Physical therapy [journal]
- Physical Training and Activity in People With Diabetic Peripheral Neuropathy: A Paradigm Shift. [JOURNAL ARTICLE]
- Phys Ther 2016 Jul 21.
Diabetic peripheral neuropathy (DPN) occurs in more than 50% of people with diabetes and is an important risk factor for skin breakdown, amputation, and reduced physical mobility (i.e., walking and stair climbing). Although it is well-established that exercise has many beneficial effects for people with diabetes, few studies have examined whether exercise provides comparable benefits to people with DPN. Until recently, DPN was considered a contra-indication for walking or any weight-bearing exercise due to concerns for injuring the participant's insensitive feet. These guidelines were recently adjusted, however, after research demonstrated that weight-bearing activities do not increase the risk of foot ulcers in people with DPN without severe foot deformity. In fact, emerging research has found positive adaptations to overload stress in these patients, including evidence for peripheral neuroplasticity in animal models and early clinical trials. This Perspective will review this evidence for peripheral neuroplasticity in animal models and early clinical trials, and adaptation of the integumentary system and the musculoskeletal system in response to overload stress. We propose these positive adaptations promote improved function in people with DPN and foster the paradigm shift of including weight-bearing exercise for people with DPN. This Perspective also will provide specific assessment and treatment recommendations for this important, high-risk group.
- Origins in the Womb: Potential Role of the Physical Therapist in Modulating the Deleterious Effects of Obesity on Maternal and Offspring Health Through Movement Promotion and Prescription During Pregnancy. [JOURNAL ARTICLE]
- Phys Ther 2016 Jul 14.
Maternal obesity and associated metabolic disease contribute to adverse outcomes in women and their offspring, many of which have significant acute and chronic implications for both mother and neonate. Targeted movement (i.e. physical activity, exercise training) during pregnancy has been shown to be safe and effective in normal-weight and obese women for improving many of these outcomes. However, movement prescription and advice during pregnancy is often not addressed by health care providers; thus, creating a unique opportunity for physical therapists to utilize their expertise in movement with pregnant patients. The objective of this Perspective is to briefly review the adverse maternal and neonatal outcomes associated with maternal obesity, the benefits of intentional maternal movement during pregnancy in obese women, the evidence-based guidelines for prescribing intentional movement during pregnancy for obese women, and the potential for physical therapists to become the driving force behind a necessary increase in movement levels among pregnant populations. Physical therapists can play a significant role in encouraging movement in healthy and metabolically challenged women during pregnancy, and thus assist in combatting the vicious cycle of obesity by improving maternal and offspring health.
- Activity in People With Diabetic Polyneuropathy (ADAPT): Study Design and Protocol for a Two-Site Randomized Controlled Trial. [JOURNAL ARTICLE]
- Phys Ther 2016 Jul 14.
Half of all patients with diabetes develop diabetic peripheral neuropathy (DPN), a complication leading to reduced mobility and quality of life. While there are no proven pharmacologic approaches to reduce DPN risk or slow its progression, evidence suggests physical activity may improve symptoms and enhance peripheral nerve regeneration.To determine the impact of an intense lifestyle intervention on neuropathy progression and quality of life in individuals with DPN.Randomized controlled trial.Two academic medical centers.140 individuals with type 2 diabetes and mild to moderate DPN.The intervention group will receive 18 months of supervised exercise training, actigraphy based counseling to reduce sedentary behavior, and individualized dietary counseling. Control group participants will receive diet and activity counseling at baseline and at 9 months.The primary outcomes are neuropathy progression as measured by intraepidermal nerve fiber density (IENFD) in a distal thigh skin biopsy and the Norfolk Quality of Life-Diabetic Neuropathy (NQOL-DN) score. Secondary outcomes include pain, gait, balance, and mobility measures.Due to the combined intervention approach, this protocol will not be able to determine which intervention components influence outcomes. There may also be difficulty with participant attrition during the 18 months study intervention.The ADAPT protocol resulted from a collaboration between physical therapists and neurologist researchers that includes as primary outcomes both a quality of life (NQOL-DN) measure and a physiologic biomarker (IENFD). It has the potential to demonstrate that an intensive lifestyle intervention may be a sustainable, clinically effective approach for people with DPN that improves patient outcomes and can have an immediate impact on patient care and future clinical trials.
- Predictors of Reduced Frequency of Physical Activity 3 Months Following Injury: Findings From the Prospective Outcomes of Injury Study. [JOURNAL ARTICLE]
- Phys Ther 2016 Jul 14.
Physical inactivity is a risk factor for non-communicable diseases. Incurring an injury has been identified as a barrier to physical activity. However, it is not known which factors, if any, are associated with reduced activity among general injury populations.To: 1) investigate change in physical activity frequency from pre-injury to three months following injury, and 2) examine the association of pre-injury, injury-related and post-injury factors with reduced physical activity frequency in participants with a range of injury types.Cohort study.Participants (n=2856) aged 18-64 years were asked about pre-injury demographic and health, injury and post-injury related factors. Data were collected via telephone interview (88%), postal questionnaire (11%) or face-to-face (0.5%) three months after injury.Of the 2793 participants with complete physical activity data, 55% (n=1536) had reduced physical activity three months after the injury event. Pre-injury and injury-related factors associated with a greater risk of reduced physical activity included: living with non-family members, having a lower extremity dislocation, sprain or strain and having an injury with greater anatomical severity. Post-injury factors associated with reduced physical activity included: having greater disability, pain or discomfort, poor general health, not being back at work and the participant having worse than expected expectations of recovery three months after injury. A high proportion of this injured cohort were seen by physiotherapists (61%).Data collection was retrospective and based on participant recall.A high proportion of participants had reduced physical activity three months after injury. Pre-injury, injury and post-injury related characteristics associated with reduced physical activity may help health professionals identify those at risk of not restoring their pre-injury physical activity frequency.
- Reliability and Validity of Force Platform Measures of Balance Impairment in Individuals With Parkinson's Disease. [JOURNAL ARTICLE]
- Phys Ther 2016 Jul 14.
Complex movement and balance impairments in Parkinson's disease contribute to high fall risk. Comprehensive balance assessment is warranted to identify intrinsic fall risk factors and direct interventions.The purpose of this study was to examine the test psychometric properties of three balance measures on the NeuroCom™ Force Platform (FP) system in persons with PD.Forty two community-dwelling individuals with idiopathic PD completed the testing protocol. Test retest reliability was assessed for the Limits of Stability (LOS), Motor Control Test (MCT) and Sensory Organization Test (SOT). Intraclass correlation coefficients (ICC 2,1) were calculated to determine test-retest reliability and minimal detectable change. Validity was assessed by comparing the FP measures with criterion gait and balance measures using Pearson Product Moment correlations. Multiple regression analyses examined the contribution of PD characteristics to FP measures.All primary FP variables demonstrated excellent test-retest reliability (ICC =0.78-0.92). The SOT and LOS demonstrated fair to good correlations (p <0.05) with criterion measures; whereas the MCT had fair correlations to balance measures only. Both SOT composite equilibrium and MCT average latency were moderately associated with disease severity.This study's sample had relatively small number of participants with positive fall history, which may limit generalizability of our findings.This study's findings provide support that FP measures are reliable and valid tests of balance impairment in persons with PD. Disease severity was significantly associated with SOT and MCT measures, perhaps reflecting that these tests are meaningful indicators of decline in postural control with disease progression. FP measures may provide valuable quantitative information about underlying balance impairments in PD to guide therapeutic interventions for fall risk reduction.
- The Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE) 2016 Statement. [Journal Article]
- Phys Ther 2016 Jul; 96(7):e1-e10.
We developed a reporting guideline to provide authors with guidance about what should be reported when writing a paper for publication in a scientific journal using a particular type of research design: the single-case experimental design. This report describes the methods used to develop the Single-Case Reporting guideline In BEhavioural interventions (SCRIBE) 2016. As a result of 2 online surveys and a 2-day meeting of experts, the SCRIBE 2016 checklist was developed, which is a set of 26 items that authors need to address when writing about single-case research. This article complements the more detailed SCRIBE 2016 Explanation and Elaboration article (Tate et al., 2016) that provides a rationale for each of the items and examples of adequate reporting from the literature. Both these resources will assist authors to prepare reports of single-case research with clarity, completeness, accuracy, and transparency. They will also provide journal reviewers and editors with a practical checklist against which such reports may be critically evaluated. We recommend that the SCRIBE 2016 is used by authors preparing manuscripts describing single-case research for publication, as well as journal reviewers and editors who are evaluating such manuscripts.Reporting guidelines, such as the Consolidated Standards of Reporting Trials (CONSORT) Statement, improve the reporting of research in the medical literature (Turner et al., 2012). Many such guidelines exist and the CONSORT Extension to Nonpharmacological Trials (Boutron et al., 2008) provides suitable guidance for reporting between-groups intervention studies in the behavioral sciences. The CONSORT Extension for N-of-1 Trials (CENT 2015) was developed for multiple crossover trials with single individuals in the medical sciences (Shamseer et al., 2015; Vohra et al., 2015), but there is no reporting guideline in the CONSORT tradition for single-case research used in the behavioral sciences. We developed the Single-Case Reporting guideline In BEhavioural interventions (SCRIBE) 2016 to meet this need. This Statement article describes the methodology of the development of the SCRIBE 2016, along with the outcome of 2 Delphi surveys and a consensus meeting of experts. We present the resulting 26-item SCRIBE 2016 checklist. The article complements the more detailed SCRIBE 2016 Explanation and Elaboration article (Tate et al., 2016) that provides a rationale for each of the items and examples of adequate reporting from the literature. Both these resources will assist authors to prepare reports of single-case research with clarity, completeness, accuracy, and transparency. They will also provide journal reviewers and editors with a practical checklist against which such reports may be critically evaluated.
- The TIDieR Checklist Will Benefit the Physical Therapy Profession. [Editorial]
- Phys Ther 2016 Jul; 96(7):930-1.
- Three Faces of Fragile X. [JOURNAL ARTICLE]
- Phys Ther 2016 Jun 23.
Fragile X syndrome (FXS) is the first of three syndromes identified as a health condition related to fragile X mental retardation (FMR1) gene dysfunction. The other two conditions are Fragile X-associated primary ovarian insufficiency syndrome (FXPOI) and Fragile X-associated tremor/ataxia syndrome (FXTAS) which together are referred to as Fragile X-associated disorders (FXD). Collectively, this group comprises the three faces of Fragile X. Even though the three conditions share a common genetic defect each one is a separate health condition that results in a variety of body function impairments such as motor delay, musculoskeletal issues related to low muscle tone, coordination limitations, ataxia, tremor, undefined muscle aches and pains; and, for FXTAS, a late onset neurodegeneration. Although each FXD condition may benefit from physical therapy intervention, available evidence as to the efficacy of intervention appropriate to FXD is, as yet, lacking. This perspective will discuss the genetic basis of FMR1 gene dysfunction and describes health conditions related to this mutation which have a range of expressions within a family. Physical therapy concerns and possible assessment and intervention strategies will be introduced. Understanding the inter-generational effect of the FMR1 mutation with potential life span expression is a key component to identifying and treating the health conditions related to this specific genetic condition.
- An Interdisciplinary Approach to Fall Prevention in a High-Risk Inpatient Pediatric Population: A Quality Improvement Project. [JOURNAL ARTICLE]
- Phys Ther 2016 Jun 23.
Within a tertiary-care pediatric medical center, the largest number of inpatient falls (8.84 falls per 1000 patient days) occurred within a 14-bed rehabilitation/ transitional care unit between February and September 2009. An interdisciplinary fall prevention program, Red Light, Green Light, was developed to better educate all staff and family members to ensure safety of transfers and ambulation of neurologically impaired children.The purpose was to develop and implement an interdisciplinary pediatric fall prevention program to reduce total falls and falls with family members of this population.Pre-intervention 2009 data and longitudinal data from 2010-2014 were obtained from retrospective review of event/incident reports.This quality improvement project was based on inpatient pediatric admissions to a rehabilitation care unit accommodating neurologically impaired children.Data extraction included: total falls, falls with caregiver (alone vs. staff vs. family), type of falls, and falls by diagnosis.Descriptive statistics were obtained on outcome measures; chi-squares were calculated on pre- and post-intervention comparisons. Total falls decreased steadily from 8.84 falls per 1000 patient days in 2009 to 1.79 falls per 1000 patient days in 2014 (X(2)(1) = 3.901, p=0.048)). Falls with family members decreased 50% post intervention (X(2)(1) = 6.26, p=0.012) LIMITATIONS: Limitations include: unit size nearly doubled post-intervention, event reporting changed to both uncontrolled and controlled therapy falls (safely lowering patient to bed, chair, or floor), and enhanced reporting increased numbers of post-intervention falls.Red Light, Green Light has resulted in reductions in overall fall rates, falls with family members, increased staff collaboration, heightened staff and family safety awareness, and a safer environment for high-risk patients.