelly
- Physiotherapy, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Geoff Strong
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Abby H Hurd
- Physiotherapy, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Research Institute of St. Joe's, Hamilton, Ontario, Canada
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Research Institute of St. Joe's, Hamilton, Ontario, Canada
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Medicine, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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11
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Lo FMW, Wong EML, Ho KY. The effects of an integrated exercise and cardiovascular health education programme on community-dwelling older adults at risk of atherosclerotic cardiovascular diseases: A study protocol for a randomised controlled trial. PLoS One 2023; 18:e0286181. [PMID: 37224162 DOI: 10.1371/journal.pone.0286181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 05/01/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Although older adults are at an increased risk of atherosclerotic cardiovascular disease (ASCVD), the effect of an integrated exercise and cardiovascular health education programme based on self-efficacy theory has not been well investigated among older adults. This study aims at examining the effect of this programme on community-dwelling older adults at risk of ASCVD concerning physical activity level, exercise self-efficacy and ASCVD risk profile. METHODS A parallel two-arm randomised controlled trial with pretest-posttest design will be performed among 190 Chinese community-dwelling adults aged 60 or above in elderly community centres of the Guangdong-Hong Kong-Macao Greater Bay Area. Eligible participants will be randomised by computerised generation. Experimental group will receive a 12-week integrated exercise and cardiovascular health education programme, which comprises a one-hour group-based health education talk conducted at Week 1, a booklet, a lecture video, a tailor-made exercise video, and a booster intervention by text messaging starting from Week 1 to Week 12. Control group will receive placebo intervention including a talk on basic health issues, a lecture video and corresponding leaflet. The outcomes will be investigated through self-report questionnaires and physiological evaluations at baseline, Week 12, Week 24, and Week 36. Physical activity level, exercise self-efficacy and ASCVD risk profile will be assessed, with physical activity level at Week 24 considered the primary outcome. The main intervention effect (group differences on continuous outcome variables) will be examined via Generalized Estimating Equations with identity link. DISCUSSION This study findings will provide clues to the effect of the integrated exercise and cardiovascular health education programme, which is theoretically underpinned with self-efficacy theory, in older adults at risk of ASCVD. It will also enhance the quality of community health education by providing insight into the effective teaching strategies targeting older adults. TRIAL REGISTRATION This study has been registered on ChinicalTrial.gov (Trial ID: NCT05434273).
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Affiliation(s)
- Flora M W Lo
- Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Eliza M L Wong
- School of Nursing, Tung Wah College, Mongkok, Hong Kong SAR, China
| | - Ka Yan Ho
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
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12
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Muñoz-Bermejo L, González-Becerra MJ, Barrios-Fernández S, Postigo-Mota S, Jerez-Barroso MDR, Martínez JAF, Suárez-Lantarón B, Marín DM, Martín-Bermúdez N, Ortés-Gómez R, Gómez-Ullate-García de León M, Martínez-Acevedo M, Rocha-Gómez L, Espejo-Antúnez S, Fraile-Bravo M, Galán MGS, Chato-Gonzalo I, Muñoz FJD, Hernández-Mocholí MÁ, Madruga-Vicente M, Prado-Solano A, Mendoza-Muñoz M, Carlos-Vivas J, Pérez-Gómez J, Pastor-Cisneros R, Fuentes-Flores P, Pereira-Payo D, De Los Ríos-Calonge J, Urbano-Mairena J, Guerra-Bustamante J, Adsuar JC. Cost-Effectiveness of the Comprehensive Interdisciplinary Program-Care in Informal Caregivers of People with Alzheimer's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15243. [PMID: 36429962 PMCID: PMC9691117 DOI: 10.3390/ijerph192215243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 05/27/2023]
Abstract
People with Alzheimer's disease (AD) diagnosis who get informal care remain at home longer, reducing the demand for healthcare resources but increasing the stress of caregiving. Research on the effectiveness of physical training, psychoeducational, cognitive-behavioural, and health education programs in reducing the caregiver load and enhancing health-related quality of life (HRQoL) exist, but none exist about an integrated interdisciplinary program. The goals of this project are (1) to assess the Integral-CARE Interdisciplinary Program (IP) applicability, safety, effects on HRQoL, and the incremental cost-effectiveness ratio for AD caregivers; (2) to evaluate the IP applicability and cost-effectiveness to enhance the physical, psychoemotional, cognitive-behavioural dimensions, and the health education status of informal caregivers, and (3) to study the transference of the results to the public and private sectors. A randomized controlled trial will be conducted with an experimental (IP) and a control group (no intervention). The PI will be conducted over nine months using face-to-face sessions (twice a week) and virtual sessions on an online platform (once a week). There will be an initial, interim (every three months), and final assessment. Focus groups with social and health agents will be organized to determine the most important information to convey to the public and private sectors in Extremadura (Spain). Applicability, safety, HRQoL, incremental cost-effectiveness ratio, and HRQoL will be the main outcome measures, while secondary measures will include sociodemographic data; physical, psychoemotional, health education, and cognitive-behavioural domains; program adherence; and patient health status. Data will be examined per procedure and intention to treat. A cost-effectiveness study will also be performed from the viewpoints of private and public healthcare resources.
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Affiliation(s)
- Laura Muñoz-Bermejo
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | | | - Sabina Barrios-Fernández
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | - Salvador Postigo-Mota
- Department of Nursing, Faculty of Medicine, University of Extremadura, 06006 Badajoz, Spain
| | - María del Rocío Jerez-Barroso
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | - Juan Agustín Franco Martínez
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Belén Suárez-Lantarón
- Education Sciences Department, Faculty of Education, University of Extremadura, 06006 Badajoz, Spain
| | - Diego Muñoz Marín
- Department of Musical, Plastic and Corporal Expression, Faculty of Sport Sciences, University of Extremadura, Av. de la Universidad, s/n, 10003 Cáceres, Spain
| | - Nieves Martín-Bermúdez
- Department of Educational Sciences, Faculty of Education and Education and Psychology, University of Extremadura, 10003 Cáceres, Spain
| | - Raquel Ortés-Gómez
- Area Specialist in the Extremadura Health Service, Geriatrics Service of the Hospital Virgen del Puerto de Plasencia, 10600 Plasencia, Spain
| | - Martín Gómez-Ullate-García de León
- Department of Teaching of Musical, Plastic and Body Expression, Faculty of Teacher Training, University of Extremadura, 10004 Cáceres, Spain
| | | | - Lara Rocha-Gómez
- Gpex-Eshaex Superior School of Hotel Management and Agrotourism of Extremadura, 06800 Mérida, Spain
| | - Sara Espejo-Antúnez
- Department of Educational Sciences, Faculty of Teacher Training, University of Extremadura, 10004 Cáceres, Spain
| | - Mercedes Fraile-Bravo
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - María Gloria Solís Galán
- Department of Educational Sciences, Faculty of Teacher Training, University of Extremadura, 10004 Cáceres, Spain
| | - Ignacio Chato-Gonzalo
- Department of Social Sciences, Language and Literature Teaching, Faculty of Teacher Training, University of Extremadura, 10004 Cáceres, Spain
| | - Francisco Javier Domínguez Muñoz
- Physical Activity and Quality of Life (AFYCAV) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Miguel Ángel Hernández-Mocholí
- Physical Activity and Quality of Life (AFYCAV) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Miguel Madruga-Vicente
- Physical Activity and Quality of Life (AFYCAV) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Angelina Prado-Solano
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | - María Mendoza-Muñoz
- Physical and Health Literacy and Health-Related Quality of Life (PHYQOL) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Jorge Carlos-Vivas
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Jorge Pérez-Gómez
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Raquel Pastor-Cisneros
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | - Paulina Fuentes-Flores
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Damián Pereira-Payo
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Javier De Los Ríos-Calonge
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Javier Urbano-Mairena
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Joan Guerra-Bustamante
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - José Carmelo Adsuar
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
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Shieh V, Zampieri C, Sansare A, Collins J, Bulea TC, Jain M. Validation of Body-Worn Sensors for Gait Analysis During a 2-min Walk Test in Children. JOURNAL FOR THE MEASUREMENT OF PHYSICAL BEHAVIOUR 2022; 5:111-119. [PMID: 37538346 PMCID: PMC10398795 DOI: 10.1123/jmpb.2021-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Introduction Instrumented gait mat systems have been regarded as one of the gold standard methods for measuring spatiotemporal gait parameters. However, their portable walkways confine walking to a restricted area and limit the number of gait cycles collected. Wearable inertial sensors are a potential alternative that allow more natural walking behavior and have fewer space restrictions. The objective of this pilot study was to establish the concurrent validity of body-worn sensors against the portable walkway system in older children. Methods Twenty-one participants (10 males) 7-17 years old performed 2-min walk tests at a self-selected and fast pace in a 25-m-long hallway, while wearing three inertial sensors. Data collection were synchronized between devices and the portions of the walk when subjects passed on the walkway were used to compare gait speed, stride length, gait cycle duration, cadence, and double support time. Regression models and Bland-Altman analysis were completed to determine agreement between systems for the selected gait parameters. Results Gait speed, cadence, gait cycle duration, and stride length as measured by inertial sensors demonstrated strong agreement overall. Double support time was found to have lower validity due to a combined bias of age, height, weight, and walking pace. Conclusion These results support the validity of wearable inertial sensors in measuring gait speed, cadence, gait cycle duration, and stride length in children 7 years old and above during a 2-min walking test. Future studies are warranted with a broader age range to thoroughly represent the pediatric population.
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Affiliation(s)
- Vincent Shieh
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Cris Zampieri
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ashwini Sansare
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - John Collins
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Thomas C Bulea
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Minal Jain
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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14
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Variations in 2-Minute Walk Test outcomes for people with lower limb amputation in the outpatient clinic and research settings. Prosthet Orthot Int 2022; 46:140-147. [PMID: 35019885 DOI: 10.1097/pxr.0000000000000090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 11/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study determined the differences in 2-Minute Walk Test (2MWT) distances between people with lower limb amputations in clinical and research settings and described variations in test administration in various clinical settings. STUDY DESIGN Retrospective Cross-sectional design. METHODS The 2MWT for 290 patients with lower limb amputations were obtained from a medium-sized prosthetic company with locations within the central United States. Data on 12 prosthetists' 2MWT administration decisions were obtained from the results of an administrative questionnaire. Patient 2MWT distances were compared with published distances. Multiple regression was used to examine the impact of test settings on 2MWT outcomes. Descriptive statistics were used to present prosthetists' variations in test administration. RESULTS Clinical 2MWT distances were significantly less than distances obtained in a research setting. Clinical facilities reported inconsistent path dimensions and potential obstacles in proximity to the test area. Variations in test administration by prosthetists with respect to path length, instructions, turn marker, and overage measurement may contribute to the differences. CONCLUSIONS Prosthetists should be aware that comparisons of patients' 2MWT distance in a clinical environment may differ from published results. Although variations in clinical environments are usually nonmodifiable characteristics of the clinical facility, test administration and scoring could be modified.
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15
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Gassner L, Dabnichki P, Pokan R, Schmoeger M, Willinger U, Maetzler W, Moser H, Zach H. Therapeutic climbing in Parkinson’s disease: Differences in self-reported health and well-being, feasibility and clinical changes. Physiother Theory Pract 2022; 39:1163-1177. [DOI: 10.1080/09593985.2022.2036279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lucia Gassner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- School of Engineering, RMIT University, VIC Australia
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, Vienna, Austria
| | | | - Rochus Pokan
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, Vienna, Austria
| | | | - Ulrike Willinger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Hermann Moser
- Therapy Center Gmundnerberg, Altmünster Am Traunsee, Austria
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Heidemarie Zach
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Hiser S, Urbanek J, Young DL, McLaughlin KH, Colantuoni E, Brotman DJ, Needham DM, Hoyer E. Improving patient selection for use of consumer grade physical activity monitors in the hospital. Braz J Phys Ther 2022; 26:100447. [PMID: 36183578 PMCID: PMC9530475 DOI: 10.1016/j.bjpt.2022.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 09/08/2022] [Accepted: 09/15/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Bedrest is toxic for inpatients and consumer grade physical activity monitors offer an economical solution to monitor patient ambulation. But these devices may not be accurate in debilitated hospitalized patients who frequently ambulate very slowly. OBJECTIVE To determine whether measures of physical capacity can help identify inpatients for whom wearable physical activity monitors may accurately measure step count. METHODS Prospective observational study of 54 adult inpatients with acute neurological diagnoses. Patients were assessed using 2 physical capacity assessments (Activity Measure for Post-Acute Care Inpatient Mobility Short Form [AM-PAC IMSF] and Katz Activities of Daily Living [ADL] scale). They also completed a 2-minute walk test (2MWT) wearing a consumer grade physical activity monitor. RESULTS The wearable activity monitor recorded steps (initiated) in 33 (61%) of the inpatients, and for 94% of inpatients with gait speeds >0.43 m/s. Physical capacity assessments correlated well with gait speed, AM-PAC IMSF r = 0.7, and Katz ADL r = 0.6, p < 0.05. When the physical activity monitor initiated, the mean absolute percent error (SD) comparing device calculated steps to observed steps, was 10% (13). AM-PAC IMSF (T-score >45) and Katz ADL (>5) cutoff scores identified inpatients for whom physical activity monitors initiated with a sensitivity of 94 and 91%, respectively. CONCLUSIONS Physical capacity assessments, such as AM-PAC, and Katz ADL, may be a useful and feasible screening strategy to help identify inpatients where wearable physical activity monitors can measure their mobility.
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Affiliation(s)
- Stephanie Hiser
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacek Urbanek
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel L. Young
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Kevin H. McLaughlin
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel J Brotman
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dale M. Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erik Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Gailey RS, Gaunaurd I, Morgan SJ, Kristal A, Balkman GS, Newton EM, Palomo JJ, Shay KM, Salem R, Hafner BJ. A Comparison of the Two-Minute Walk Test and Comprehensive High-level Activity Mobility Predictor (CHAMP) in People with a Leg Prosthesis. Clin Rehabil 2021; 36:703-712. [PMID: 34930042 DOI: 10.1177/02692155211069323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine if the two-minute walk test (2MWT) could serve as an alternative measure of high-level mobility in lower limb prosthesis users when circumstances preclude administration of the Comprehensive High-level Activity Mobility Predictor (CHAMP). DESIGN Cross-sectional study. SETTING Indoor recreational athletic field and gymnasium. SUBJECTS Fifty-eight adult lower limb prosthesis users with unilateral or bilateral lower limb amputation who participate in recreational athletic activities. INTERVENTION N/A. MAIN MEASURES The 2MWT and CHAMP while using their preferred prosthesis(es) on an indoor artificial athletic field or hardwood gymnasium floor. RESULTS Thirty-nine men and nineteen women with a median age of 38.3 years participated in the study. Most participants experienced amputation(s) due to trauma (62%) or tumor (10%) and were generally higher functioning (K4 (91.4%) and K3 (8.6%)). The median (range) score for the CHAMP was 23.0 points (1.5-33.5) and the mean ± standard deviation (range) 2MWT distance walked was 188.6 ± 33.9 m (100.2-254.3 m). The CHAMP demonstrated a strong positive relationship with 2MWT (r = 0.83, p < 0.001). The 2MWT distance predicted 70% of the variance in CHAMP score. CONCLUSIONS Although the 2MWT does not test multi-directional agility like the CHAMP, they were found to be highly correlated. If space is limited, the two-minute walk test can serve as an alternative measure for assessing high-level mobility capabilities in lower limb prosthesis users.
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Affiliation(s)
- Robert S Gailey
- Department of Physical Therapy, 12235University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Ignacio Gaunaurd
- Department of Physical Therapy, 12235University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Sara J Morgan
- Department of Rehabilitation Medicine, 205280University of Washington School of Medicine, Seattle, WA, USA.,Spine Research Program, 20731Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
| | - Anat Kristal
- Department of Physical Therapy, 12235University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Geoffrey S Balkman
- Department of Rehabilitation Medicine, 205280University of Washington School of Medicine, Seattle, WA, USA
| | - Eavey M Newton
- Department of Physical Therapy, 12235University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Jose J Palomo
- Department of Physical Therapy, 12235University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Kevin M Shay
- Department of Physical Therapy, 12235University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Rana Salem
- Department of Rehabilitation Medicine, 205280University of Washington School of Medicine, Seattle, WA, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, 205280University of Washington School of Medicine, Seattle, WA, USA
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18
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Instrumented and Standard Measures of Physical Performance in Adults With Chronic Kidney Disease. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2021. [DOI: 10.1097/jat.0000000000000179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Frazer SWT, van der Veen R, Baan A, Hermans MEW, Olij BF. Evaluation of Implementing TOM: A Group-Based Fall Prevention Programme among Community-Dwelling Older Adults in The Netherlands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6360. [PMID: 34208319 PMCID: PMC8296192 DOI: 10.3390/ijerph18126360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022]
Abstract
There is strong evidence that effective fall prevention elements exist, but the implementation into society remains difficult. The aim of the current study is to describe and evaluate the implementation of the fall prevention programme "Thuis Onbezorgd Mobiel" (TOM). This novel approach combines effective components into a multidisciplinary group-based programme for adults aged 65 years or older with an increased risk of falling. To investigate the impact on several health-related outcomes such as subjective health, quality of life, physical functioning, and falls, we applied a quasi-experimental pre-post design including a follow-up period. A total of 164 older adults subscribed to the programme: 80 were eligible to start and 73 completed it. The impact analysis revealed a significant improvement in subjective health, physical functioning, and quality of life directly after participating in the programme. The impact on subjective health and quality of life persisted six months after the programme. Important facilitators for the implementation of the programme were social contact and clear communication. Lack of a concrete follow-up was seen as an important barrier. The results of the current research help guide further implementation of effective fall prevention interventions in practice.
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Affiliation(s)
- Sanne W. T. Frazer
- Consumer Safety Institute (VeiligheidNL), Overschiestraat 65, 1065 XD Amsterdam, The Netherlands; (R.v.d.V.); (A.B.); (M.E.W.H.); (B.F.O.)
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20
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Lo CWT, Lin CY, Tsang WWN, Yan CH, Wong AYL. Psychometric Properties of Brief-Balance Evaluation Systems Test Among Multiple Populations: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 103:155-175.e2. [PMID: 34015349 DOI: 10.1016/j.apmr.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To synthesize evidence regarding the psychometric properties of the Brief-Balance Evaluation Systems Test (BESTest) in assessing postural controls across various populations. DATA SOURCES Articles were searched in 9 databases from inception to March 2020. STUDY SELECTION Two reviewers independently screened titles, abstracts, and full-text articles to include studies that reported at least 1 psychometric property of the Brief-BESTest. There were no language restrictions. DATA EXTRACTION The 2 independent reviewers extracted data (including psychometric properties of Brief-BESTest) from the included studies. The methodological quality of the included studies was appraised by the Consensus-based Standards for the Selection of Health Status Measurement Instruments checklist, and the quality of statistical outcomes was assessed by the Terwee et al method. A best-evidence synthesis for each measurement property of the Brief-BESTest in each population was conducted. DATA SYNTHESIS Twenty-four studies encompassing 13 populations were included. There was moderate to strong positive evidence to support the internal consistency (Cronbach α>0.82), criterion validity (ρ≥0.73, r≥0.71), and construct validity (ρ≥0.66, r≥0.50, area under curve>0.72) of the Brief-BESTest in different populations. Moderate to strong positive evidence supported the responsiveness of the Brief-BESTest in detecting changes in postural controls of patients 4 weeks after total knee arthroplasty or patients with subacute stroke after 4-week rehabilitation. However, there was strong negative evidence for the structural validity of this scale in patients with various neurologic conditions. The evidence for the reliability of individual items and measurement errors remains unknown. CONCLUSIONS The Brief-BESTest is a valid (criterion- and construct-related) tool to assess postural control in multiple populations. However, further studies on the reliability of individual items and minimal clinically important difference of the Brief-BESTest are warranted before recommending it as an alternative to the BESTest and Mini-BESTest in clinical research/practice.
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Affiliation(s)
- Cathy W T Lo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - William W N Tsang
- Department of Physiotherapy, School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong SAR, China
| | - Chun Hoi Yan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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21
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Responsiveness and interpretability of commonly used outcome assessments of mobility capacity in older hospital patients with cognitive spectrum disorders. Health Qual Life Outcomes 2021; 19:68. [PMID: 33648508 PMCID: PMC7923341 DOI: 10.1186/s12955-021-01690-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
Background In older hospital patients with cognitive spectrum disorders (CSD), mobility should be monitored frequently with standardised and psychometrically sound measurement instruments. This study aimed to examine the responsiveness, minimal important change (MIC), floor effects and ceiling effects of commonly used outcome assessments of mobility capacity in older patients with dementia, delirium or other cognitive impairment. Methods In a cross-sectional study that included acute older hospital patients with CSD (study period: 02/2015–12/2015), the following mobility assessments were applied: de Morton Mobility Index (DEMMI), Hierarchical Assessment of Balance and Mobility (HABAM), Performance Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed test, 5-times chair rise test, 2-min walk test, Timed Up and Go test, Barthel Index mobility subscale, and Functional Ambulation Categories. These assessments were administered shorty after hospital admission (baseline) and repeated prior to discharge (follow-up). Global rating of mobility change scales and a clinical anchor of functional ambulation were used as external criteria to determine the area under the curve (AUC). Construct- and anchor-based approaches determined responsiveness. MIC values for each instrument were established from different anchor- and distribution-based approaches. Results Of the 63 participants (age range: 69–94 years) completing follow-up assessments with mild (Mini Mental State Examination: 19–24 points; 67%) and moderate (10–18 points; 33%) cognitive impairment, 25% were diagnosed with dementia alone, 13% with delirium alone, 11% with delirium superimposed on dementia and 51% with another cognitive impairment. The follow-up assessment was performed 10.8 ± 2.5 (range: 7–17) days on average after the baseline assessment. The DEMMI was the most responsive mobility assessment (all AUC > 0.7). For the other instruments, the data provided conflicting evidence of responsiveness, or evidence of no responsiveness. MIC values for each instrument varied depending on the method used for calculation. The DEMMI and HABAM were the only instruments without floor or ceiling effects. Conclusions Most outcome assessments of mobility capacity seem insufficiently responsive to change in older hospital patients with CSD. The significant floor effects of most instruments further limit the monitoring of mobility alterations over time in this population. The DEMMI was the only instrument that was able to distinguish clinically important changes from measurement error. Trial registration German Clinical Trials Register (DRKS00005591). Registered February 2, 2015.
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22
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Yuksel E, Unver B, Kalkan S, Karatosun V. Reliability and minimal detectable change of the 2-minute walk test and Timed Up and Go test in patients with total hip arthroplasty. Hip Int 2021; 31:43-49. [PMID: 31928090 DOI: 10.1177/1120700019888614] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Performance-based outcome measures are becoming increasingly important in health care. The 2-minute walk test (2MWT) and the Timed Up and Go test (TUG) are frequently used in clinical trials as performance-based tests in many diseases including osteoarthritis. The purposes of this study were: (1) to determine test-retest reliability of data for the 2MWT and the TUG; (2) to determine minimal detectable change (MDC) scores for the TUG and 2MWT in patients with total hip arthroplasty (THA). METHODS 37 patients, who had undergone primary THA, were included. Patients twice performed trials for the 2MWT and TUG on the same day. In addition to demographic data of patients, the Harris Hip Score, 2MWT and TUG scores were recorded. RESULTS The TUG and 2MWT showed excellent test-retest reliability. The Intraclass correlation coefficient ICC (2,1), Standard error of measurement (SEM) and minimal detectable chance at the 95% CI (MDC95) for TUG were 0.96, 0.59 seconds and 1.62 seconds respectively. The ICC (2,1), SEM and MDC95 for 2MWT were 0.96, 6.37 m and 17.56 m respectively. CONCLUSION Clinicians and researchers can be confident that greater changes than 1.62 seconds for TUG and 17.56 m for the 2MWT over time represent a real clinical change in rehabilitation process in patients with THA. Both the 2MWT and TUG may assist in early identification of patients who may need additional rehabilitation to reduce the potential for poor outcomes after THA. Therefore, both of these tests can be used in a clinical setting with a small measurement error.
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Affiliation(s)
- Ertugrul Yuksel
- Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Bayram Unver
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Serpil Kalkan
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Vasfi Karatosun
- Department of Orthopaedics and Traumatology, School of Medicine, Dokuz Eylül University, Izmir, Turkey
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23
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Canan Outdoor Multisurface Terrain Enhance the Effects of Fall Prevention Exercise in Older Adults? A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197023. [PMID: 32992927 PMCID: PMC7579330 DOI: 10.3390/ijerph17197023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022]
Abstract
Walking on complex surface conditions in outdoor environments is important for active aging. This study aimed at examining whether fall prevention exercise integrated with an outdoor multisurface terrain compared with indoor solid ground was more beneficial for older adults. Twenty-two older nursing home residents were randomly assigned to outdoor multisurface terrain (n = 11, 79.5 ± 2.1 years) or indoor solid ground (n = 11, 78.8 ± 5.2 years) groups. Training occurred five times per week (30 min) for 3 weeks. The following performance test outcomes were measured: 10 m walk test (10 mWT), multisurface terrain walk test (MTWT), 2 min walk test (2 MWT), timed up and go test (TUGT), single-leg standing test with eyes open (SLSTEO), single-leg standing test with eyes closed (SLSTEC), and closed cycles test (CCT). Compared with baseline, the outdoor multisurface terrain training significantly improved performance in all tests (p < 0.01). The improvements of the outdoor multisurface terrain group after intervention were significantly higher than those of the indoor solid group in the 10 mWT (p = 0.049), MTWT (p = 0.02), and 2 MWT (p = 0.000). Exercise combined with outdoor multisurface terrain training may be an efficacious approach and a feasible environmental intervention for fall prevention in older adults.
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Kitagaki K, Murata S, Tsuboi Y, Isa T, Ono R. Relationship between exercise capacity and depressive symptoms in community-dwelling older adults. Arch Gerontol Geriatr 2020; 89:104084. [DOI: 10.1016/j.archger.2020.104084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/31/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022]
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Chan WLS, Pin TW. Reliability, validity and minimal detectable change of 2-min walk test and 10-m walk test in frail older adults receiving day care and residential care. Aging Clin Exp Res 2020; 32:597-604. [PMID: 31243742 DOI: 10.1007/s40520-019-01255-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The psychometric properties of the 2-min walk test (2MWT) and 10-m walk test (10MeWT) for frail older adults are unclear. AIMS To determine the test-retest and inter-rater reliability, construct and known-group validity, and minimal detectable change at 95% level of confidence (MDC95) of these walk tests in frail older adults receiving day care and residential care services. METHODS A cross-sectional study with repeated measures was conducted on frail older adults who could walk independently for at least 15 m. The participants completed the 2MWT and 10MeWT on three separate occasions over a 2-week period under two independent assessors. RESULTS Forty-four frail older adults were examined. Excellent test-rest (ICC = 0.95-0.99) and inter-rater reliability (ICC = 0.95-0.97) were shown in both walk tests. Good to strong correlations were found between the walk tests and 6-min walk test (r = 0.89-0.92), Elderly Mobility Scale (r = 0.56-0.57), Berg Balance Scale (r = 0.66-0.66) and Modified Barthel Index (r = 0.55-0.59). The MDC95 were 7.7 m in the 2MWT and 0.13 m/s in the 10MeWT. DISCUSSION Although the walking performances of the day care and residential care participants were similar, the validity of the walk tests was different between these two subgroups. CONCLUSIONS The 2MWT and 10MeWT are reliable and valid measures in evaluating the walking performances of frail older adults. The MDC95 of the walk tests has been recommended.
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McGough EL, Lin SY, Belza B, Becofsky KM, Jones DL, Liu M, Wilcox S, Logsdon RG. A Scoping Review of Physical Performance Outcome Measures Used in Exercise Interventions for Older Adults With Alzheimer Disease and Related Dementias. J Geriatr Phys Ther 2020; 42:28-47. [PMID: 29210934 DOI: 10.1519/jpt.0000000000000159] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE There is growing evidence that exercise interventions can mitigate functional decline and reduce fall risk in older adults with Alzheimer disease and related dementias (ADRD). Although physical performance outcome measures have been successfully used in older adults without cognitive impairment, additional research is needed regarding their use with individuals who have ADRD, and who may have difficulty following instructions regarding performance of these measures. The purpose of this scoping review was to identify commonly used physical performance outcome measures, for exercise interventions, that are responsive and reliable in older adults with ADRD. Ultimately, we aimed to provide recommendations regarding the use of outcome measures for individuals with ADRD across several domains of physical performance. METHODS A scoping review was conducted to broadly assess physical performance outcome measures used in exercise interventions for older adults with ADRD. Exercise intervention studies that included at least 1 measure of physical performance were included. All physical performance outcome measures were abstracted, coded, and categorized into 5 domains of physical performance: fitness, functional mobility, gait, balance, and strength. Criteria for recommendations were based on (1) the frequency of use, (2) responsiveness, and (3) reliability. Frequency was determined by the number of studies that used the outcome measure per physical performance domain. Responsiveness was assessed via calculated effect size of the outcome measures across studies within physical performance domains. Reliability was evaluated via published studies of psychometric properties. RESULTS AND DISCUSSION A total of 20 physical performance outcome measures were extracted from 48 articles that met study inclusion criteria. The most frequently used outcome measures were the 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, the Berg Balance Scale, and isometric strength measures. These outcome measures demonstrated a small, medium, or large effect in at least 50% of the exercise intervention studies. Good to excellent reliability was reported in samples of older adults with mild to moderate dementia. Fitness, functional mobility, gait, balance, and strength represent important domains of physical performance for older adults. The 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, Berg Balance Scale, and isometric strength are recommended as commonly used and reliable physical performance outcome measures for exercise interventions in older adults with mild to moderate ADRD. Further research is needed on optimal measures for individuals with severe ADRD. CONCLUSIONS The results of this review will aid clinicians and researchers in selecting reliable measures to evaluate physical performance outcomes in response to exercise interventions in older adults with ADRD.
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Affiliation(s)
- Ellen L McGough
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Shih-Yin Lin
- School of Nursing, University of Washington, Seattle, Washington
| | - Basia Belza
- School of Nursing, University of Washington, Seattle, Washington.,Health Promotion Research Center, University of Washington, Seattle, Washington
| | - Katie M Becofsky
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Dina L Jones
- Department of Orthopaedics, Division of Physical Therapy, and Injury Control Research Center, West Virginia University, Morgantown, West Virginia
| | - Minhui Liu
- School of Nursing, University of Washington, Seattle, Washington.,Center for Innovative Care in Aging School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Sara Wilcox
- Department of Exercise Science and Prevention Research Center, University of South Columbia, South Carolina
| | - Rebecca G Logsdon
- School of Nursing, University of Washington, Seattle, Washington.,Health Promotion Research Center, University of Washington, Seattle, Washington
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Beckerman H, Heine M, van den Akker LE, de Groot V. The 2-minute walk test is not a valid method to determine aerobic capacity in persons with Multiple Sclerosis. NeuroRehabilitation 2020; 45:239-245. [PMID: 31498142 PMCID: PMC6918899 DOI: 10.3233/nre-192792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND: Walking tests, like the 2-minute fast walk test, are simple, inexpensive performance-based tests, and therefore seem attractive to estimate the aerobic fitness in people with chronic diseases. OBJECTIVE: To determine the criterion validity of the 2-minute fast walk test for estimating aerobic capacity in patients with Multiple Sclerosis (MS), by comparing it with the peak oxygen uptake (VO2peak in mL/kg/min) as measured by Cardiopulmonary Exercise Testing (CPET) on a cycle ergometer. METHODS: The 2 min fast walk test was performed on a marked indoor trajectory, using a static start protocol. Aerobic capacity (VO2peak, in mL/kg/min) was derived from CPET on a cycle ergometer. Criterion validity was tested by means of Pearson’s correlation coefficient and should be at least 0.70 for a good criterion validity of the 2 min walk test. Linear regression analysis was applied to more precisely estimate VO2peak. RESULTS: In total 141 people with severe MS-related fatigue (mean age 47.0 years (range 23–68 years), 73% women, median disease duration 7.8 years (range 0.3 – 28.7 years)) performed both tests. The distance walked in two minutes ranged from 52.0 to 290.0 m (mean 175.1 m, sd 44.9 m), while the VO2peak varied between 11.31 and 40.28 mL/kg/min (mean 22.52 mL/kg/min, sd 6.07 mL/kg/min). The correlation between the 2 min walk test and VO2peak was 0.441 (95% CI: 0.309–0.570). The absolute residual error in estimated VO2peak was 5.47 mL/kg/min. CONCLUSIONS: Due to the poor correlation found between the 2 min walk test and VO2peak, the 2-min walk test cannot be recommended as a valid alternative for estimating aerobic capacity in persons with MS.
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Affiliation(s)
- Heleen Beckerman
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Vrije Universiteit, MS Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martin Heine
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Vrije Universiteit, MS Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands
| | - Lizanne E van den Akker
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Vrije Universiteit, MS Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Vrije Universiteit, MS Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Effect of temperature-control liner materials on long-term outcomes of lower limb prosthesis use: a randomized controlled trial protocol. Trials 2020; 21:61. [PMID: 31924257 PMCID: PMC6954540 DOI: 10.1186/s13063-019-3920-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022] Open
Abstract
Background In people living with limb loss, addressing the resulting functional deficit with prostheses increases the risk for secondary conditions such as pressure sores, impaired blood perfusion, and injuries from accidental falls. Any of those occurrences can render the prosthesis temporarily useless, making it challenging for users to engage in many activities of daily life, including work, exercise, and social participation. Many of the described issues originate at the interface between residual limb and prosthetic socket, where the objectives of sufficient weight distribution and suspension are conflicting with the necessity to facilitate heat exchange and limit contact pressure and friction. Recently, prosthesis liners that contain phase-change material have become commercially available, holding the promise that the micro climate at the interface between the residual limb skin and the prosthetic socket can be regulated to reduce the users’ tendency to sweat. Preliminary studies on these liners indicate that the socket temperatures inside the socket stayed lower and rose slower than in conventional liners. However, the clinical relevance of those findings remains unclear. The purpose of this study is to investigate whether longer (6+ months) periods of use of phase-change material based temperature-control liners have clinically meaningful effects. Methods The protocol is a double-blind longitudinal cross-over research design. A sample of trans-tibial prosthesis users are wearing their regular gel or silicone liners for six months and phase-change material liners for another six months in a randomized sequence. Their prostheses is equipped with activity monitors to detect days when they could not wear their prosthesis. In six-week intervals, individuals’ activity, physical performance, and overall prosthesis assessment is recorded using standardized methods. Discussion Expected results will inform prescription and reimbursement practice of phase-change material-based prosthesis liners and will help improve and economize prosthetic fitting for people with limb loss. The design and duration of the protocol, including randomization, blinding, and within-subject comparison, will generate scientific evidence of a comparably high level. Inclusion of a comparably large sample and different climates, e.g. across all four seasons, will make findings applicable to a large number of prosthesis users. Trial registration Clinicaltrials.gov, NCT03428815. Registered on 12 February 2018.
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McCaskell DS, Molloy AJ, Childerhose L, Costigan FA, Reid JC, McCaughan M, Clarke F, Cook DJ, Rudkowski JC, Farley C, Karachi T, Rochwerg B, Newman A, Fox-Robichaud A, Herridge MS, Lo V, Feltracco D, Burns KE, Porteous R, Seely AJE, Ball IM, Seczek A, Kho ME. Project management lessons learned from the multicentre CYCLE pilot randomized controlled trial. Trials 2019; 20:532. [PMID: 31455384 PMCID: PMC6712681 DOI: 10.1186/s13063-019-3634-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/08/2019] [Indexed: 11/16/2022] Open
Abstract
Background Clinical trials management can be studied using project management theory. The CYCLE pilot randomized controlled trial (RCT) was conducted to determine the feasibility of a future rehabilitation trial of early in-bed cycling in the intensive care unit (ICU). In-bed cycling is a novel intervention, not typically available in ICUs. Implementation of this intervention requires personnel with specialized clinical expertise caring for critically ill patients and use of the in-bed cycle. Our objective was to describe the implementation and conduct of our pilot RCT using a project management approach. Methods We retrospectively reviewed activities, timelines, and personnel involved in the trial. We organized activities into four project management phases: initiation, planning, execution, and monitoring and controlling. Data sources included Methods Centre documents used for trial coordination and conduct, and the trial data set. We report descriptive statistics as counts and proportions and also medians and quartiles, and we summarize the lessons learned. Results Seven ICUs in Canada participated in the trial. Time from research ethics board and contracts submission to first enrolment was a median (first quartile, third quartile) of 185 (146, 209) and 162 (114, 181) days, respectively. We trained 128 personnel on the CYCLE pilot RCT protocol, and 80 (63%) completed trial-related activities. Four sites required additional training after start-up due to staff turnover and leaves of absence. Over 15 months, we screened 864 patients: 256 were eligible and 66 were enrolled. Despite an 85% consent rate, 74% (190/256) of eligible patients were not randomized, largely (80% [152/190]) due to physiotherapist availability. Thirteen percent of recruitment weeks were lost due to physiotherapist staffing shortages. We highlight five key lessons learned: (1) prepare and anticipate site needs; (2) communicate regularly; (3) proactively analyse and act on process measure data; (4) develop contingency plans; (5) express appreciation to participating sites. Conclusions Our analysis highlights the scope of relevant activities, rigorous training and monitoring, number and types of required personnel, and time required to conduct a multicentre ICU rehabilitation intervention trial. Our lessons learned can help others interested in implementing complex intervention trials, such as rehabilitation. Trial registration ClinicalTrials.gov, NCT02377830. Registered prospectively on 4 March 2015. Electronic supplementary material The online version of this article (10.1186/s13063-019-3634-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Devin S McCaskell
- The Research Institute of St. Joe's Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Alexander J Molloy
- The Research Institute of St. Joe's Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Laura Childerhose
- McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.,Department of Health Research Methods, Evidence and Impact McMaster University Health Sciences Centre, Room 2C16, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - F Aileen Costigan
- The Research Institute of St. Joe's Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Julie C Reid
- McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Magda McCaughan
- Department of Physiotherapy, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - France Clarke
- Department of Health Research Methods, Evidence and Impact McMaster University Health Sciences Centre, Room 2C16, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Deborah J Cook
- Department of Physiotherapy, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada.,Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Jill C Rudkowski
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Department of Critical Care, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Christopher Farley
- Juravinski Hospital, Hamilton, 711 Concession St, Hamilton, ON, L8V 1C3, Canada
| | - Tim Karachi
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Department of Critical Care, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Department of Critical Care, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Anastasia Newman
- McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.,Hamilton General Hospital, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada
| | - Alison Fox-Robichaud
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Hamilton General Hospital, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada
| | | | - Vincent Lo
- Department of Physical Therapy, University of Toronto, Rehabilitation Sciences Centre, 8th Floor, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Deanna Feltracco
- St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Karen Ea Burns
- St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | | | | | - Ian M Ball
- Department of Medicine and Department of Epidemiology and Biostatistics, Western University, Critical Care Trauma Centre, London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Amy Seczek
- McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Michelle E Kho
- The Research Institute of St. Joe's Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada. .,McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada. .,Department of Physiotherapy, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada.
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Chan WLS, Pin TW. Practice effect and cueing of 2-minute walk test, 6-minute walk test and 10-meter walk test in frail older adults with and without dementia - Recommendations to walk tests protocols. Exp Gerontol 2019; 124:110648. [PMID: 31279000 DOI: 10.1016/j.exger.2019.110648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/11/2019] [Accepted: 06/27/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES 1) To determine if there was a practice effect associated with walk tests performed by frail older adults with and without dementia, 2) to examine the role of systematic cueing in the walk tests for those with dementia, and 3) to make recommendations to testing protocols of the walk tests for frail older adults with and without dementia. SETTING Residential and day care facilities. PARTICIPANTS 44 frail older adults with normal cognition (NON-DEM) and 39 older adults with Alzheimer's disease or dementia (DEM) who were able to walk independently for at least 15 m. METHODS All the participants completed multiple trials of 2-minute walk test (2MWT), 6-minute walk test (6MWT) and 10-meter walk test (10MeWT) on three separate testing occasions. The DEM group was facilitated to complete the walk tests using a progressive cueing system. RESULTS Significant increases in the walking performance within the same testing occasion were found in the 2MWT (NON-DEM: p = .002; DEM: p ≤ .044) and 6MWT (NON-DEM: p ≤ .004; DEM: p ≤ .002) for both groups but only in the 10MeWT (p ≤ .023) for the DEM group. Significant increases in the walking performance across testing occasions were shown in the 2MWT (p ≤ .047), 6MWT (p ≤ .005) and 10MeWT (p ≤ .039) for the NON-DEM group but not the DEM group (all p > .05). Multivariate regression analyses showed that the cognitive function of the DEM group was independently and inversely associated with the level of cueing provided during the walk tests (p ≤ .007). CONCLUSION Practice effect associated with the walk tests was found within and across testing occasions for frail older adults with normal cognition, and only within the same testing occasion for those with dementia. Systematic cueing should be provided for those with dementia to complete the walk tests. Testing protocols of the walk tests have been recommended for these two population groups.
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Affiliation(s)
- Wayne L S Chan
- Physiotherapy Department, Chi Lin Nunnery Elderly Service, 5 Chi Lin Drive, Diamond Hill, Hong Kong; Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - Tamis W Pin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
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Costigan FA, Rochwerg B, Molloy AJ, McCaughan M, Millen T, Reid JC, Farley C, Patterson L, Kho ME. I SURVIVE: inter-rater reliability of three physical functional outcome measures in intensive care unit survivors. Can J Anaesth 2019; 66:1173-1183. [PMID: 31147985 DOI: 10.1007/s12630-019-01411-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/04/2019] [Accepted: 03/22/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE We prospectively assessed inter-rater reliability of three physical function measures in Canadian intensive care unit (ICU) survivors in the inpatient setting. METHODS We enrolled patients who had an ICU length of stay of ≥ three days, were mechanically ventilated for ≥ 24 hr, and were ambulating independently before hospital admission. Weekly from ICU discharge to hospital discharge, two trained frontline clinicians, blinded to each other's findings, independently performed the Physical Function ICU Test-scored (PFIT-s; score out of 10), 30-sec sit-to-stand (30STS; # of stands), and two-minute walk test (2MWT; distance in m), all within 24 hr. We calculated the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC90). RESULTS We enrolled 42 patients. PFIT-s: in 36 patients with 66 paired scores, the ICC was 0.78 (95% confidence interval [CI], 0.66 to 0.86), the SEM was 1.04, and the MDC90 was 2.42. 30STS: in 35 patients with 67 paired scores, the ICC was 0.85 (95% CI, 0.76 to 0.90), the SEM was 1.91, and the MDC90 was 4.45. 2MWT: in 35 patients with 58 paired scores, the ICC was 0.78 (95% CI, 0.66 to 0.87), the SEM was 20.87, and the MDC90 was 48.69. CONCLUSION These three measures show good inter-rater reliability when used by trained frontline clinicians to assess physical function in ICU survivors in the inpatient setting.
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Affiliation(s)
- F Aileen Costigan
- Physiotherapy Department, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Bram Rochwerg
- Department of Medicine (Division of Critical Care), McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Magda McCaughan
- Physiotherapy Department, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Tina Millen
- Department of Critical Care, Juravinski Hospital, Hamilton, ON, Canada
| | - Julie C Reid
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Chris Farley
- Department of Critical Care, Juravinski Hospital, Hamilton, ON, Canada
| | - Laurel Patterson
- Physiotherapy Department, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Michelle E Kho
- Physiotherapy Department, St. Joseph's Healthcare, Hamilton, ON, Canada. .,Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada. .,Institute of Applied Health Science, School of Rehabilitation Science, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
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Pin TW, Butler PB, Purves S. Use of whole body vibration therapy in individuals with moderate severity of cerebral palsy- a feasibility study. BMC Neurol 2019; 19:80. [PMID: 31043157 PMCID: PMC6495512 DOI: 10.1186/s12883-019-1307-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 04/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background This pilot study was to examine the feasibility and tolerance of whole body vibration therapy (WBVT) for children and adults with moderate severity of cerebral palsy (CP) being graded as levels III or IV on the Gross Motor Function Classification Scale (GMFCS). Methods Study participants received the additional WBVT when standing still on the vibration platform for three 3-min bouts of vibration (20 Hz, 2 mm amplitude), 4 days per week for 4 weeks. In addition to questions relating to feasibility and participants’ opinions, assessment at baseline and completion of the intervention included the Gross Motor Function Measure-66 Item Set (GMFM-66 IS), 2-min walk test (2MWT), Timed Up and Go test (TUG) and Pediatric Evaluation of Disability Inventory (PEDI). Wilcoxon Signed Ranks test was used to compare the results. Results Fourteen participants (mean age = 25.25 years SD 3.71; 9 males, 64%; GMFCS level III n = 13, 92%) were recruited and completed the study. The attendance rate was over 90% with no adverse events. All participants tolerated the protocol which was satisfactorily delivered in a clinical setting. Conclusions The present WBVT protocol was feasible, safe and well-tolerated by the participants with moderate severity of CP, justifying future studies with larger samples and more rigorous study design. Trial registration The present study has been registered under the ClinicalTrials.gov (NCT03375736) and the date of registration commenced on 18 December 2017.
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Affiliation(s)
- Tamis W Pin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | | | - Sheila Purves
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Braun T, Thiel C, Schulz RJ, Grüneberg C. Reliability of mobility measures in older medical patients with cognitive impairment. BMC Geriatr 2019; 19:20. [PMID: 30674278 PMCID: PMC6343264 DOI: 10.1186/s12877-019-1036-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/14/2019] [Indexed: 01/06/2023] Open
Abstract
Background Mobility is a key indicator of physical functioning in older people, but there is limited evidence of the reliability of mobility measures in older people with cognitive impairment. This study aimed to examine the test-retest reliability and measurement error of common measurement instruments of mobility and physical functioning in older patients with dementia, delirium or other cognitive impairment. Methods A cross-sectional study was performed in a geriatric hospital. Older acute medical patients with cognitive impairment, indicated by a Mini-Mental State Examination (MMSE) score of ≤24 points, were assessed twice within 1 day by a trained physiotherapist. The following instruments were applied: de Morton Mobility Index, Hierarchical Assessment of Balance and Mobility, Performance-Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed, 5-times chair rise test, 2-min walk test, timed up and go test, Barthel Index mobility subscale and Functional Ambulation Categories. As appropriate, the intraclass correlation coefficient (ICC), Cohen’s kappa, standard error of measurement, limits of agreement and minimal detectable change (MDC) values were estimated. Results Sixty-five older acute medical patients with cognitive impairment participated in the study (mean age: 82 ± 7 years; mean MMSE: 20 ± 4, range: 10 to 24 points). Some participants were physically or cognitively unable to perform the gait speed (46%), 2-min walk (46%), timed up and go (51%) and chair rise (75%) tests. ICC and kappa values were above 0.9 in all instruments except for the gait speed (ICC = 0.86) and chair rise (ICC = 0.72) measures. Measurement error is reported for each instrument. The absolute limits of agreement ranged from 11% (de Morton Mobility Index and Hierarchical Assessment of Balance and Mobility) to 35% (chair rise test). Conclusions The test-retest reliability is sufficient (> 0.7) for group-comparisons in all examined instruments. Most mobility measurements have limited use for individual monitoring of mobility over time in older hospital patients with cognitive impairment because of the large measurement error (> 20% of scale width), even though relative reliability estimations seem sufficient (> 0.9) for this purpose. Trial registration German Clinical Trials Register (DRKS00005591). Registered 2 February 2015. Electronic supplementary material The online version of this article (10.1186/s12877-019-1036-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.
| | - Christian Thiel
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.,Faculty of Sports Science, Training and Exercise Science, Ruhr-University Bochum, Bochum, Germany
| | - Ralf-Joachim Schulz
- Department of Geriatric Medicine, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Cologne, Germany
| | - Christian Grüneberg
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
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Pin TW, Butler PB. The effect of interactive computer play on balance and functional abilities in children with moderate cerebral palsy: a pilot randomized study. Clin Rehabil 2019; 33:704-710. [PMID: 30599772 DOI: 10.1177/0269215518821714] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES: To investigate the feasibility and potential efficacy of a six-week interactive computer play training on balance and gross motor function in children with moderate cerebral palsy. DESIGN: A pilot single-blinded matched randomized controlled study. SETTING: Community. PARTICIPANTS: In total, 18 children with moderate cerebral palsy were recruited, paired according to age and severity of cerebral palsy and randomized into intervention group or control group. INTERVENTION: The intervention group received additional trunk control training using the interactive computer play in sitting four times per week, 20 minutes per session for six weeks. All study children continued their usual physiotherapy programme. MEASUREMENTS: All study children were assessed at baseline, week 3, week 6 (completion of intervention) and week 12 using the Pediatric Reach Test, Gross Motor Function Measure-66-Item Set and 2-Minute Walk Test. RESULTS: All intervention children completed and enjoyed the training with no reported adverse event. All children were assessed at all time points. No significant difference was found between the two groups in all assessments. In both groups of children, significant improvements were found in the Gross Motor Function Measure-66-Item Set between week 3 (intervention group: mean 53.41, SD 5.34; control group: mean 52.86, SD 8.33) and week 6 (intervention group: mean 55.00, SD 6.32; control group: mean 54.20, SD 8.35). CONCLUSION: The intervention protocol of a six-week interactive computer play training was feasible and safe for children with moderate cerebral palsy in special school settings. Future studies with larger sample sizes or using single-subject designs are recommended.
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Affiliation(s)
- Tamis W Pin
- 1 Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Chan WLS, Pin TW. Reliability, validity and minimal detectable change of 2-minute walk test, 6-minute walk test and 10-meter walk test in frail older adults with dementia. Exp Gerontol 2018; 115:9-18. [PMID: 30423359 DOI: 10.1016/j.exger.2018.11.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/08/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Walk tests are commonly used to evaluate walking ability in frail older adults with dementia but their psychometric evidence in this population is lacking. OBJECTIVES 1) To examine test-retest and inter-rater reliability, construct and known-group validity, and minimal detectable change at 95% level of confidence (MDC95) of walk tests in frail older adults with dementia, and 2) to examine the feasibility and consistency of a cueing system in facilitating participants in completing walk tests. DESIGN Psychometric study with repeated measures. SETTING Day care and residential care facilities. PARTICIPANTS Thirty-nine frail older adults with a mean age 87.1 and a diagnosis of dementia or Alzheimer's disease who were able to walk independently for at least 15 m. METHODS The participants underwent a 2-minute walk test (2MWT), 6-minute walk test (6MWT) and 10-meter walk test (10MeWT) on 6 separate occasions under 2 independent assessors using a cueing system. Functional status was measured using the Elderly Mobility Scale (EMS), Berg Balance Scale (BBS) and Modified Barthel Index (MBI). RESULTS Excellent test-retest (ICC = 0.91-0.98) and inter-rater reliability (ICC = 0.86-0.96) were shown in the 2MWT, 6MWT and 10MeWT. The walk tests were strongly correlated with each other (ρ = 0.85-0.94). The correlations between the walk tests and the functional measures were moderate in general (ρ = 0.34-0.55). All the walk tests were able to distinguish between those who could walk outdoor and indoor only (p ≤ .036). The MDC95 were 9.1 m in the 2MWT, 28.1 m in the 6MWT, and.16 m/s in the 10MeWT. The cues provided by the assessors in the walk tests were generally consistent (ICC = 0.62-0.89). CONCLUSIONS The 2MWT, 6MWT and 10MeWT are reliable and valid measures in evaluating walking ability in frail older adults with dementia. The MDC95 of the walk tests has been established. The cueing system is feasible and reliable to facilitate the administration of the walk tests in this population group.
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Affiliation(s)
- Wayne L S Chan
- Physiotherapy Department, Chi Lin Nunnery Elderly Service, 5 Chi Lin Drive, Diamond Hill, Hong Kong.
| | - Tamis W Pin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
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Alqarni A, Manlapaz D, Baxter D, Tumilty S, Mani R. Test procedures to assess somatosensory abnormalities in individuals with neck pain: a systematic review of psychometric properties. PHYSICAL THERAPY REVIEWS 2018. [DOI: 10.1080/10833196.2018.1512737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Abdullah Alqarni
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Donald Manlapaz
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Baxter
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Valet M, Lejeune T, Devis M, van Pesch V, El Sankari S, Stoquart G. Timed Up-and-Go and 2-Minute Walk Test in patients with multiple sclerosis with mild disability: reliability, responsiveness and link with perceived fatigue. Eur J Phys Rehabil Med 2018; 55:450-455. [PMID: 30311490 DOI: 10.23736/s1973-9087.18.05366-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Mobility limitations are frequent in patients with multiple sclerosis (MS), and could already be present in patients with so-called mild neurological disability (Expanded Disability Status Scale≤4). Assessing mobility in these patients is therefore of paramount importance. Timed Up-and-Go Test (TUG) and 2-Minute Walk Test (2MWT) are two clinically feasible tests which reliability and responsiveness are unknown among these patients. Whether fatigue, which is the number one symptom among these patients, is linked to these limitations remains unknown. AIM The aim of this study was to explore the intrarater reliability and minimal detectable change (MDC95), as an index of responsiveness, of TUG and 2MWT. To explore their link with perceived fatigue among patients with MS. DESIGN Cross-sectional observational study, including two measures. SETTING Two university hospital outpatient centers. POPULATION Patients (N.=63, 49 seen twice) with MS with mild disability (Expanded Disability Status Scale≤4). METHODS 2MWT and TUG were performed twice in one occasion, and repeated 2 weeks later. Modified fatigue impact scale (MFIS) was used to assess fatigue. Intraclass coefficient correlations were calculated for immediate and 2-week reliability. MDC95 were computed. Correlations between mobility indices and fatigue were explored using Spearman's ρ. RESULTS Mobility was impaired in comparison to normative values (2MWT: -4.9% from normative distance; TUG: +32% from normative time). The immediate reliability was excellent for both the 2MWT (ICC=0.98) and TUG (ICC=0.98). Reliability at 2 weeks was excellent for 2MWT (ICC=0.95) and very good for TUG (ICC=0.90). MDC95 were respectively 20m (2MWT) and 1.3s (TUG). Both measures were significantly weakly correlated to total MFIS (ρ=-0.37 and 0.39, respectively; P<0.01). CONCLUSIONS The 2MWT and TUG are highly reliable and responsive in the assessment of respectively the walking capacity and general mobility of patients with MS with mild disability. Mobility impairments are linked to perceived fatigue among these patients. CLINICAL REHABILITATION IMPACT TUG and 2MWT are easy to administer and could be reliably used in so called mildly disabled patients with MS to assess mobility limitation.
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Affiliation(s)
- Maxime Valet
- Department of Health Sciences, Institute of Experimental and Clinical Research, Neuromusculoskeletal Lab (NMSK), Catholic University of Louvain, Brussels, Belgium - .,Department of Physical Medicine and Rehabilitation, Saint-Luc University Clinic, Brussels, Belgium -
| | - Thierry Lejeune
- Department of Health Sciences, Institute of Experimental and Clinical Research, Neuromusculoskeletal Lab (NMSK), Catholic University of Louvain, Brussels, Belgium.,Department of Physical Medicine and Rehabilitation, Saint-Luc University Clinic, Brussels, Belgium
| | - Marine Devis
- Department of Physical Medicine and Rehabilitation, Saint-Luc University Clinic, Brussels, Belgium
| | - Vincent van Pesch
- Department of Neurology, Saint-Luc University Clinic, Brussels, Belgium
| | | | - Gaëtan Stoquart
- Department of Health Sciences, Institute of Experimental and Clinical Research, Neuromusculoskeletal Lab (NMSK), Catholic University of Louvain, Brussels, Belgium.,Department of Physical Medicine and Rehabilitation, Saint-Luc University Clinic, Brussels, Belgium
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Guirao L, Samitier B, Tibau R, Alós J, Monago M, Morales-Suarez-Varela M, Pleguezuelos E. Distance and speed of walking in individuals with trans-femoral amputation fitted with a distal weight-bearing implant. Orthop Traumatol Surg Res 2018; 104:929-933. [PMID: 29864519 DOI: 10.1016/j.otsr.2018.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/01/2018] [Accepted: 04/30/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Preservation of femoral condyles in patients with knee disarticulation amputation (KDA) facilitates distal support inside the socket, compared to trans-femoral amputation (TFA), and allows the direct transfer of weight-bearing loads toward residual limbs. HYPOTHESIS The hypothesis was that the gait distance and speed of TFA patients after a surgical femoral implant that allowed the distal support of the residuum would improve. MATERIAL AND METHODS Twenty-three TFA patients received a titanium implant that allowed the distal weight bearing of the residuum inside the socket. The post-intervention follow-up period lasted 14 months. Gait distance and speed were assessed with the 2-minute walk test (2MWT). RESULTS The amputation etiology was trauma in 11 patients (48%), peripheral vascular disease in nine (39%) and oncologic disease in three (13%). The mean 2MWT distance was 103.6±34.7m prior to femoral implant and 128±38.9m at 14 months, which implies an improvement of 24% (p<0.001). The mean gait speed was 0.86±0.29m/s prior to femoral implant and 1.06±0.32m/s at 14 months (p<0.001). DISCUSSION After implant placement, distance covered increased by 24%. This value is higher than those described by other groups, such as Rau (12.6%) and Darter (19.2%), who assessed improvement in distance covered with the 2MWT in a younger population and after completing different physiotherapy programs. Our results showed improved distance walked and gait speed as well as in the physical functioning score in TFA patients 14 months after receiving a femoral implant that permitted distal residuum loading. TYPE OF STUDY An experimental prospective study. LEVEL OF PROOF III, case-control study.
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Affiliation(s)
- Lluis Guirao
- Department of physical and rehabilitation medicine, hospital de Mataró, Barcelona, Spain.
| | - Beatriz Samitier
- Department of physical and rehabilitation medicine, hospital de Mataró, Barcelona, Spain
| | - Rafael Tibau
- Department of orthopedics, hospital de Mataró, Barcelona, Spain
| | - Jesús Alós
- Department of vascular surgery, hospital de Mataró, Barcelona, Spain
| | - Mireia Monago
- Department of physical and rehabilitation medicine, hospital de Mataró, Barcelona, Spain
| | - Maria Morales-Suarez-Varela
- Unit of public health and environmental care, department of preventive medicine, CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, university of Valencia, Madrid, Spain
| | - Eulogio Pleguezuelos
- Department of physical and rehabilitation medicine, hospital de Mataró, Barcelona, Spain
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A systematic review and meta-analysis of the reliability and validity of sensorimotor measurement instruments in people with chronic low back pain. Musculoskelet Sci Pract 2018; 35:73-83. [PMID: 29549815 DOI: 10.1016/j.msksp.2018.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Deficits in the sensorimotor system and its peripheral and central processing of the affected body part might be a contributing factor to chronic low back pain (CLBP). Hence, sensorimotor assessment is important. Valid and reliable sensorimotor measurement instruments are needed. OBJECTIVE To investigate the reliability and validity of sensorimotor measurement instruments for people with chronic low back pain (CLBP). DESIGN Systematic review and meta-analysis. METHODS The review was undertaken using the COSMIN guidelines. Databases were searched for studies investigating the clinimetric properties of sensorimotor tests in people with CLBP. The methodological study quality was rated by two independent reviewers using the COSMIN 4-point rating checklist. RESULTS Ten studies were included covering six sensorimotor measurement instruments with findings for reliability/measurement error, known-groups validity and convergent validity. The methodological quality ranged from poor to good, with only one study rated as good. There was insufficient evidence of enough quality to assess reliability/measurement error or convergent validity. Two-point discrimination, laterality judgement and movement control tests had moderate evidence supporting their ability to distinguish between healthy people and those with CLBP. CONCLUSIONS Two-point discrimination, laterality judgment and movement control tests demonstrate the greatest level of known-groups validity for people with CLBP. However, as the reliability of these measurement tools has yet to be established, this validity data should be interpreted cautiously. Further research is warranted to investigate the clinimetric properties of these sensorimotor techniques.
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Hoyer EH, Young DL, Klein LM, Kreif J, Shumock K, Hiser S, Friedman M, Lavezza A, Jette A, Chan KS, Needham DM. Toward a Common Language for Measuring Patient Mobility in the Hospital: Reliability and Construct Validity of Interprofessional Mobility Measures. Phys Ther 2018; 98:133-142. [PMID: 29106679 DOI: 10.1093/ptj/pzx110] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 11/01/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The lack of common language among interprofessional inpatient clinical teams is an important barrier to achieving inpatient mobilization. In The Johns Hopkins Hospital, the Activity Measure for Post-Acute Care (AM-PAC) Inpatient Mobility Short Form (IMSF), also called "6-Clicks," and the Johns Hopkins Highest Level of Mobility (JH-HLM) are part of routine clinical practice. The measurement characteristics of these tools when used by both nurses and physical therapists for interprofessional communication or assessment are unknown. OBJECTIVE The purposes of this study were to evaluate the reliability and minimal detectable change of AM-PAC IMSF and JH-HLM when completed by nurses and physical therapists and to evaluate the construct validity of both measures when used by nurses. DESIGN A prospective evaluation of a convenience sample was used. METHODS The test-retest reliability and the interrater reliability of AM-PAC IMSF and JH-HLM for inpatients in the neuroscience department (n = 118) of an academic medical center were evaluated. Each participant was independently scored twice by a team of 2 nurses and 1 physical therapist; a total of 4 physical therapists and 8 nurses participated in reliability testing. In a separate inpatient study protocol (n = 69), construct validity was evaluated via an assessment of convergent validity with other measures of function (grip strength, Katz Activities of Daily Living Scale, 2-minute walk test, 5-times sit-to-stand test) used by 5 nurses. RESULTS The test-retest reliability values (intraclass correlation coefficients) for physical therapists and nurses were 0.91 and 0.97, respectively, for AM-PAC IMSF and 0.94 and 0.95, respectively, for JH-HLM. The interrater reliability values (intraclass correlation coefficients) between physical therapists and nurses were 0.96 for AM-PAC IMSF and 0.99 for JH-HLM. Construct validity (Spearman correlations) ranged from 0.25 between JH-HLM and right-hand grip strength to 0.80 between AM-PAC IMSF and the Katz Activities of Daily Living Scale. LIMITATIONS The results were obtained from inpatients in the neuroscience department of a single hospital. CONCLUSIONS The AM-PAC IMSF and JH-HLM had excellent interrater reliability and test-retest reliability for both physical therapists and nurses. The evaluation of convergent validity suggested that AM-PAC IMSF and JH-HLM measured constructs of patient mobility and physical functioning.
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Affiliation(s)
- Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University; Division of General Internal Medicine, Johns Hopkins University; Outcome After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel L Young
- Department of Physical Therapy, University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Box 453029, Las Vegas, NV 89154-3029; and Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Lisa M Klein
- Department of Neurosciences, Johns Hopkins Hospital, Baltimore, Maryland
| | - Julie Kreif
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University
| | - Kara Shumock
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University
| | - Stephanie Hiser
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University
| | - Michael Friedman
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University; and Outcome After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University
| | - Alan Jette
- School of Public Health, Health and Disability Research Institute, Boston University, Boston, Massachusetts
| | - Kitty S Chan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; and Outcome After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine
| | - Dale M Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University; OACIS Group, Johns Hopkins University School of Medicine; and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine
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Alqarni AM, Manlapaz D, Baxter D, Tumilty S, Mani R. Test Procedures to Assess Somatosensory Abnormalities in Individuals with Peripheral Joint Pain: A Systematic Review of Psychometric Properties. Pain Pract 2018; 18:895-924. [PMID: 29350873 DOI: 10.1111/papr.12680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/11/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Test procedures that were developed to assess somatosensory abnormalities should possess optimal psychometric properties (PMPs) to be used in clinical practice. The aim of this systematic review was to evaluate the literature to assess the level of evidence for PMPs of test procedures investigated in individuals with peripheral joint pain (PJP). METHODS A comprehensive electronic literature search was conducted in 7 databases from inception to March 2016. The Quality Appraisal for Reliability Studies (QAREL) checklist and the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) tool were used to assess risk for bias of the included studies. Level of evidence was evaluated based on the methodological quality and the quality of the measurement properties. RESULTS Forty-one studies related to PJP were included. The majority of included studies were considered to be of insufficient methodological quality, and the level of evidence for PMPs varied across different test procedures. The level of evidence for PMPs varied across different test procedures in different types of PJP. Hand-held pressure algometry is the only test procedure that showed moderate positive evidence of intrarater reliability, agreement, and responsiveness, simultaneously, when it was investigated in patients with chronic knee osteoarthritis. CONCLUSIONS This systematic review identified that the level of evidence for PMPs varied across different testing procedures to assess somatosensory abnormalities for different PJP populations. Further research with standardized protocols is recommended to further investigate the predictive ability and responsiveness of reported test procedures in order to warrant their extended utility in clinical practice.
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Affiliation(s)
- Abdullah Mohammad Alqarni
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Donald Manlapaz
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Baxter
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Johnston KN, Potter AJ, Phillips AC. Minimal important difference and responsiveness of 2-minute walk test performance in people with COPD undergoing pulmonary rehabilitation. Int J Chron Obstruct Pulmon Dis 2017; 12:2849-2857. [PMID: 29070945 PMCID: PMC5640407 DOI: 10.2147/copd.s143179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Field exercise tests (eg, 6-minute walk test [6MWT]) are important measures of functional exercise capacity in people with COPD. Shorter tests such as the 2-minute walk test (2MWT) may offer advantages in some populations but lack information about responsiveness to change. This study examined responsiveness, minimal important difference (MID), test-retest reliability, and construct validity of the 2MWT in people with stable COPD attending outpatient pulmonary rehabilitation (PR). METHODS At pre-PR assessment, study participants completed a 2MWT twice in addition to usual measures (6MWT and Chronic Respiratory Questionnaire). At post-PR assessment following a standard PR program, measures were repeated and global rating of change scores obtained (patient and therapist). Pre-post program change scores were examined for correlations with change in 2-minute walk distance (2MWD) and used (where r≥0.3) to estimate the MID through anchor-based methods. Distribution-based estimates based on standard error of measurement were examined. Test-retest reliability (intraclass correlation coefficient [ICC] and Bland-Altman agreement) and validity (Pearson correlation with 6-minute walk distance [6MWD]) were reported. RESULTS Fifty-nine people (28 men) with stable COPD, mean age 68 years (SD 10 years), and percentage predicted forced expiratory volume in 1 second 48% (SD 20%) attended pre-PR assessment. Test-retest ICC for same-session 2MWD was 0.985. A mean difference of 2.4 m (95% confidence interval [CI] 0.7-4.0 m, P=0.006) occurred between the first and second trials. 2MWD and 6MWD were highly correlated (r=0.87, P<0.001). Forty-one participants completed PR and were included in responsiveness and MID analysis. Mean 2MWD improved significantly post-PR (8.8 m, 95% CI 3.6-14 m, P=0.001). The MID in 2MWD, anchored against clinically meaningful change in 6MWD, was 5.5 m (area under curve =0.81, P=0.001). Distribution-based methods estimated an MID of 4 m. CONCLUSION Change in 2MWD of at least 5.5 m following a PR program corresponded to a clinically meaningful change. A practice test is recommended due to learning effects.
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Affiliation(s)
- Kylie Nicole Johnston
- School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Adrian James Potter
- School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Anna Caroline Phillips
- School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
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Jeong IC, Bychkov D, Hiser S, Kreif JD, Klein LM, Hoyer EH, Searson PC. Using a Real-Time Location System for Assessment of Patient Ambulation in a Hospital Setting. Arch Phys Med Rehabil 2017; 98:1366-1373.e1. [PMID: 28286202 DOI: 10.1016/j.apmr.2017.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/20/2017] [Accepted: 02/02/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the feasibility of using an infrared-based Real-Time Location System (RTLS) for measuring patient ambulation in a 2-minute walk test (2MWT) by comparing the distance walked and the Johns Hopkins Highest Level of Mobility (JH-HLM) score to clinician observation as a criterion standard. DESIGN Criterion standard validation study. SETTING Inpatient, university hospital. PARTICIPANTS Patients (N=25) in an adult neuroscience/brain rescue unit. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES RTLS and clinician-reported ambulation distance in feet, and JH-HLM score on an 8-point ordinal scale. RESULTS The RTLS ambulation distance for the 25 patients in the 2MWT was between 68 and 516ft. The mean difference between clinician-reported and RTLS ambulation distance was 8.4±11.7ft (2.7%±4.6%). The correlation between clinician-reported and RTLS ambulation distance was 97.9% (P<.01). The clinician-reported ambulation distance for 2 patients was +100ft and -99ft compared with the RTLS distance, implying clinician error in counting the number of laps (98ft). The correlation between the RTLS distance and clinician-reported distance excluding these 2 patients is 99.8% (P<.01). The accuracy of the RTLS for assessment of JH-HLM score for all 25 patients was 96%. The average patient speed obtained from RTLS data varied between 0.4 and 3.0mph. CONCLUSIONS The RTLS is able to accurately measure patient ambulation and calculate JH-HLM for a 2MWT when compared with clinician observation as the criterion standard.
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Affiliation(s)
- In Cheol Jeong
- Measurement Corps, Johns Hopkins Individualized Health Initiative, Johns Hopkins University, Baltimore, MD
| | - David Bychkov
- Measurement Corps, Johns Hopkins Individualized Health Initiative, Johns Hopkins University, Baltimore, MD
| | | | | | | | - Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
| | - Peter C Searson
- Measurement Corps, Johns Hopkins Individualized Health Initiative, Johns Hopkins University, Baltimore, MD.
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Pin TW, Choi HL. Reliability, validity, and norms of the 2-min walk test in children with and without neuromuscular disorders aged 6-12. Disabil Rehabil 2017. [PMID: 28637155 DOI: 10.1080/09638288.2017.1294208] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE The 2-min walk test may be more appropriate functional exercise test for young children. This study aimed to examine the 2-min walk test's reliability; validity; and minimal clinically important difference; and to establish norms for children aged 6-12. METHODS Sixty-one healthy children were recruited to examine the 2-min walk test's reliability. Forty-six children with neuromuscular disorders (63% cerebral palsy) were recruited to test the validity. The normative study involved 716 healthy children without neuromuscular disorders (male = 51%, female = 49%). They walked at a self-selected speed for 2 min along a smooth, flat path 15 m in length. RESULTS The mean distance covered in the 2-min walk test was 152.8 m (SD =27.5). No significant difference was found in the children's test-retest results (p > 0.05). The intra- and inter-rater reliability were high (all intra-class correlation coefficients >0.8). All children, except one with neuromuscular disorders, completed the 2-min walk test, of which the minimal clinically important difference at 95% confidence interval was 23.2 m for the entire group, 15.7 m for children walking with aids, and 16.6 m for those walking independently. CONCLUSIONS The 2-min walk test is a feasible, reliable, and valid exercise test for children with and without neuromuscular disorders aged 6-12. The first normative references and minimal clinically important difference for children with neuromuscular disorders were established for children of this age group. Implications for rehabilitation The 2-min walk test is a feasible, safe, reliable, and valid time-based walk test for children aged 6-12 years. Normative references have been established for healthy children aged 6-12 years. Minimal clinically important difference at 95% confidence interval were calculated for children with neuromuscular disorders who walked without aids (i.e., independent and stand-by supervision) and those who walked with aids equal to 16.6 and 15.7 m, respectively. Distance covered by the healthy children in the 2 min did not correlate with age, gender, height, and weight of the children.
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Affiliation(s)
- Tamis W Pin
- a Department of Rehabilitation Sciences , Hong Kong Polytechnic University , Kowloon, Hong Kong
| | - H L Choi
- a Department of Rehabilitation Sciences , Hong Kong Polytechnic University , Kowloon, Hong Kong
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Yuksel E, Kalkan S, Cekmece S, Unver B, Karatosun V. Assessing Minimal Detectable Changes and Test-Retest Reliability of the Timed Up and Go Test and the 2-Minute Walk Test in Patients With Total Knee Arthroplasty. J Arthroplasty 2017; 32:426-430. [PMID: 27639305 DOI: 10.1016/j.arth.2016.07.031] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/01/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Two-minute walk test (2MWT) and the Timed Up and Go test (TUG) are simple, quick, and can be applied in a short time as part of the routine medical examination. They were shown to be reliable and valid tests in many patient groups. The aims of the present study were: (1) to determine test-retest reliability of data for the TUG and 2MWT and (2) to determine minimal detectable change (MDC) scores for the TUG and 2MWT in patients with TKA. METHODS Forty-eight patients with total knee arthroplasty, operated by the same surgeon, were included in this study. Patients performed trials for TUG and 2MWT twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. RESULTS The TUG and 2MWT showed an excellent test-retest reliability in this study. Intraclass correlation coefficient [ICC(2,1)] for TUG and 2MWT were 0.98 and 0.97, respectively. Standard error of measurement and MDC95 for TUG were 0.82 and 2.27, respectively. Standard error of measurement and MDC95 for 2MWT were 5.40 and 14.96, respectively. CONCLUSION The TUG and 2MWT have an excellent test-retest reliability in patients with TKA. Clinicians and researchers can be confident that changes in TUG time above 2.27 seconds and changes in 2MWT distances above 14.96 meters, represent a "real" clinical change in an individual patient with TKA. We, therefore, recommend the use of these 2 tests as complementary outcome measures for functional evaluation in patients TKA.
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Affiliation(s)
- Ertugrul Yuksel
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Balçova, Izmir, Turkey
| | - Serpil Kalkan
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Balçova, Izmir, Turkey
| | - Senol Cekmece
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Balçova, Izmir, Turkey
| | - Bayram Unver
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Balçova, Izmir, Turkey
| | - Vasfi Karatosun
- Department of Orthopedics and Traumatology, School of Medicine, Dokuz Eylul University, Balçova, Izmir, Turkey
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Rossano C, Terrier P. Visually-guided gait training in paretic patients during the first rehabilitation phase: study protocol for a randomized controlled trial. Trials 2016; 17:523. [PMID: 27788679 PMCID: PMC5081976 DOI: 10.1186/s13063-016-1630-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/23/2016] [Indexed: 01/04/2023] Open
Abstract
Background After a lesion to the central nervous system, many patients suffer from reduced walking capability. In the first rehabilitation phase, repeated walking exercises facilitate muscular strength and stimulate brain plasticity and motor relearning. However, marked limping, an unsteady gait, and poor management of obstacle clearance may persist, which increases a patient’s risk of falling. Gait training with augmented reality has been recommended to improve gait coordination. The objective of this study is to test whether a gait rehabilitation program using augmented reality is superior to a conventional treadmill training program of equivalent intensity. Methods/design The GASPAR trial (Gait Adaptation for Stroke Patients with Augmented Reality) is a pragmatic, parallel-arm, single-center, nonblind, superiority randomized control trial in neurorehabilitation. The setting is a rehabilitation clinic in Switzerland. The planned number of participants is 70–100. The intervention uses instrumented treadmills equipped with projectors that display shapes on the walking surface. The principle is that patients must adapt their gait to the image that unfolds in front of them. Specific exercises for gait symmetry, coordination enhancement, and gait agility are provided. The program includes twenty 30-min sessions spanning 4 weeks. The comparator group receives standard treadmill training of a similar frequency and intensity. The main outcome to be measured in the trial is walking speed, which is assessed with the 2-min Walk Test. Moreover, gait parameters are recorded during the gait training sessions. Other outcomes are balance control (Berg Balance Scale) and the fear of falling (Falls Efficacy Scale). The statistical analyses will compare the baseline assessment for each participant (before the intervention) with a post-intervention assessment (taken a few days after the end of the program). Furthermore, a follow-up assessment will take place 3 months after discharge. Discussion The study results will provide new knowledge about recovery in neurological patients and will contribute to the design of better rehabilitation programs to accompany this process. The findings will also help health care funders to decide whether treadmills equipped with augmented reality capabilities are a worthwhile investment. Trial registration ClinicalTrials.gov ID: NCT02808078, registered on 16 June 2016.
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Affiliation(s)
- Cathia Rossano
- IRR, Institute for Research in Rehabilitation, Sion, Switzerland
| | - Philippe Terrier
- IRR, Institute for Research in Rehabilitation, Sion, Switzerland. .,Clinique romande de réadaptation SUVACare, Av. Gd-Champsec 90, 1951, Sion, Switzerland.
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Kho ME, Molloy AJ, Clarke F, Herridge MS, Koo KKY, Rudkowski J, Seely AJE, Pellizzari JR, Tarride JE, Mourtzakis M, Karachi T, Cook DJ. CYCLE pilot: a protocol for a pilot randomised study of early cycle ergometry versus routine physiotherapy in mechanically ventilated patients. BMJ Open 2016; 6:e011659. [PMID: 27059469 PMCID: PMC4838736 DOI: 10.1136/bmjopen-2016-011659] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Early exercise with in-bed cycling as part of an intensive care unit (ICU) rehabilitation programme has the potential to improve physical and functional outcomes following critical illness. The objective of this study is to determine the feasibility of enrolling adults in a multicentre pilot randomised clinical trial (RCT) of early in-bed cycling versus routine physiotherapy to inform a larger RCT. METHODS AND ANALYSIS 60-patient parallel group pilot RCT in 7 Canadian medical-surgical ICUs. We will include all previously ambulatory adult patients within the first 0-4 days of mechanical ventilation, without exclusion criteria. After informed consent, patients will be randomised using a web-based, centralised electronic system, to 30 min of in-bed leg cycling in addition to routine physiotherapy, 5 days per week, for the duration of their ICU stay (28 days maximum) or routine physiotherapy alone. We will measure patients' muscle strength (Medical Research Council Sum Score, quadriceps force) and function (Physical Function in ICU Test (scored), 30 s sit-to-stand, 2 min walk test) at ICU awakening, ICU discharge and hospital discharge. Our 4 feasibility outcomes are: (1) patient accrual of 1-2 patients per month per centre, (2) protocol violation rate <20%, (3) outcome measure ascertainment >80% at the 3 time points and (4) blinded outcomes ascertainment >80% at hospital discharge. Hospital outcome assessors are blinded to group assignment, whereas participants, ICU physiotherapists, ICU caregivers, research coordinators and ICU outcome assessors are not blinded to group assignment. We will analyse feasibility outcomes with descriptive statistics. ETHICS AND DISSEMINATION Each participating centre will obtain local ethics approval, and results of the study will be published to inform the design and conduct of a future multicentre RCT of in-bed cycling to improve physical outcomes in ICU survivors. TRIAL REGISTRATION NUMBER NCT02377830; Pre-results.
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Affiliation(s)
- Michelle E Kho
- McMaster University, School of Rehabilitation Science, Hamilton, Ontario, Canada
- Department of Physiotherapy, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alexander J Molloy
- Department of Physiotherapy, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - France Clarke
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Margaret S Herridge
- Department of Medicine, University of Toronto, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Karen K Y Koo
- Swedish Early Mobility Program in Critical Care, Swedish Medical Group, First Hill Campus, Seattle, Washington, USA
- Department of Medicine, Western University, London, Ontario, Canada
| | - Jill Rudkowski
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andrew J E Seely
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph R Pellizzari
- Consultation-Liaison Psychiatry Service, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Programs for the Assessment of Technology in Health, Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada
| | - Marina Mourtzakis
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Timothy Karachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Loyd BJ, Fields TT, Stephenson RO, Stevens-Lapsley J, Christiansen CL. Explaining modified 2-min walk test outcomes in male Veterans with traumatic or nontraumatic lower-limb amputation. ACTA ACUST UNITED AC 2016; 53:1035-1044. [PMID: 28355035 DOI: 10.1682/jrrd.2015.03.0038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 12/15/2015] [Indexed: 11/05/2022]
Abstract
Little evidence exists to support the presence of differences in spatiotemporal gait parameters and ambulation ability between those individuals with traumatic and nontraumatic lower-limb amputation (LLA). We conducted an exploratory study of 81 male Veterans with unilateral amputation to quantify differences in spatiotemporal gait parameters and ambulatory mobility between Veterans with traumatic and nontraumatic LLA. Furthermore, we identified variables that significantly contributed to the explanation of variability in modified 2-min walk test distance. All participants completed the modified 2-min walk test and a spatiotemporal gait analysis using an instrumented walkway during a routine physical therapy visit. Veterans with nontraumatic LLA walked significantly shorter mean distances during a modified 2-min walk test than Veterans with traumatic LLA. Variables identified as significant contributors to modified 2-min walk test variability were amputated limb stance time, amputated limb step length, and percentage of the gait cycle spent in double support. These findings demonstrate that differences in spatiotemporal gait parameters and ambulatory mobility exist between Veterans with traumatic and nontraumatic LLA and identify important spatiotemporal parameters of gait contributing to this decline. These parameters should be considered as targets for intervention and future investigation.
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Affiliation(s)
- Brian J Loyd
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
| | - Thomas T Fields
- Department of Physical Medicine and Rehabilitation, Denver Veterans Administration (VA) Medical Center, Denver, CO
| | - Ryan O Stephenson
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO.,Department of Physical Medicine and Rehabilitation, Denver Veterans Administration (VA) Medical Center, Denver, CO
| | - Jennifer Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO.,Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO.,Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO
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Vill K, Ille L, Schroeder SA, Blaschek A, Müller-Felber W. Six-minute walk test versus two-minute walk test in children with Duchenne muscular dystrophy: Is more time more information? Eur J Paediatr Neurol 2015; 19:640-6. [PMID: 26455815 DOI: 10.1016/j.ejpn.2015.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/12/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND/PURPOSE The six minute walk test is a widely accepted primary outcome parameter in most studies in Duchenne muscular dystrophy (DMD). To compare information obtained by the six minute walk distance (6MWD) test and the two minute walk distance (2MWD) in patients with DMD, a cohort of 13 voluntary DMD boys did a repeated six minute walking test. METHODS Patients had to be ambulatory with a physical disability according to Levels 1-3 on the Vignos-Scale for lower extremity. Measurements were taken at one minute intervals. Reliability was measured by intraclass correlation. RESULTS Test-retest reliability for 6MWD and 2MWD in two different age classes was very good for both subgroups. Test-retest-reliability was lower in patients with more advanced disability in both tests. Walking speed remained completely stable from time points 1-6 minutes in the whole study patient collective, which indicates that physical exhaustion is not reached after six minutes even in more disabled patients. CONCLUSION Thus the 6MWD in DMD patients does not give additional information as compared to a 2MWD.
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Affiliation(s)
- Katharina Vill
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
| | - Lena Ille
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
| | - Sebastian A Schroeder
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
| | - Astrid Blaschek
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
| | - Wolfgang Müller-Felber
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
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Application of ICF Model to a Patient With Home Mechanical Ventilation. Cardiopulm Phys Ther J 2015. [DOI: 10.1097/cpt.0000000000000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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