OBJECTIVE:

To refine the Transfer Assessment Instrument (TAI 2.0), develop a training program for the TAI and analyze TAI 3.0's basic psychometric properties, including reliability, standard error of measurement (SEM), minimal detectable change (MDC) and construct validity.

DESIGN:

repeated measures

SETTING:

2011 National Disabled Veterans Winter Sports Clinic in Snowmass, Colorado, United States of America

PARTICIPANTS:

Forty-one wheelchair users who perform sitting-pivot or standing pivot transfers.

INTERVENTION:

Not applicable.

MAIN OUTCOME MEASURES:

Transfer Assessment Instrument version 3.0, intraclass correlation coefficients (ICC), SEMs and MDCs for reliable measurement of raters' responses. Spearman's correlation coefficient, one-way ANOVA, and independent t-tests to evaluate construct validity.

RESULTS:

TAI 3.0 had acceptable to high levels of reliability (range: 0.74 to 0.88). The SEMs for part 1, part 2 and final scores ranged from 0.45 to 0.75. The minimal detectable change was 1.5 points on the 10 point scale for the final score. There were weak correlations (rho ranged from -0.13 to 0.25, p>0.11) between TAI final scores and subjects' characteristics (e.g. gender, body mass index, age, type of disability, length of wheelchair use, grip and elbow strength, and sitting balance).

CONCLUSIONS:

With comprehensive training the refined TAI 3.0 yields high reliability among raters of different clinical backgrounds and experience. TAI 3.0 was unbiased towards certain physical characteristics that may influence transfer. TAI fills a void in the field by providing a quantitative measurement of transfers and a tool that can be used to detect problems and guide transfer training.

OBJECTIVES:

To determine if shear modulus in upper trapezius muscle myofascial trigger points (MTrPs) reduces acutely following dry needling (DN). The secondary objective was to determine if a change in posture from sitting to prone affects shear modulus.

DESIGN:

Ultrasound images were acquired in B mode with a linear transducer oriented in the transverse plane, followed by performance of SWE pre and post DN and during sitting and prone.

SETTING:

University.

PARTICIPANTS:

Seven female participants (46 ± 17 years old) with palpable MTrPs were recruited.

INTERVENTION:

All participants were dry needled in prone using solid filament needles that were inserted and manipulated inside the MTrPs. SWE was performed before and after DN in sitting and prone.

MAIN OUTCOME MEASURE:

MTrPs were evaluated by shear modulus using SWE.

RESULTS:

Palpable reductions in stiffness were noted post DN and in prone position. These changes were apparent in the shear modulus map obtained with ultrasound SWE. With significant main effects, shear modulus reduced from pre to post DN (P < 0.01) and from sitting to prone position (P < 0.05). No significant interaction effect between time and posture was observed.

CONCLUSION:

Shear modulus measured with ultrasound SWE reduced post DN and in prone compared with sitting, in agreement with reductions in palpable stiffness. These findings suggested that DN and posture have significant effects on shear modulus of MTrPs, and that shear modulus measurement with ultrasound SWE may be sensitive enough to detect these effects.

OBJECTIVE:

To conduct a systematic review of evidence surrounding the effects of exercise training on physical fitness, mobility, fatigue and health-related quality of life in adults with MS. Data Sources: The databases included: EMBASE 1980 to 2011 Week 12; Ovid MEDLINE(R) and Ovid OLDMEDLINE(R) 1947 to March Week 3 2011; PsycINFO 1967 to March Week 4 2011; CINAHL all-inclusive; SportDiscus all-inclusive; Cochrane Library all-inclusive; PEDro all-inclusive.

STUDY SELECTION:

The review was limited to English language studies (published prior to December 2011) of people with MS that evaluated the effects of exercise training on outcomes of physical fitness, mobility, fatigue, and/or health related quality of life.

DATA EXTRACTION:

One research assistant extracted data and rated study quality. A second research assistant verified the extraction and quality assessment.

DATA SYNTHESIS:

From the 4362 studies identified, 54 studies were included in the review. The extracted data were analyzed using a descriptive approach. There was strong evidence that exercise performed 2 times per week at a moderate intensity increases aerobic capacity and muscular strength. The evidence was not consistent regarding the effects of exercise training on other outcomes.

CONCLUSIONS:

Among those with mild to moderate disability from MS, there is sufficient evidence that exercise training is effective for improving both aerobic capacity and muscular strength. Exercise may improve mobility, fatigue, and health related quality of life.

OBJECTIVES:

To investigate sensory and sensorimotor function in violin and viola players with and without neck pain.

DESIGN:

Prospective, cross-sectional study.

SETTING:

University laboratory, Australia.

PARTICIPANTS:

A convenience sample of 22 violin players with playing related neck pain, 21 violinists without neck pain and 21 healthy non-musician comparison subjects.

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURES:

Thermal pain thresholds (cold and heat) and pressure pain thresholds (PPTs) over the cervical spine and over a remote region (tibialis anterior muscle). Motor performance tests including reactions times, speed of movement, accuracy, coordination and tapping speed assessed with a special upper limb test battery (The Human Performance Measurement/Basic Elements of Performance).

RESULTS:

Musicians with neck pain had significantly lower heat and elevated cold pain thresholds as well as lower PPTs over C5/6 (p < 0.01) and over the tibialis anterior (p <0.05). Motor performance tests revealed no differences between the symptomatic and asymptomatic musicians and non-musician comparison groups (p > 0.05).

CONCLUSIONS:

Violin players with neck pain demonstrated signs of sensory impairment suggesting that playing-related neck pain may be associated with augmented central pain processing consistent with findings in other neck pain groups. No differences were evident in the motor performance tests. Fine motor skills of violin players may be better assessed in the context of playing their musical instruments before definitive conclusions can be drawn about the presence or not of sensorimotor impairments in this group of musicians with playing-related neck pain.

OBJECTIVE:

To determine the feasibility of a randomized controlled trial investigating the effectiveness of physiotherapy for sleep disturbance in chronic low back pain (≥12 weeks; CLBP).

DESIGN:

Randomized controlled trial with evaluations at baseline, 3 and 6 months.

SETTING:

Outpatient physiotherapy department in academic teaching hospital.

PARTICIPANTS:

Participants with CLBP were randomly assigned to a walking programme (WP n=20: mean age ±SD, 46.4 ±13.8y), supervised exercise class (SEC n=20: mean age ±SD, 41.3 ± 11.9y) or usual physiotherapy (UP n=20: mean age ±SD, 47.1 ±14.3y). The 3 month evaluation was completed by 44 participants (73%), and 42 (70%) completed the 6 month evaluation.

INTERVENTIONS:

Participants received a physiotherapy delivered 8 week WP, an 8 week group SEC [one class per week] or one-to-one UP [advice, manual therapy and exercise].

MAIN OUTCOME MEASURES:

Sleep was assessed by the self-reported Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Pittsburgh Sleep Diary, and objective actigraphy.

RESULTS:

The groups were comparable at baseline. The majority (95%, n=57) of participants had sleep disturbance. The acceptability of actigraphy was excellent at baseline (58/60 participants), but dropped at three months (n=26/44). There were improvements on the PSQI and ISI in all groups at 3 and 6 months, with predominantly medium effect sizes [Cohen's d= 0.2 to 0.5].

CONCLUSIONS:

The high prevalence of sleep disturbance indicated the feasibility of good recruitment in future trials. The PSQI would be a suitable screening tool and outcome measure, alongside an objective non-obtrusive sleep outcome measure. The effectiveness of physiotherapy for sleep disturbance in CLBP warrants investigation in a fully powered randomized controlled trial.

OBJECTIVE:

To describe the quality of patients' continuity experiences in a population of outpatients receiving post-acute rehabilitation care, and to check which elements and types of continuity most strongly determine their satisfaction with care and functional changes.

DESIGN:

A cross-sectional self-report survey.

SETTING:

Three post-acute ambulatory centres in metropolitan areas.

Participants:

218 outpatients (mean age 38.5 years, SD=11.7)

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURE:

The questionnaire included experiences regarding aspects of informational (transference of information, accumulated knowledge), management (consistency and flexibility of care) and relational (established relationship and consistency of provider) continuity, as well as questions concerning patients' socio-demographic characteristics, satisfaction with care and global rating change.

RESULTS:

Respondents indicated more problems in terms of management and relational continuity than in informational continuity. For all patient groups, experiences regarding elements of management continuity (R(2)=15.3-22.4%), followed by relational continuity (R(2)=14.3-25.2%), explained most of the variance of satisfaction. Consistency and flexibility of care, together with established relationship, were the most determining elements of satisfaction. Experiences regarding elements of management continuity explained most of the variance of change (18.5%), and flexibility was the most decisive element.

CONCLUSIONS:

Patient satisfaction and functional changes are related with experiences in aspects of management continuity, where there is room for improvement. Measures of management continuity may be promising as indicators of continuity, and they should be prioritized.

OBJECTIVE:

To prospectively and longitudinally examine how concussion affects gait balance control in adolescents during single and dual-task walking.

DESIGN:

Cohort, prospective, repeated-measures design.

SETTING:

Motion analysis laboratory.

PARTICIPANTS:

Twenty adolescents identified as suffering a concussion were matched with twenty healthy control subjects and tested five times across a two month period following injury.

INTERVENTIONS:

Not applicable

MAIN OUTCOME MEASURES:

Gait temporal-distance parameters included average walking speed, step length, step width; whole body center of mass (COM) parameters included medial/lateral displacement, and peak COM medial/lateral and anterior velocities; dual-task cost was defined as percent change from single to dual-task conditions; and Stroop test accuracy.

RESULTS:

No between-group differences were observed for step length and step width. The dual-task cost for average walking speed for concussed subjects was greater than control subjects across the two month testing period (main effect of group p = .019), as were the dual-task costs for peak anterior COM velocity (main effect of group p = .017) and total COM medial/lateral displacement (main effect of group p = .013). The total COM medial/lateral displacement (group x task interaction p = .006) and peak COM medial/lateral velocity (main effect of group p = .027; main effect of task p = .010) were significantly greater in concussed subjects compared with control subjects during dual-task walking. Concussed subjects were significantly less accurate than controls on the Stroop test (main effect of group p = .004).

CONCLUSIONS:

The findings suggest that concussion affects the ability of adolescents to control body posture during gait up to two months following injury. Furthermore, dual-task paradigms may provide additional useful information in the clinical assessment and recovery of concussion.

OBJECTIVES:

To systematically classify the physical activity research for individuals with a spinal cord injury by using the Behavioral Epidemiologic Framework. To identify where the physical activity research for individuals with a spinal cord injury has focused between 2000-2012.

DESIGN:

Relevant research was identified and the then categorized into one of five phases by following the coding rules of the Behavioral Epidemiology Framework. Phase 1 studies link physical activity and health outcomes, phase 2 studies validate or develop measures of physical activity, phase 3 studies identify factors that influence behavior or examine explanatory theories of behavior, phase 4 studies evaluate interventions, and phase 5 studies disseminate health promotion programs or policies, and translate research into practice.

SETTING:

Specific keywords were identified and then searched through EBSCOHOST, PubMed, and Google Scholar.

PARTICIPANTS:

Not applicable.

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURES:

Not applicable.

RESULTS:

113 articles met the criteria. 55% were categorized as phase 1, 12% as phase 2, 24% as phase 3, 5% as phase 4, and 4% as phase 5,

CONCLUSION:

The majority of studies were categorized as phase 1, 2 or 3, which implies that this field is still in the early stages of development and research should focus on intervention development and dissemination.

OBJECTIVE:

To investigate the relationship of diabetes comorbidity and the rehabilitation outcomes of patients with stroke

Design:

Secondary data analysis

Setting:

Inpatient rehabilitation facilities across the United States

PARTICIPANTS:

Patients with stroke (N = 35,243) who received inpatient rehabilitation in 2004 through 2008

INTERVENTION:

None

MAIN OUTCOME MEASURES:

Functional Independence Measure, length of stay, discharge destination

RESULTS:

The mean age of the sample was 71.0 ± 13.2 years. The percent of the sample who were Medicare beneficiaries was 53.8%, whereas 46.2% had other sources of funding. Of the patients in the sample, 34.5% had a comorbidity of diabetes with 17.2% classified as tier-eligible and 82.8% as nontier eligible. Findings included that patients in this sample with diabetes were admitted for rehabilitation services at a younger age than those without diabetes and support previous studies in which tier-eligible diabetes comorbidities moderated by patient age were found to be significant predictors of stroke rehabilitation outcomes. Furthermore, similar findings remained regardless

CONCLUSIONS:

This study provides additional evidence that diabetes as a comorbidity is significantly related to stroke rehabilitation outcome, but the relationship is moderated by patient age.

OBJECTIVE:

To investigate the effects of a resistance-based chin-to-chest exercise on measures of hyolaryngeal muscle activation compared to a head-lift exercise.

DESIGN:

Within-subject repeated measures design.

SETTING:

Academic research laboratory.

PARTICIPANTS:

Normal young females (N=20) without history of dysphagia, cervical spine conditions, neurological disease, or head/neck cancer (mean age = 22.5).

INTERVENTIONS:

All patients performed an isometric jaw-opening exercise against resistance (Chin-to-Chest or CtC) and an isometric head-lift exercise, both targeting activation in the hyolaryngeal (suprahyoid) muscles. The CtC exercise required jaw opening into a chin brace secured against the upper torso for a duration of 10 seconds. The isometric head-lift exercise required lifting and holding the head from a supine position for 10 seconds. The degree to which each exercise activated the suprahyoid muscles was measured using surface electromyography (sEMG).

MAIN OUTCOME MEASURES:

Microvolts (μV) as measured from sEMG sensors placed on the skin surface above the hyolaryngeal muscles (surface of skin above geniohyoid, mylohyoid, & anterior digastric). Dependent variables included the peak μV during 10 seconds of sustained contraction and the difference in μV from rest to peak contraction for each exercise.

RESULTS:

Activation in the hyolaryngeal musculature as measured via sEMG was significantly greater when participants performed the CtC exercise compared to the head-lift exercise. Measures of peak μV during contraction were significantly greater for CtC (t=10.72, p<.001) compared to the head-lift exercise, and difference measures in μV calculated between rest and contraction for each exercise revealed a two-fold increase in hyolaryngeal muscular activation for CtC (t=8.27, p<.001).

CONCLUSIONS:

The isometric CtC exercise resulted in greater activation of the hyolaryngeal muscles compared to an isometric head-lift exercise. Results support the need for further investigations to determine if the CtC exercise has a positive effect as a rehabilitative exercise for clinical populations with dysphagia secondary to UES dysfunction where hyolaryngeal excursion is a physiological impairment.