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Alghamdi NH, Pohlig RT, Seymore KD, Sions JM, Crenshaw JR, Grävare Silbernagel K. Immediate and Short-Term Effects of In-Shoe Heel-Lift Orthoses on Clinical and Biomechanical Outcomes in Patients With Insertional Achilles Tendinopathy. Orthop J Sports Med 2024; 12:23259671231221583. [PMID: 38332846 PMCID: PMC10851750 DOI: 10.1177/23259671231221583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 07/31/2023] [Indexed: 02/10/2024] Open
Abstract
Background Physical therapists frequently employ heel lifts as an intervention to reduce Achilles tendon pain and restore function. Purpose To determine the short-term effect of heel lifts on clinical and gait outcomes in participants with insertional Achilles tendinopathy (IAT). Study Design Case series; Level of evidence, 4. Methods Participants with IAT underwent eligibility screening and completed assessments at baseline and 2 weeks later. Primary outcomes included symptom severity (Victoria Institute of Sports Assessment-Achilles [VISA-A]), gait analysis with the 10-m walk-test at 2 speeds (normal and fast), and pain during walking. Pain and gait analysis were assessed under 3 conditions: before fitting 20-mm heel lifts, immediately after heel-lift fitting, and after 2 weeks of wearing heel lifts. Ultrasound images and measurements at the Achilles insertion were obtained from prone and standing positions (with and without heel lifts). Spatiotemporal gait parameters and tibial tilt angles were evaluated at normal speed using inertia measurement units during the 3 study conditions. Differences between the conditions were analyzed using paired t test or analysis of variance. Results Overall, 20 participants (12 female, 13 with bilateral IAT; mean age, 51 ± 9.3 years; mean body mass index 31.6 ± 6.8 kg/m2) completed all assessments. Symptom severity (VISA-A) of the more symptomatic side significantly improved at 2 weeks (60 ± 20.6) compared with baseline (52.2 ± 20.4; P < .01). Pain during gait (Numeric Pain Rating Scale) was significantly reduced immediately after heel-lift fitting (0.7 ± 2.0) when compared with baseline (2.2 ± 2.7, P = .043). Spatiotemporal gait parameters and tibial tilt angle before and after using heel lifts at normal walking speed were not significantly different; however, gait speed, stride length, and tibial tilt angle on both sides increased significantly immediately after using heel lifts and were maintained after 2 weeks of wear. Conclusion Using heel lifts not only improved symptom severity after 2 weeks but also immediately reduced pain during gait and had a positive impact on gait pattern and speed.
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Affiliation(s)
- Nabeel Hamdan Alghamdi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ryan T. Pohlig
- Department of Epidemiology, University of Delaware, Newark, Delaware, USA
| | - Kayla D. Seymore
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA
- Biomechanics and Movements Science Program, University of Delaware, Newark, Delaware, USA
| | - Jaclyn Megan Sions
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA
- Biomechanics and Movements Science Program, University of Delaware, Newark, Delaware, USA
| | - Jeremy R. Crenshaw
- Biomechanics and Movements Science Program, University of Delaware, Newark, Delaware, USA
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Karin Grävare Silbernagel
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, Delaware, USA
- Biomechanics and Movements Science Program, University of Delaware, Newark, Delaware, USA
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Laksmi PW, Purnamasari D, Sofian N, Sari NK, Kurniawan M, Sukrisman L, Tahapary DL, Dwimartutie N, Rinaldi I. Physio-cognitive decline syndrome among middle-aged diabetes patients: Handgrip strength significantly correlates with glycaemic control and cognitive score. Heliyon 2024; 10:e24018. [PMID: 38293379 PMCID: PMC10827469 DOI: 10.1016/j.heliyon.2024.e24018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Aims To investigate the correlation between glycaemic control with component of Physio-Cognitive Decline Syndrome (PCDS) and among each component of PCDS itself. Methods A cross sectional study was conducted (January 2021-November 2022) at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia on consecutively recruited T2DM outpatients aged 40-59 years old. Data on the latest three months HbA1c, hand grip strength (HGS), usual gait speed (GS), and Indonesian Montreal Cognitive Assessment (MoCA-Ina) were evaluated. Pearson or Spearman's test was used to analyse the correlations. Results There were 133 subjects with median age 53 (40-59) years. The PCDS was found in 48.1 % subjects, of which 64.1 % with uncontrolled glycaemia. Significant correlations were found between HGS and HbA1c (r = -0.24, R2 = 0.06, p < 0.01) and MoCA-Ina score (r = 0.21, R2 = 0.04, p < 0.05). Conclusion The higher HbA1c and the lower MoCA-Ina score, the weaker handgrip strength was.
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Affiliation(s)
- Purwita Wijaya Laksmi
- Geriatric Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dyah Purnamasari
- Endocrinology, Metabolism, and Diabetes Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular, and Aging Research Center, The Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Naldo Sofian
- Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nina Kemala Sari
- Geriatric Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Mohammad Kurniawan
- Department of Neurology, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Lugyanti Sukrisman
- Medical Hematology and Oncology Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dicky Levenus Tahapary
- Endocrinology, Metabolism, and Diabetes Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Metabolic Disorder, Cardiovascular, and Aging Research Center, The Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Noto Dwimartutie
- Geriatric Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ikhwan Rinaldi
- Medical Hematology and Oncology Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Kuo YL, Lin KY, Wu MH, Wu CH, Tsai YJ. Transabdominal ultrasonography-guided biofeedback training for pelvic floor muscles integrated with stabilization exercise improved pregnancy-related pelvic girdle pain and disability: a randomized controlled trial. Physiotherapy 2024; 124:106-115. [PMID: 38875838 DOI: 10.1016/j.physio.2024.01.005] [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: 10/14/2022] [Revised: 12/14/2023] [Accepted: 01/20/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES Investigate effects of integrated training for pelvic floor muscles (PFM) with and without transabdominal ultrasonography (TAUS) imaging-guided biofeedback in postpartum women with pregnancy-related pelvic girdle pain (PPGP). DESIGN Three-arm, single-blinded randomized controlled trial SETTING: University laboratory PARTICIPANTS: Fifty-three postpartum women with PPGP randomized into stabilization exercise with TAUS-guided biofeedback (BIO+EXE), exercise (EXE), and control (CON) groups. INTERVENTIONS The BIO+EXE and EXE groups underwent an 8-week exercise program, with the BIO+EXE group receiving additional TAUS-guided biofeedback for PFM training during the first 4 weeks. The CON group only received a pelvic educational session. MAIN OUTCOME MEASURES Primary outcomes included self-reported pain (numeric rating scale) and disability (pelvic girdle questionnaire). Secondary outcomes included functional tests (active straight leg raising [ASLR] fatigue, timed up-and-go, and 6-meter walking tests) and muscle contractibility indicated by muscle thickness changes for abdominal muscles and bladder base displacement for PFM (ultrasonographic measures). RESULTS The BIO+EXE group had lower pain [1.8 (1.5) vs. 4.4 (1.5), mean difference -2.6, 95% confidence interval (CI) -3.9 to -1.2] and disability [14% (10) vs. 28% (21), mean difference -14, 95% CI -25 to -2] and faster walking speed [3.1 seconds (1) vs. 3.3 seconds (1), mean difference -0.2, 95% CI -1.0 to -0.2] than the CON group. The EXE group only had lower pain intensity compared to the CON group [2.7 (2.0) vs. 4.4 (1.5), mean difference -1.7, 95% CI -3.1 to -0.4]. No significant differences were observed among groups in timed up-and-go, ASLR fatigue, or muscle contractibility. CONCLUSIONS Integrated training for PFM and stabilization with TAUS-guided biofeedback seems to be beneficial for reducing pain and disability in postpartum women with PPGP. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Yi-Liang Kuo
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuan-Yin Lin
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Hsing Wu
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chi-Hsuan Wu
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ju Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Ueyama H, Kanemoto N, Minoda Y, Taniguchi Y, Nakamura H. Perioperative Essential Amino Acid Supplementation Facilitates Quadriceps Muscle Strength and Volume Recovery After TKA: A Double-Blinded Randomized Controlled Trial. J Bone Joint Surg Am 2023; 105:345-353. [PMID: 36856692 DOI: 10.2106/jbjs.22.00675] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Perioperative essential amino acid (EAA) supplementation suppresses lower-limb muscle atrophy and promotes functional improvement in the first 4 weeks after total knee arthroplasty (TKA). However, its effect on the recovery of muscle volume and strength in the intermediate term is unclear. The aim of this study was to evaluate the effect of perioperative EAA supplementation on the recovery of lower-limb muscle volume and strength in the 2 years after TKA. METHODS Sixty patients who underwent unilateral TKA for primary knee osteoarthritis were included in this double-blinded randomized controlled trial. After excluding dropouts, 26 patients assigned to the EAA group (9 g/day) and 26 assigned to the placebo group (powdered lactose, 9 g/day) were available for analysis. Patients received EAA supplementation or a placebo from 1 week prior to surgery to 2 weeks after it. The rectus femoris muscle area was measured using ultrasonography and quadriceps muscle strength was measured isometrically with a handheld dynamometer, preoperatively and periodically up to 2 years postoperatively. Knee pain, knee range of motion, functional mobility, and Knee Society Score 2011 subjective scores were measured at each time point. Perioperative management, except for supplementation, was identical in the 2 groups. RESULTS Taking the baseline as 100%, the mean values in the EAA and placebo groups were 134% ± 31% and 114% ± 27%, respectively, for the rectus femoris muscle area and 159% ± 54% and 125% ± 40% for the quadriceps muscle strength, respectively, at 2 years after surgery. The differences were significant (p < 0.05). Clinical outcomes were not significantly different between the 2 groups. CONCLUSIONS Perioperative EAA supplementation contributes to the recovery of rectus femoris muscle volume and quadriceps muscle strength in the 2 years after TKA. The EAA supplementation did not impact clinical outcomes. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.,Department of Orthopedic Surgery, Tanabe Central Hospital, Tanabe City, Wakayama, Japan.,Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Japan
| | - Narihiro Kanemoto
- Department of Orthopedic Surgery, Tanabe Central Hospital, Tanabe City, Wakayama, Japan
| | - Yukihide Minoda
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Japan
| | - Yoshiki Taniguchi
- Department of Orthopedic Surgery, Tanabe Central Hospital, Tanabe City, Wakayama, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Japan
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5
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Nascimento WLCD, Moura DM, Almeida KDO, Gomes-Neto M, Jezler SFDO, Alves IGN. Lung and physical function in post COVID-19 and clinical and functional associations: a cross-sectional study in Brazil. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221436. [PMID: 37075368 PMCID: PMC10176661 DOI: 10.1590/1806-9282.20221436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/02/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE The purpose of this study was to assess exercise capacity, lung and physical function in COVID-19 survivors, and the association of lesion-level characteristics assessed by chest computed tomography, probable sarcopenia, and percentage of diffusing capacity of the lung for carbon monoxide with clinical and functional variables. METHODS This study was conducted in Salvador, Bahia, Brazil. All patients had a laboratory-confirmed SARS-CoV-2 infection. The sociodemographic characteristics, COVID-19 exposure history, pulmonary function, computed tomography, and functionality of the participants between 1 and 3 months of diagnosis of the disease were collected. RESULTS A total of 135 patients after COVID-19 recovery were included in this study. Probable sarcopenia, reduction in percentage of diffusing capacity of the lung for carbon monoxide, and a lower 6-min walk distance were observed after COVID-19 infection. Computed tomography>50% was associated with a longer length of stay and a lower percentage of diffusing capacity of the lung for carbon monoxide. Probable sarcopenia diagnosis was associated with a worse percentage of the predicted 6-min walk distance in relation to the predicted, absolute 6-min walk distance (m), percentage of diffusing capacity of the lung for carbon monoxide, and percentage of total lung capacity. CONCLUSION Muscle disability and lung dysfunction are common in COVID-19 survivors. Hospitalization was associated with the worst muscle force and diffusing capacity of the lung for carbon monoxide. Computed tomography characteristics could be a marker of prolonged hospital stay after the acute phase of COVID-19. Additionally, the probable diagnosis of sarcopenia could be a marker of impact on walking distance. These results highlight the need for long-term follow-up of those patients and rehabilitation programs.
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Affiliation(s)
| | | | | | - Mansueto Gomes-Neto
- Universidade Federal da Bahia, Department of Physiotherapy - Salvador (BA), Brazil
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6
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Dierick F, Bouché AF, Guérin S, Steinmetz JP, Federspiel C, Barvaux V, Buisseret F. Quasi-experimental pilot study to improve mobility and balance in recurrently falling nursing home residents by voluntary non-targeted side-stepping exercise intervention. BMC Geriatr 2022; 22:1006. [PMID: 36585630 PMCID: PMC9804952 DOI: 10.1186/s12877-022-03696-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Side-stepping is a potential exercise program to reduce fall risk in community-dwelling adults in their seventies, but it has never been tested in nursing home residents. This was a pilot quasi-experimental study to examine the feasibility and potential mobility and balance benefits of an intervention based on voluntary non-targeted side-stepping exercises in nursing home residents who fall recurrently. METHODS Twenty-two participants were recruited and non-randomly assigned to an intervention group ([Formula: see text]11, side-stepping exercises, STEP) participating in an 8-week protocol and to a control group ([Formula: see text]11, usual physiotherapy care, CTRL). They were clinically assessed at 4-time points: baseline, after 4 and 8 weeks, and after a 4-week follow-up period (usual physiotherapy care). Statistical differences between time points were assessed with a Friedman repeated measures ANOVA on ranks or a one-way repeated measures ANOVA. RESULTS Compared to baseline, significant benefits were observed in the STEP group at 8 weeks for the Timed Up and Go ([Formula: see text]0.020) and 6-minute walking test ([Formula: see text]0.001) as well as for the Berg Balance Scale ([Formula: see text]0.041) and Mini motor test ([Formula: see text]0.026). At follow-up, the Tinetti Performance Oriented Mobility Assessment and Berg Balance Scale significantly worsened in the STEP group ([Formula: see text]0.009 and [Formula: see text]0.001, respectively). No significant differences were found between the groups at the same time points. CONCLUSIONS Our intervention was feasible and improved mobility and balance after almost 8 weeks. Studies with larger samples and randomized control trials are needed to consolidate our preliminary observations and confirm the deterioration of some tests when side-stepping exercises are discontinued. TRIAL REGISTRATION Identifier: ISRCTN13584053. Retrospectively registered 01/09/2022.
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Affiliation(s)
- Frédéric Dierick
- Centre National de Rééducation Fonctionnelle et de Réadaptation – Rehazenter, Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Rue André Vésale 1, 2674 Luxembourg, Luxembourg
| | - Anne-France Bouché
- “Le Richemont”, Physiotherapy Department, Korian Group, Rue de L’Enclos 13, 5537 Bioul-Anhée, Belgium
| | - Serge Guérin
- INSEEC Grande Ecole, Avenue Claude Vellefaux 27, 75010 Paris, France
| | | | | | - Vincent Barvaux
- grid.466351.30000 0004 4684 7362Haute Ecole Louvain en Hainaut, Rue de l’Hôpital 2, 6060 Gilly, Belgium
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Liddle J, Ireland D, Krysinska K, Harrison F, Lamont R, Karunanithi M, Kang K, Reppermund S, Sachdev PS, Gustafsson L, Brauer S, Pachana NA, Brodaty H. Lifespace metrics of older adults with mild cognitive impairment and dementia recorded via geolocation data. Australas J Ageing 2021; 40:e341-e346. [PMID: 34698431 DOI: 10.1111/ajag.13007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Lifespace, the physical area in which someone conducts life activities, indicates lived community mobility. This study explored the feasibility of technology-based lifespace measurement for older people with dementia and mild cognitive impairment (MCI), including the generation of a range of lifespace metrics, and investigation of relationships with health and mobility status. METHODS An exploratory study was conducted within a longitudinal observational study. Eighteen older adults (mean age 86.7 years (SD: 3.2); 8 men; 15 MCI), participated. Lifespace metrics were generated from geolocation data (GPS and Bluetooth beacon) collected through a smartphone application for one week (2015-2016). Cognitive and mobility-related outcomes were compared from study data sets at baseline (2005-2007) and 6-year follow-up (2011-2014). RESULTS Lifespace data could be collected from all participants, and metrics were generated including percentage of time at home, maximum distance from home, episodes of travel in a week, days in a week participants left home, lifespace area (daily, weekly and total), indoor lifespace (regions in the home/hour), and a developed lifespace score that combined time, frequency of travel, distance and area. Results indicated a large range of lifespace areas (0.1 - 97.88 km2 ; median 6.77 km2 ) with similar patterns across lifespace metrics. Significant relationships were found between lifespace metrics and concurrent driving status and anteceding scores on the sit-to-stand test (at baseline and follow-up). CONCLUSIONS Further longitudinal exploration of lifespace is required to develop an understanding of the nature of lifespace of older community-dwelling people, and its relationship with health, mobility and well-being outcomes.
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Affiliation(s)
- Jacki Liddle
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Qld, Australia
| | - David Ireland
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Qld, Australia
| | - Karolina Krysinska
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.,Centre for Mental Health, School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia
| | - Fleur Harrison
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
| | - Robyn Lamont
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - Mohan Karunanithi
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Qld, Australia
| | - Kristan Kang
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
| | - Simone Reppermund
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
| | - Louise Gustafsson
- School of Allied Health Sciences, Griffith University, Brisbane, Qld, Australia
| | - Sandra Brauer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - Nancy A Pachana
- School of Psychology, University of Queensland, Brisbane, Qld, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
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Thilarajah S, Bower KJ, Williams G, Clark RA, Tan D, Pua YH. Paretic and Nonparetic Step Tests Are Noninterchangeable in Stroke: A Prospective Cohort Study. Phys Ther 2021; 101:6134189. [PMID: 33587141 DOI: 10.1093/ptj/pzab060] [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: 05/15/2020] [Revised: 11/20/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The step test (ST) is a common clinical assessment of dynamic balance among survivors of stroke. The ST assesses a person's ability to place their paretic (paretic ST) or nonparetic (nonparetic ST) foot rapidly and repeatedly on and off a standardized block while standing. No study has formally explored if the 2 tests are interchangeable. Our study aimed to: (1) differentiate the correlates of paretic and nonparetic ST, and (2) compare their associations with physical function and falls. METHODS Eighty-one survivors of stroke were consecutively recruited from inpatient rehabilitation units (n = 4) and were assessed within 1 week prior to discharge. In addition to the ST, a handheld dynamometer and computerized posturography were used to measure lower limb muscle strength and standing balance, respectively. Self-selected gait speed and Timed Up and Go test were also assessed as measures of physical function. Falls data were monitored for 12 months post discharge using monthly calendars. Multivariable regression analyses were used to differentiate (1) the correlates of paretic and nonparetic STs, and (2) their associations with physical function and falls. RESULTS The median score for the paretic and nonparetic STs were 8 and 9 steps, respectively. Paretic ankle plantar-flexor and dorsiflexor strength were the strongest correlates of nonparetic ST, whereas both paretic ankle and knee extensor strength were the strongest correlates of paretic ST. In multivariable analyses adjusting for each other, both STs were independently associated with gait speed and Timed Up and Go scores. Paretic ST (odds ratio = 0.37; 95% CI = 0.22 to 0.62) was a stronger predictor than nonparetic ST (odds ratio = 0.51; 95% CI = 0.34 to 0.78) in predicting future falls. CONCLUSION This study confirmed that the paretic and nonparetic STs are noninterchangeable. ST scores should be assessed separately to achieve a more complete interpretation. IMPACT To our knowledge, this study is the first to objectively evaluate the similarities and differences between paretic and nonparetic STs. This information may refine the use and interpretation of the 2 STs for survivors of stroke.
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Affiliation(s)
| | - Kelly J Bower
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gavin Williams
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.,Epworth HealthCare, Richmond, Melbourne, Victoria, Australia
| | - Ross A Clark
- School of Health and Exercise Science, The University of the Sunshine Coast, Queensland, Australia
| | - Dawn Tan
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore
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9
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Cheng DKY, Dagenais M, Alsbury-Nealy K, Legasto JM, Scodras S, Aravind G, Takhar P, Nekolaichuk E, Salbach NM. Distance-limited walk tests post-stroke: A systematic review of measurement properties. NeuroRehabilitation 2021; 48:413-439. [PMID: 33967070 PMCID: PMC8293643 DOI: 10.3233/nre-210026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/15/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Improving walking capacity is a key objective of post-stroke rehabilitation. Evidence describing the quality and protocols of standardized tools for assessing walking capacity can facilitate their implementation. OBJECTIVE To synthesize existing literature describing test protocols and measurement properties of distance-limited walk tests in people post-stroke. METHODS Electronic database searches were completed in 2017. Records were screened and appraised for quality. RESULTS Data were extracted from 43 eligible articles. Among the 12 walk tests identified, the 10-metre walk test (10mWT) at a comfortable pace was most commonly evaluated. Sixty-three unique protocols at comfortable and fast paces were identified. Walking pace and walkway surface, but not walkway length, influenced walking speed. Intraclass correlation coefficients for test-retest reliability ranged from 0.80-0.99 across walk tests. Measurement error values ranged from 0.04-0.40 and 0.06 to 0.20 for the 10mWT at comfortable and fast and paces, respectively. Across walk tests, performance was most frequently correlated with measures of strength, balance, and physical activity (r = 0.26-0.8, p < 0.05). CONCLUSIONS The 10mWT has the most evidence of reliability and validity. Findings indicate that studies that include people with severe walking deficits, in acute and subacute phases of recovery, with improved quality of reporting, are needed.
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Affiliation(s)
- Darren Kai-Young Cheng
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | | | - Kyla Alsbury-Nealy
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | - Jean Michelle Legasto
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | - Stephanie Scodras
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | - Gayatri Aravind
- Michener Institute of Education, University Health Network, Canada
| | - Pam Takhar
- Department of Physical Therapy, University of Toronto, Canada
| | - Erica Nekolaichuk
- Gerstein Science Information Centre, University of Toronto, Toronto, ON, Canada
| | - Nancy Margaret Salbach
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Canada
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10
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Lee PY, Huang JC, Tseng HY, Yang YC, Lin SI. Effects of Trunk Exercise on Unstable Surfaces in Persons with Stroke: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239135. [PMID: 33297451 PMCID: PMC7730209 DOI: 10.3390/ijerph17239135] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022]
Abstract
Background: Improving balance-related ability is an important goal in stroke rehabilitation. Evidence is needed to demonstrate how this goal could be better achieved. Aim: Determine if trunk exercises on unstable surfaces would improve trunk control and balance for persons in the subacute stage of stroke. Design: An assessor-blind randomized controlled trial. Setting: Inpatients in the department of rehabilitation in a general hospital. Population: Patients who suffered a first-time stroke with onset from one to six months. Methods: Inpatients with stroke were assigned to upper limb exercises (control group, n = 17) or trunk exercises on unstable surfaces (experimental group, n = 18) to receive training twice a week for six weeks, in addition to their daily conventional stroke rehabilitation. Sensorimotor function tests, including hand grip, plantar sensitivity, stroke rehabilitation assessment of movement and Fugl-Meyer lower extremity motor scale, and clinical outcome assessments, including Trunk Impairment Scale and 6 m walk test, were conducted before and after six weeks of training. The center of the pressure area while maintaining static posture and peak displacement while leaning forward, as well as the average speed of raising the unaffected arm, were measured in sitting without foot support, sitting with foot support and standing to reflect trunk control, sitting balance and standing balance, respectively. Results: The between-group differences in the sensorimotor functions were nonsignificant before and after training. Compared with the control group, the experimental group had significantly greater forward leaning and faster arm raising in sitting without foot support, higher Trunk Impairment Scale total score, and shorter 6 m walking time after training, but not before training. Conclusion: Trunk exercises on unstable surfaces could further improve trunk control, the ability to raise the unaffected arm rapidly in sitting, and walking for persons in the subacute stage of stroke. This intervention may be considered to be included in stroke rehabilitation.
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Affiliation(s)
- Pei-Yun Lee
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (P.-Y.L.); (J.-C.H.)
| | - Jhen-Cih Huang
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (P.-Y.L.); (J.-C.H.)
| | - Hui-Yu Tseng
- Department of Rehabilitation Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan 701, Taiwan;
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Sang-I Lin
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (P.-Y.L.); (J.-C.H.)
- Correspondence: ; Tel.: +886-6-2353535 (ext. 5020); Fax: +886-6-2370411
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11
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Bessa NPOS, Lima Filho BFD, Medeiros CSPD, Ribeiro TS, Campos TF, Cavalcanti FADC. Effects of exergames training on postural balance in patients who had a chronic stroke: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e038593. [PMID: 33148737 PMCID: PMC7643507 DOI: 10.1136/bmjopen-2020-038593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Exergames training, as an additional therapy to standard care, has been widely used for motor recovery after patients who had a stroke, and it is a valuable and positive tool in the rehabilitation of this population. This study describes a single-blind randomised clinical trial that will aim to investigate the effects of exergames training on postural balance in patients with chronic stroke. METHODS AND ANALYSIS Forty-two individuals with chronic stroke (>6 months), aged 20-75 years, will be randomised into two groups: the experimental group, which will be subjected to an exergames protocol, and control group, which will undergo a kinesiotherapy protocol. Both protocols are based on postural balance. The intervention will consist of 40-minute sessions two times per week for 10 consecutive weeks. The volunteers will be evaluated before the treatment, at the end of the interventions and 8 weeks thereafter. The primary outcome will be postural balance (Berg Balance Scale, Functional Reach Test, Timed Up and Go test and Centre of Pressure variables) and secondary outcomes will include gait (6 m timed walk and Kinovea Software), cortical activation patterns (electroencephalography Emotiv EPOC), functional independence (Functional Independence Measure), quality of life (Stroke-Specific Quality of Life Scale) and motivation (Intrinsic Motivation Inventory). ETHICS AND DISSEMINATION This protocol was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (number 3.434.350). The results of the study will be disseminated to participants through social networks and will be submitted to a peer-reviewed journal and scientific meetings. TRIAL REGISTRATION NUMBER Brazilian Registry of Clinical Trials (RBR-78v9hx).
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Affiliation(s)
| | | | | | - Tatiana Souza Ribeiro
- Departament of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Tânia Fernandes Campos
- Departament of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
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12
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Ueyama H, Kanemoto N, Minoda Y, Taniguchi Y, Nakamura H. 2020 Chitranjan S. Ranawat Award: Perioperative essential amino acid supplementation suppresses rectus femoris muscle atrophy and accelerates early functional recovery following total knee arthroplasty. Bone Joint J 2020; 102-B:10-18. [PMID: 32475274 DOI: 10.1302/0301-620x.102b6.bjj-2019-1370.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIMS The aim of this study was to assess the effectiveness of perioperative essential amino acid (EAA) supplementation to prevent rectus femoris muscle atrophy and facilitate early recovery of function after total knee arthroplasty (TKA). METHODS The study involved 60 patients who underwent unilateral TKA for primary knee osteo-arthritis (OA). This was a double-blind, placebo-controlled, randomized control trial with patients randomly allocated to two groups, 30 patients each: the essential amino acid supplementation (9 g daily) and placebo (lactose powder, 9 g daily) groups. Supplementation and placebo were provided from one week before to two weeks after surgery. The area of the rectus femoris muscle were measured by ultrasound imaging one month before surgery and one, two, three, and four weeks postoperatively. The serum albumin level, a visual analogue knee pain score, and mobility were also measured at each time point. The time to recovery of activities of daily living (ADLs) was recorded. Postoperative nutrition and physiotherapy were identical in both groups. RESULTS The mean relative change from baseline was as follows for the amino acid group: 116% in rectus femoris muscle area (71% to 206%); 95% in serum albumin (80% to 115%) and 39% in VAS pain (0% to 100%) at four weeks after surgery. These values in the placebo group were: 97% in muscle area (68 to 155); 89% in serum albumin (71% to 100%) and 56% in VAS pain four weeks after surgery (0% to 100%). All changes were statistically significant (p < 0.05). The mean time to recovery of ADLs was shorter in the amino acid group compared with the placebo group (p = 0.005). CONCLUSION Perioperative essential amino acid supplementation prevents rectus femoris muscle atrophy and accelerates early functional recovery after TKA. Cite this article: Bone Joint J 2020;102-B(6 Supple A):10-18.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan, Department of Orthopaedic Surgery, Tanabe Central Hospital, Wakayama, Japan
| | - Narihiro Kanemoto
- Department of Orthopaedic Surgery, Tanabe Central Hospital, Wakayama, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Taniguchi
- Department of Orthopaedic Surgery, Tanabe Central Hospital, Wakayama, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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13
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Lanzola G, Bagarotti R, Sacchi L, Salvi E, Alloni A, Picardi M, Sterpi I, Boninsegna R, Corbo M, Quaglini S. Bringing spatiotemporal gait analysis into clinical practice: Instrument validation and pilot study of a commercial sensorized carpet. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 188:105292. [PMID: 31923818 DOI: 10.1016/j.cmpb.2019.105292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/01/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE We illustrate a low-cost platform easing the estimation of spatio-temporal parameters (GA-STP) ready for large-scale deployment in fall prevention. METHODS We used a commercial sensorized carpet with a limited cost and a very coarse resolution. An instrument validation test was accomplished: the Wilcoxon test for paired samples and the correlation test with Spearman method were used to compare the values computed by the platform with reference ones. Hierarchical clustering using Ward's method and ROC curves have been used to assess the performance in a pilot study enrolling patients. RESULTS Validation shows no significant difference between computed and reference values of gait speed (ρ-value:0.99; p-value:2.2E-16), step number (ρ-value:0.91; p-value:5.8E-16) and stride-length (ρ-value:0.92; p-value:7.5E-9). The clinical pilot study confirms that the platform may also be used to track the improvements occurring during a rehabilitation program. CONCLUSIONS We believe that the use of a commercial carpet makes the solution proposed ready to be deployed on a large scale for effectively bringing GA into the clinical practice.
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Affiliation(s)
- Giordano Lanzola
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy.
| | - Riccardo Bagarotti
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Lucia Sacchi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Elisa Salvi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | | | - Michela Picardi
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico (CCP), Milano, Italy
| | - Irma Sterpi
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico (CCP), Milano, Italy
| | - Rosangela Boninsegna
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico (CCP), Milano, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico (CCP), Milano, Italy
| | - Silvana Quaglini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
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14
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Joseph C, Rhoda A, Conradsson DM. Levels and patterns of physical activity in stroke survivors with different ambulation status living in low-income areas of Cape Town, South Africa. Top Stroke Rehabil 2020; 27:494-502. [PMID: 32188361 DOI: 10.1080/10749357.2020.1741242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Little is known about physical activity (PA) in people with stroke living in low-income areas. The aim of this study was to characterize and contrast the levels and patterns of PA between stroke survivors with different ambulation status living in low-income areas in Cape Town, South Africa. Methods: In this cross-sectional study, 45 community-dwelling stroke survivors living in low-income areas in Cape Town participated. Accelerometers (Actigraph wGT3X-BT) were used to assess PA levels (vector magnitude counts and number of steps) and time spent sedentary, in light and moderate-to-vigorous PA (MVPA). Total daily PA and within-day activity patterns were compared between limited community ambulators (gait speed: <0.8 m/s) and community ambulators (gait speed: ≥0.8 m/s). Results: Limited community ambulators (n = 23) took fewer steps per day (1091 vs. 3524 steps, P < .001), spent more time sedentary (80% vs 68%, P = .002) and less time in light PA (18% vs 25%, P = .008) and MVPA (1% vs 5%, P < .001) than community ambulators (n = 22). The limited ambulation group had a consistent pattern of PA across the day without any significant variations in PA levels or intensity, whereas the unlimited ambulating group was most active in the morning followed by a gradual reduction in PA throughout the day. Conclusions: Community ambulating stroke survivors showed greater PA levels and a more variable diurnal pattern in contrast to the limited ambulation group. Different interventions may be required to assist the different groups to start engaging in health-enhancing PA.
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Affiliation(s)
- Conran Joseph
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University , Cape Town, South Africa
| | - Anthea Rhoda
- Faculty of Community and Health Sciences, Physiotherapy Department, University of the Western Cape , Cape Town, South Africa
| | - David Moulaee Conradsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet , Stockholm, Sweden.,Function Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital , Stockholm, Sweden
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15
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Liu Y, Gong F. Determination of whether supplemental oxygen therapy is beneficial during exercise training in patients with COPD: A systematic review and meta-analysis. Exp Ther Med 2019; 18:4081-4089. [PMID: 31616520 PMCID: PMC6781835 DOI: 10.3892/etm.2019.8026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/09/2019] [Indexed: 12/03/2022] Open
Abstract
Exercise training is an integral component of the pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to systematically search the published literature and analyze the evidence on the efficacy of supplemental oxygen in improving outcomes during exercise training in patients with COPD. The PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and Google scholar databases were searched electronically for articles in the English language published up to May, 2019. In total, 7 trials were included in this systematic review and meta-analysis. There was considerable heterogeneity amongst the included studies. Meta-analysis indicated no significant difference in power (random: MD = −2.38; 95% CI, −5.79 to 1.03; P=0.86) and maximum energy expenditure (VO2 max) (random: MD = −0.01; 95% CI, −0.06 to 0.07; P=0.45) between the oxygen and control groups on maximal exercise testing. Qualitative analysis of the included studies revealed no benefits of supplemental oxygen in improving exercise capacity and dyspnea scores. Data on the quality of life assessed by the Chronic Respiratory Disease Questionnaire was pooled for 95 participants in the study group and 91 participants in the control group. The results indicated no beneficial effects of supplemental oxygen in improving quality of life outcomes (random: MD = −0.09; 95% CI, −0.16 to −0.01; P=0.59). On the whole, the findings of this study indicate that supplemental oxygen during the exercise training of patients with COPD does not improve exercise capacity, dyspnea scores and quality of life. However, the quality of the evidence is weak. Multi-center randomized controlled trials with homogenous methodology and intervention are required to provide stronger evidence on this subject.
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Affiliation(s)
- Ying Liu
- Fourth Department of Respiratory and Critical Care Medicine, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan 410005, P.R. China
| | - Fanghua Gong
- Department of Nursing, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan 410005, P.R. China
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16
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Effects of high intensity speed-based treadmill training on ambulatory function in people with chronic stroke: A preliminary study with long-term follow-up. Sci Rep 2019; 9:1985. [PMID: 30760772 PMCID: PMC6374472 DOI: 10.1038/s41598-018-37982-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/17/2018] [Indexed: 12/12/2022] Open
Abstract
High intensity treadmill training has shown to be beneficial for stroke survivors, yet the feasibility and long-term effects remain unclear. In this study, we aimed to determine whether a 4-week high intensity speed-based treadmill training (HISTT) is feasible for chronic stroke survivors, and we examined its effects on ambulatory function, and long-term retention. Sixteen individuals post-stroke participated in 40 minutes of HISTT for four weeks at a frequency of three sessions per week. Gait speed was measured using the 10-meter walk test, endurance was measured using the 6-minute walk test, and quality of life was assessed using the Stroke Impact Scale (SIS) at baseline, post-training, and at 3-month follow-up. All participants successfully completed the training without any serious adverse events. Participants significantly increased fastest walking speed by 19%, self-selected walking speed by 18%, and walking endurance by 12% after the training. These improvements were maintained for 3 months after the intervention. Our results indicate that this modified speed-based high intensity walking program has the potential to be a feasible and effective method of gait training for stroke survivors. However, the small sample size and lack of a control group warrant caution in interpretation of results. Further studies are recommended to better understand effectiveness of this protocol in combination with other physical therapy interventions for functional recovery after stroke.
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Innovative Exercise as an Intervention for Older Adults with Knee Osteoarthritis: A Pilot Feasibility Study. Can J Aging 2018; 38:111-121. [DOI: 10.1017/s0714980818000454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RÉSUMÉL’exercice peut diminuer la morbidité associée à l’arthrose du genou. Nous avons réalisé une étude auprès de 22 participants avec arthrose du genou (68 % de femmes) ayant en moyenne 69,5 ans (ÉT : 7,4). Les participants ont été aléatoirement assignés à un groupe d’exercice de marche carrée (square-stepping exercise; SSE; 2 fois/semaine pour 24 semaines) ou à un groupe contrôle. Nous avons évalué la faisabilité (recrutement et présence) du SSE et son efficacité en lien avec les symptômes (WOMAC), l’équilibre (Fullerton), la mobilité (test de la chaise de 30 secondes) et la vitesse de marche après 12 et 24 semaines. Le groupe SSE avait un taux de présence de 49,3% et sa performance au test de la chaise de 30 secondes tendait à s’améliorer après 12 semaines (F=1,8, p=0,12, ηp2=0,16) et 24 semaines (F=3,4, p=0,09, ηp2=0,18), tout comme sa vitesse de marche à 24 semaines (F=2,4, p=0,14, ηp2=0,14), comparativement au groupe contrôle, en contrôlant pour les données de base. Aucune différence n’a été observée sur le plan des symptômes ou de l’équilibre. Les taux de présence et de recrutement faibles indiquent une faisabilité limitée du SSE chez les personnes âgées avec arthrose du genou. Les tendances observées suggèrent que le SSE peut améliorer la fonction du membre inférieur et la vitesse de marche. Les études futures sur le programme SSE devraient se pencher sur son efficacité en lien avec les symptômes et l’équilibre, et viser l’amélioration de sa faisabilité.
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18
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Corrigendum to "The Effects of Fermented Laminaria japonica on Short-Term Working Memory and Physical Fitness in the Elderly". EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:1764038. [PMID: 30271450 PMCID: PMC6151247 DOI: 10.1155/2018/1764038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/15/2018] [Indexed: 11/30/2022]
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Associations Between Bicycling and Reduced Fall-Related Physical Performance in Older Adults. J Aging Phys Act 2018; 26:514-519. [PMID: 29182418 DOI: 10.1123/japa.2017-0243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Falls among older adults remain a significant public health issue. Bicycling positively influences falls risk factors including reduced balance, muscle weakness, and low self-perceived confidence in maintaining balance. However, this association has not been systematically examined. We recruited 107 community-dwelling participants aged 65 years and older in the Netherlands to determine the relationship between bicycling and falls risk factors. Participants completed three questionnaires on cycling behavior and balance confidence, and also undertook five falls-related physical performance tasks encompassing tests of balance, strength, gait, and endurance. On average, current bicyclists showed significantly better scores in all physical tasks and confidence compared with nonriders ranging from a 10% difference in 6-m walk time to a 141% difference in single-leg balance time (all ps = .01). Type of bike used and duration of bicycling displayed varied associations (.01 < ps < .79). Our findings suggest that bicycle riding warrants further prospective investigation for fall prevention and active aging.
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Tan CK, Kadone H, Watanabe H, Marushima A, Yamazaki M, Sankai Y, Suzuki K. Lateral Symmetry of Synergies in Lower Limb Muscles of Acute Post-stroke Patients After Robotic Intervention. Front Neurosci 2018; 12:276. [PMID: 29922121 PMCID: PMC5996914 DOI: 10.3389/fnins.2018.00276] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 04/09/2018] [Indexed: 01/24/2023] Open
Abstract
Gait disturbance is commonly associated with stroke, which is a serious neurological disease. With current technology, various exoskeletons have been developed to provide therapy, leading to many studies evaluating the use of such exoskeletons as an intervention tool. Although these studies report improvements in patients who had undergone robotic intervention, they are usually reported with clinical assessment, which are unable to characterize how muscle activations change in patients after robotic intervention. We believe that muscle activations can provide an objective view on gait performance of patients. To quantify improvement of lateral symmetry before and after robotic intervention, muscle synergy analysis with Non-Negative Matrix Factorization was used to evaluate patients' EMG data. Eight stroke patients in their acute phase were evaluated before and after a course of robotic intervention with the Hybrid Assistive Limb (HAL), lasting over 3 weeks. We found a significant increase in similarity between lateral synergies of patients after robotic intervention. This is associated with significant improvements in gait measures like walking speed, step cadence, stance duration percentage of gait cycle. Clinical assessments [Functional Independence Measure-Locomotion (FIM-Locomotion), FIM-Motor (General), and Fugl-Meyer Assessment-Lower Extremity (FMA-LE)] showed significant improvements as well. Our study shows that muscle synergy analysis can be a good tool to quantify the change in neuromuscular coordination of lateral symmetry during walking in stroke patients.
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Affiliation(s)
- Chun Kwang Tan
- Artificial Intelligence Laboratory, University of Tsukuba, Tsukuba, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hiroki Watanabe
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan.,Faculty of Engineering, University of Tsukuba, Tsukuba, Japan
| | - Kenji Suzuki
- Artificial Intelligence Laboratory, University of Tsukuba, Tsukuba, Japan.,Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan.,Faculty of Engineering, University of Tsukuba, Tsukuba, Japan
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Hutin E, Ghédira M, Loche CM, Mardale V, Hennegrave C, Gracies JM, Bayle N. Intra- and inter-rater reliability of the 10-meter ambulation test in hemiparesis is better barefoot at maximal speed. Top Stroke Rehabil 2018; 25:345-350. [PMID: 29663851 DOI: 10.1080/10749357.2018.1460932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives Reliability of clinical tests to evaluate ambulation in chronic hemiparesis may vary according to the testing condition. The 10-meter ambulation test (AT10) assesses walking speed and step length over 10 m, starting and ending in seated position. In the present study, we compared the intra- and inter-reliability of AT10 in chronic hemiparesis in four different conditions: with shoes and barefoot, at free and maximal safe speed. Methods Ten patients with hemiparesis, >1 year post-stroke (age 45 ± 12, time since stroke 16 ± 9 months, mean ± SD) participated in the reliability study (registration, ID-RCB-2017-A00090-53). All patients performed the AT10 twice, one week apart, in each of the four conditions. The number of steps and time to complete the task were manually recorded by four independent raters. The main outcome measurements were the intraclass correlation coefficients (ICC), coefficients of variation (CV), and mean raw differences (DIFF) of the three parameters of AT10 (speed, step length, and cadence) in each of the four conditions. Effects of wearing shoes and speed condition were explored using ANOVA. Results Across all conditions, mean intra- and inter-rater ICCs were, respectively, 98.5 ± 0.1 and 99.9 ± 0.1% for speed, 98.3 ± 0.1 and 99.7 ± 0.2% for step length, and 96.5 ± 0.1 and 98.9 ± 0.6% for cadence. Mean intra- and inter-rater CV for speed were 0.051 ± 0.016 and 0.022 ± 0.002, respectively. Intra-rater reliability of speed assessments was higher at maximal than at free speed (ICC, CV, DIFF, p < 0.05). At free speed, intra-rater ICCs were higher barefoot than with shoes (p < 0.05). Discussion Performing the 10-meter ambulation test barefoot at maximal speed optimizes its reliability.
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Affiliation(s)
- Emilie Hutin
- a Laboratoire Analyse et Restauration du Mouvement (ARM), Bioingénierie, Tissus et Neuroplasticité (BIOTN), EA 7377 , Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC) , Créteil , France
| | - Mouna Ghédira
- a Laboratoire Analyse et Restauration du Mouvement (ARM), Bioingénierie, Tissus et Neuroplasticité (BIOTN), EA 7377 , Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC) , Créteil , France
| | - Catherine-Marie Loche
- a Laboratoire Analyse et Restauration du Mouvement (ARM), Bioingénierie, Tissus et Neuroplasticité (BIOTN), EA 7377 , Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC) , Créteil , France.,b Service de Rééducation Neurolocomotrice , Hôpital Albert Chenevier, Assistance Publique des Hôpitaux de Paris (AP-HP) , Créteil , France
| | - Valentina Mardale
- a Laboratoire Analyse et Restauration du Mouvement (ARM), Bioingénierie, Tissus et Neuroplasticité (BIOTN), EA 7377 , Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC) , Créteil , France.,b Service de Rééducation Neurolocomotrice , Hôpital Albert Chenevier, Assistance Publique des Hôpitaux de Paris (AP-HP) , Créteil , France
| | - Catherine Hennegrave
- a Laboratoire Analyse et Restauration du Mouvement (ARM), Bioingénierie, Tissus et Neuroplasticité (BIOTN), EA 7377 , Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC) , Créteil , France.,b Service de Rééducation Neurolocomotrice , Hôpital Albert Chenevier, Assistance Publique des Hôpitaux de Paris (AP-HP) , Créteil , France
| | - Jean-Michel Gracies
- a Laboratoire Analyse et Restauration du Mouvement (ARM), Bioingénierie, Tissus et Neuroplasticité (BIOTN), EA 7377 , Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC) , Créteil , France.,b Service de Rééducation Neurolocomotrice , Hôpital Albert Chenevier, Assistance Publique des Hôpitaux de Paris (AP-HP) , Créteil , France
| | - Nicolas Bayle
- a Laboratoire Analyse et Restauration du Mouvement (ARM), Bioingénierie, Tissus et Neuroplasticité (BIOTN), EA 7377 , Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC) , Créteil , France.,b Service de Rééducation Neurolocomotrice , Hôpital Albert Chenevier, Assistance Publique des Hôpitaux de Paris (AP-HP) , Créteil , France
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Broderick P, Horgan F, Blake C, Hickey P, O'Reilly J, Ehrensberger M, Simpson D, Roberts D, Monaghan K. Mirror therapy and treadmill training for a patient with chronic stroke: A case report. Physiother Theory Pract 2018; 35:478-488. [PMID: 29589777 DOI: 10.1080/09593985.2018.1453903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION A large proportion of patients with chronic stroke have permanent lower limb functional disability leading to reduced levels of independent mobility. Individually, both mirror therapy and treadmill training have been shown to improve aspects of lower limb functioning in patients with stroke. This case report examined whether a new combination of both interventions would lead to improvements in lower limb functional disability for a patient with chronic stroke. CASE DESCRIPTION The participant was a 50-year-old female who had a left middle cerebral artery infarction (47 months' post stroke). Due to hemiparesis, she had lower limb motor impairment and gait deficits. INTERVENTION The participant engaged in a combination of mirror therapy and treadmill training for 30 minutes per day, 3 days per week, for 4 weeks. OUTCOMES Modified Ashworth Scale, Fugl-Meyer Assessment-Lower Extremity and the 10 m Walk Test demonstrated clinically meaningful change. The 6 Minute Walk Test did not demonstrate meaningful change. DISCUSSION The positive outcomes from this new combination therapy for this participant are encouraging given the relatively small dose of training and indicate the potential benefit of mirror therapy as an adjunct to treadmill training for enhancing lower limb muscle tone, motor function and walking velocity in patients with chronic stroke.
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Affiliation(s)
- Patrick Broderick
- a Department of Science , Institute of Technology Sligo , Sligo , Ireland
| | - Frances Horgan
- b Department of Physiotherapy , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Catherine Blake
- c Department of Health Science , University College Dublin , Dublin , Ireland
| | - Paula Hickey
- d Department of Geriatrics , Sligo University Hospital , Sligo , Ireland
| | - Joanne O'Reilly
- e Department of Physiotherapy , Sligo University Hospital , Sligo , Ireland
| | | | - Daniel Simpson
- a Department of Science , Institute of Technology Sligo , Sligo , Ireland
| | - David Roberts
- f Department of Design , Institute of Technology Sligo , Sligo , Ireland
| | - Kenneth Monaghan
- g Department of Health Science , Institute of Technology Sligo , Sligo , Ireland
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Uygur M, Bellumori M, Knight CA. Effects of a low-resistance, interval bicycling intervention in Parkinson's Disease. Physiother Theory Pract 2017; 33:897-904. [PMID: 28812404 DOI: 10.1080/09593985.2017.1359868] [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] [Indexed: 10/19/2022]
Abstract
Previous studies have shown that people with Parkinson's disease (PD) benefit from a variety of exercise modalities with respect to symptom management and function. Among the possible exercise modalities, speedwork has been identified as a promising strategy, with direct implications for the rate and amplitude of nervous system involvement. Considering that previous speed-based exercise for PD has often been equipment, personnel and/or facility dependent, and often time intensive, our purpose was to develop a population-specific exercise program that could be self-administered with equipment that is readily found in fitness centers or perhaps the home. Fourteen individuals with PD (Hoehn-Yahr (H-Y) stage of 3.0 or less) participated in twelve 30-min sessions of low-resistance interval training on a stationary recumbent bicycle. Motor examination section of the Unified Parkinson's Disease Rating Scale (UPDRS), 10-meter walk (10mW), timed-up-and-go (TUG), functional reach, four-square step test (4SST), nine-hole peg test (9HPT) and simple reaction time scores all exhibited significant improvements (p < 0.05). These results add further support to the practice of speedwork for people with PD and outline a population-amenable program with high feasibility.
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Affiliation(s)
- Mehmet Uygur
- a Department of Health and Exercise Science , Rowan University , Glassboro , NJ , USA
| | - Maria Bellumori
- b Kinesiology Department , California State University , Monterey Bay , CA , USA
| | - Christopher A Knight
- c Department of Kinesiology and Applied Physiology , University of Delaware , Newark , DE , USA
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Joseph C, Conradsson D, Hagströmer M, Lawal I, Rhoda A. Objectively assessed physical activity and associated factors of sedentary behavior among survivors of stroke living in Cape Town, South Africa. Disabil Rehabil 2017. [PMID: 28625084 DOI: 10.1080/09638288.2017.1338761] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To investigate objectively measured physical activity in stroke survivors living in low-income areas of Cape Town, South Africa, specifically to: (a) describe the volume of daily physical activity and time spent in different intensity levels and (b) investigate the association of factors covering the International Classification of Functioning, Disability and Health with sedentary behavior. MATERIALS AND METHODS A cross-sectional design was used, where forty-five ambulatory community-dwelling stroke survivors participated. Volume and intensity of physical activity were assessed with accelerometers for three to five consecutive days. Personal and environmental factors, along with body function and activity, were captured. Multiple linear regression was used to investigate factors associated with the percentage of days spent sedentary. RESULTS The median number of steps per day was 2393, and of the average 703 minutes of wear time, 80% were spent in sedentary, 15% in light, and 5% in moderate-to-vigorous intensity physical activity. Age, stroke severity, and failing to receive outpatient rehabilitation were independently associated with sedentary, which, taken together, explained 52% of the variance. CONCLUSIONS Low volumes of physical activity and high amount of sedentary time emphasize the need to develop strategies that will increase physical activity. Providing outpatient rehabilitation in a systematic manner post-stroke is a potential target of health care programs in order to reduce sedentary behavior. Implications for rehabilitation Objectively measured physical activity among community-dwelling survivors of stroke in Cape Town, South Africa was low in volume, and the majority did not meet the recommendations of 150 minutes of at least moderate intensity physical activity. The majority of stroke survivors in South Africa spent most of their time sedentary, which could further increase the risk of cardiovascular impairments. Outpatient rehabilitation should be provided to all patients after stroke since it appears to reduce sedentary time.
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Affiliation(s)
- Conran Joseph
- a Physiotherapy Department , University of the Western Cape , Cape Town , South Africa.,b Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Stockholm , Sweden
| | - David Conradsson
- b Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Stockholm , Sweden.,c Functional Area Occupational Therapy & Physiotherapy , Allied Health Professionals Function, Karolinska University Hospital , Stockholm , Sweden
| | - Maria Hagströmer
- b Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Stockholm , Sweden.,c Functional Area Occupational Therapy & Physiotherapy , Allied Health Professionals Function, Karolinska University Hospital , Stockholm , Sweden
| | - Isa Lawal
- a Physiotherapy Department , University of the Western Cape , Cape Town , South Africa
| | - Anthea Rhoda
- a Physiotherapy Department , University of the Western Cape , Cape Town , South Africa
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Lee D, Lee G, Jeong J. Mirror Therapy with Neuromuscular Electrical Stimulation for improving motor function of stroke survivors: A pilot randomized clinical study. Technol Health Care 2017; 24:503-11. [PMID: 26890230 DOI: 10.3233/thc-161144] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study was to investigate the effects of Mirror Therapy (MT) combined with Neuromuscular Electrical Stimulation (NMES) on muscle strength and tone, motor function, balance, and gait ability in stroke survivors with hemiplegia. METHODS This study was a randomized controlled trial. Twenty-seven hemiplegic stroke survivors from a rehabilitation center participated in the study. The participants were randomly assigned to either an experimental or a control group. The experimental group (n = 14) underwent MT combined with NMES and conventional physical therapy, and the control group (n = 13) underwent conventional physical therapy alone. Muscle strength and tone, balance, and gait ability were examined at baseline and after 4 weeks of intervention. A hand-held dynamometer was used to assess muscle strength, the Modified Ashworth Scale (MAS) was used to assess muscle tone, the Berg Balance Scale (BBS) and Timed Up and Go test (TUG) were used to ascertain balance, and the 6-m Walk Test (6mWT) was used to examine gait ability. RESULTS After the intervention, compared to baseline values, there were significant improvements in muscle strength and MAS, BBS, TUG, and 6mWT values in the experimental group (P< 0.05). In addition, at post-intervention, there were significant differences between the two groups in muscle strength and BBS (P< 0.05). CONCLUSION MT combined with NMES may effectively improve muscle strength and balance in hemiplegic stroke survivors. However, further studies are necessary to demonstrate brain reorganization after MT combined with NMES.
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Affiliation(s)
- DongGeon Lee
- Department of Physical Therapy, Kyungnam University, Changwon, Korea
| | - GyuChang Lee
- Department of Physical Therapy, Kyungnam University, Changwon, Korea
| | - JiSim Jeong
- Saessac Children Developmental Center, Changwon, Korea
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Bring J, Bring A. Measuring gait – how the choice of measure can affect the statistical results and the clinical interpretation. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2016.1229026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Johan Bring
- Department of Mathematics and Statistics, Gävle University, Gävle, Sweden
| | - Annika Bring
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Morris ME, Menz HB, McGinley JL, Watts JJ, Huxham FE, Murphy AT, Danoudis ME, Iansek R. A Randomized Controlled Trial to Reduce Falls in People With Parkinson’s Disease. Neurorehabil Neural Repair 2015; 29:777-85. [DOI: 10.1177/1545968314565511] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Falls are common and disabling in people with Parkinson’s disease (PD). There is a need to quantify the effects of movement rehabilitation on falls in PD. Objective. To evaluate 2 physical therapy interventions in reducing falls in PD. Methods. We randomized 210 people with PD to 3 groups: progressive resistance strength training coupled with falls prevention education, movement strategy training combined with falls prevention education, and life-skills information (control). All received 8 weeks of out-patient therapy once per week and a structured home program. The primary end point was the falls rate, recorded prospectively over a 12 month period, starting from the completion of the intervention. Secondary outcomes were walking speed, disability, and quality of life. Results. A total of 1547 falls were reported for the trial. The falls rate was higher in the control group compared with the groups that received strength training or strategy training. There were 193 falls for the progressive resistance strength training group, 441 for the movement strategy group and 913 for the control group. The strength training group had 84.9% fewer falls than controls (incidence rate ratio [IRR] = 0.151, 95% CI 0.071-0.322, P < .001). The movement strategy training group had 61.5% fewer falls than controls (IRR = 0.385, 95% CI 0.184-0.808, P = .012). Disability scores improved in the intervention groups following therapy while deteriorating in the control group. Conclusions. Rehabilitation combining falls prevention education with strength training or movement strategy training reduces the rate of falls in people with mild to moderately severe PD and is feasible.
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Affiliation(s)
| | | | | | | | | | - Anna T. Murphy
- Kingston Centre, Monash Health, Cheltenham, Victoria, Australia
| | | | - Robert Iansek
- La Trobe University, Bundoora, Victoria, Australia
- Kingston Centre, Monash Health, Cheltenham, Victoria, Australia
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Fisher S, Lucas L, Adam Thrasher T. Robot-Assisted Gait Training for Patients with Hemiparesis Due to Stroke. Top Stroke Rehabil 2015; 18:269-76. [DOI: 10.1310/tsr1803-269] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mentiplay BF, Adair B, Bower KJ, Williams G, Tole G, Clark RA. Associations between lower limb strength and gait velocity following stroke: A systematic review. Brain Inj 2014; 29:409-22. [DOI: 10.3109/02699052.2014.995231] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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30
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Uygur M, Bellumori M, LeNoir K, Poole K, Pretzer-Aboff I, Knight CA. Immediate effects of high-speed cycling intervals on bradykinesia in Parkinson's disease. Physiother Theory Pract 2014; 31:77-82. [DOI: 10.3109/09593985.2014.972530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Miller KJ, Hunt MA, Pollock CL, Bryant D, Garland SJ. Protocol for a randomized controlled clinical trial investigating the effectiveness of Fast muscle Activation and Stepping Training (FAST) for improving balance and mobility in sub-acute stroke. BMC Neurol 2014; 14:187. [PMID: 25300433 PMCID: PMC4207320 DOI: 10.1186/s12883-014-0187-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 09/17/2014] [Indexed: 11/14/2022] Open
Abstract
Background Following stroke, many people have difficulty activating their paretic muscles quickly and with sufficient power to regain their balance by taking quick and effective steps. Reduced dynamic balance and mobility following stroke, or ‘walking balance’, is associated with reduced self-efficacy and restrictions in daily living activities, community integration, and quality of life. Targeted training of movement speeds required to effectively regain balance has been largely overlooked in post-stroke rehabilitation. The Fast muscle Activation and Stepping Training (FAST) program incorporates fast functional movements known to produce bursts of muscle activation essential for stepping and regaining standing balance effectively. The purpose of this study is to: 1) compare the effectiveness of an outpatient FAST program to an active control outpatient physiotherapy intervention in improving walking balance following stroke, and 2) explore potential mechanisms associated with improvements in walking balance. Methods/Design This will be an assessor-blinded, parallel group randomized controlled trial design. Sixty participants (30 per group) who have sustained a stroke within the previous six months will be randomly assigned with stratification for lower limb motor recovery to receive twelve 45-minute 1:1 physiotherapy intervention sessions over 6 – 10 weeks in an outpatient setting of either: 1) FAST intervention - systematic and progressive practice of fast squatting and stepping exercises, or 2) active control - conventional physiotherapy directed at improving balance and mobility that includes no targeted fast movement training. The same blinded research physiotherapist will assess outcomes at three time points: 1) baseline (prior to intervention), 2) follow up (within one week post-intervention); and 3) retention (one month post-intervention). The primary outcome is dynamic balance assessed using the Community Balance and Mobility Scale. We will also assess fast and self-selected walking speed, balance self-efficacy, and the ability to respond to internal and external perturbations to balance and associated changes in postural muscle activation. Discussion The targeted training of fast functional movements in the FAST program is expected to improve walking balance following stroke compared to the active control intervention. Unique to this study is the investigation of potential mechanisms associated with improvements in walking balance. Trial registration NCT01573585 Electronic supplementary material The online version of this article (doi:10.1186/s12883-014-0187-y) contains supplementary material, which is available to authorized users.
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Combs SA, Diehl MD, Filip J, Long E. Short-distance walking speed tests in people with Parkinson disease: reliability, responsiveness, and validity. Gait Posture 2014; 39:784-8. [PMID: 24246801 DOI: 10.1016/j.gaitpost.2013.10.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 09/08/2013] [Accepted: 10/21/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The aims of this study were to determine test-retest reliability and responsiveness of short-distance walking speed tests for persons with Parkinson disease (PD). Discriminant and convergent validity of walking speed tests were also examined. METHODS Eighty-eight participants with PD (mean age, 66 years) with mild to moderate severity (stages 1-4 on the Hoehn and Yahr Scale) were tested on medications. Measures of activity included the comfortable and fast 10-m walk tests (CWT, FWT), 6-min walk test (6MWT), mini balance evaluations systems test (mini-BEST Test), fear of falling (FoF), and the Activity-Specific Balance Confidence Scale (ABC). The mobility subsection of the PD quality of life-39 (PDQ39-M) served as a participation-based measure. RESULTS Test-retest reliability was high for both walking speed measures (CWT, ICC(2,1) = 0.98; FWT, ICC(2,1) = 0.99). Minimal detectable change (MDC(95)) for the CWT and FWT was 0.09 m/s and 0.13 m/s respectively. Participants at Hoehn & Yahr levels 3/4 demonstrated significantly slower walking speed with the CWT and FWT than participants at Hoehn & Yahr levels 1 and 2 (P < .01). The CWT and FWT were both significantly (P ≤ .002) correlated with all activity and participation-based measures. CONCLUSIONS Short-distance walking speed tests are clinically useful measures for persons with PD. The CWT and FWT are highly reliable and responsive to change in persons with PD. Short distance walking speed can be used to discriminate differences in gait function between persons with mild and moderate PD severity. The CWT and FWT had moderate to strong associations with other activity and participation based measures demonstrating convergent validity.
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Affiliation(s)
- Stephanie A Combs
- Krannert School of Physical Therapy, University of Indianapolis, 1400 East Hanna Avenue, Indianapolis, IN 46227, United States.
| | - M Dyer Diehl
- Krannert School of Physical Therapy, University of Indianapolis, 1400 East Hanna Avenue, Indianapolis, IN 46227, United States.
| | - Jacqueline Filip
- Krannert School of Physical Therapy, University of Indianapolis, 1400 East Hanna Avenue, Indianapolis, IN 46227, United States.
| | - Erin Long
- Krannert School of Physical Therapy, University of Indianapolis, 1400 East Hanna Avenue, Indianapolis, IN 46227, United States.
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Farag I, Sherrington C, Kamper SJ, Ferreira M, Moseley AM, Lord SR, Cameron ID. Measures of physical functioning after hip fracture: construct validity and responsiveness of performance-based and self-reported measures. Age Ageing 2012; 41:659-64. [PMID: 22798380 DOI: 10.1093/ageing/afs090] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES this study aimed to investigate the construct validity and responsiveness of performance-based and self-reported measures of strength, mobility and balance after hip fracture. DESIGN secondary analysis of clinical trial data. SUBJECTS a total of 148 older people undergoing hip fracture rehabilitation. METHODS correlation coefficients assessed construct validity. Internal responsiveness was assessed by calculating effect sizes (ES) I and II. Area under the receiver operating characteristic curve (AUC) assessed external responsiveness with change in EuroQol as the reference. RESULTS correlations between performance-based and self-reported measures were small to medium (strength r = 0.17, mobility r = 0.45 and balance r = 0.37). The most responsive performance-based measures included walking speed (ESI 1.7, ESII 1.2), Physical Performance and Mobility Examination (ESI 1.3, ESII 1.0) and chair-rise test (ESI 1.1, ESII 0.8). Self-reported mobility (ESI 0.8, ESII 0.6) and strength (ESI 0.8, ESII 0.6) were more responsive than self-reported balance (ESI 0.3, ESII 0.2). External responsiveness (AUC) was greatest for walking speed (0.72) and lowest for the measures of body sway (0.53). CONCLUSION self-reported and performance-based indices appear to assess different constructs and may provide complementary information about physical functioning in people after hip fracture. Measures of strength and mobility showed greater ability to detect change than measures of balance.
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Affiliation(s)
- I Farag
- George Institute for Global Health, University of Sydney, Sydney, Australia.
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van Bloemendaal M, van de Water ATM, van de Port IGL. Walking tests for stroke survivors: a systematic review of their measurement properties. Disabil Rehabil 2012; 34:2207-21. [PMID: 22583082 DOI: 10.3109/09638288.2012.680649] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To provide an overview of walking tests including their measurement properties that have been used in stroke survivors. METHOD Electronic databases were searched using specific search strategies. Retrieved studies were selected by using specified inclusion criteria. A modified consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist was applied for methodological quality assessment of the included studies. A quality assessment for statistical outcomes was used to assess measurement properties of the walking tests. Tests that were included were categorized according to the framework of the international classification of functioning, disability and health (ICF). RESULTS Thirty-two studies, evaluating 23 walking tests, were included. The tests assessed walking using the outcome measures of walking speed, walking distance, functional ambulation and walking on different surfaces. The methodological design and statistical methods of most studies evaluating reliability and criterion validity were sufficient, and found the outcome measures to be reliable and valid. However, data on measurement error, minimal important difference and minimal important change were lacking and responsiveness was correctly evaluated in one study only. CONCLUSIONS Many walking tests have been clinimetrically evaluated in stroke survivors. Most walking tests were found to be reliable and valid.
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Effectiveness of a targeted exercise intervention in reversing older people's mild balance dysfunction: a randomized controlled trial. Phys Ther 2012; 92:24-37. [PMID: 21979272 DOI: 10.2522/ptj.20100289] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous research has mainly targeted older people with high risk of falling. The effectiveness of exercise interventions in older people with mild levels of balance dysfunction remains unexplored. OBJECTIVE This study evaluated the effectiveness of a home balance and strength exercise intervention in older people systematically screened as having mild balance dysfunction. DESIGN This was a community-based, randomized controlled trial with assessors blinded to group allocation. PARTICIPANTS Study participants were older people who reported concerns about their balance but remained community ambulant (n=225). After a comprehensive balance assessment, those classified as having mild balance dysfunction (n=165) were randomized into the trial. INTERVENTION Participants in the intervention group (n=83) received a 6-month physical therapist-prescribed balance and strength home exercise program, based on the Otago Exercise Program and the Visual Health Information Balance and Vestibular Exercise Kit. Participants in the control group (n=82) continued with their usual activities. OUTCOME MEASURES Laboratory and clinical measures of balance, mobility, and strength were assessed at baseline and at a 6-month reassessment. RESULTS After 6 months, the intervention group (n=59) significantly improved relative to the control group (n=62) for: the Functional Reach Test (mean difference=2.95 cm, 95% confidence interval [CI]=1.75 to 4.15), the Step Test (2.10 steps/15 seconds, 95% CI=1.17 to 3.02), hip abductor strength (0.02, 95% CI=0.01 to 0.03), and gait step width (2.17 cm, 95% CI=1.23 to 3.11). There were nonsignificant trends for improvement on most other measures. Fourteen participants in the intervention group (23.7%) achieved balance performance within the normative range following the exercise program, compared with 3 participants (4.8%) in the control group. LIMITATIONS Loss to follow-up (26.6%) was slightly higher than in some similar studies but was unlikely to have biased the results. CONCLUSIONS A physical therapist-prescribed home exercise program targeting balance and strength was effective in improving a number of balance and related outcomes in older people with mild balance impairment.
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