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Physical therapy [journal]
- Validating a Simple Discharge Planning Tool Following Hospital Admission for an Isolated Lower Limb Fracture. [JOURNAL ARTICLE]
- Phys Ther 2014 Apr 17.
BackgroundEarly, accurate prediction of discharge destination from the acute hospital assists individual patients and the wider hospital system. The Trauma Rehabilitation and Prediction Tool (TRaPT), developed using registry data, determines probability of inpatient rehabilitation discharge for patients with isolated lower limb fractures.ObjectiveAims of this study include prospective validation of the TRaPT, assessing whether its performance could be improved by adding additional demographic data, and simplifying it for use as a bedside tool.DesignCohort, measurement focused study.MethodsPatients admitted to a major trauma centre in Melbourne, Australia, with isolated lower limb fractures were included. Individual's TRaPT scores were calculated from admission data. Performance of the TRaPT score alone, and in combination with frailty, weight bearing status and home supports, was assessed using measures of discrimination and calibration. Simplified TRaPT was developed by rounding the coefficients of variables in the original model and grouping age into eight categories. Simplified TRaPT performance measures including specificity, sensitivity, and positive and negative predictive values were evaluated.ResultsOne hundred and fourteen patients were included. Prospective validation of the TRaPT showed excellent discrimination [C-statistic 0.90 (95% CI 0.82, 0.97)], a sensitivity of 80% and specificity of 94%. All patients able to weight bear were discharged directly home. Simplified TRaPT scores had a sensitivity of 80% and a specificity of 88%.LimitationsGeneralizability may be limited given the compensation system that exists in Australia but the methods used will assist in designing a similar tool in any population.ConclusionsTRaPT accurately predicted discharge destination for 80% of patients and may form a useful aid for discharge decision making, with the simplified version facilitating its use as a bedside tool.
- Treadmill Training Following Surgical Removal of a Spinal Tumor in Infancy. [JOURNAL ARTICLE]
- Phys Ther 2014 Apr 17.
Background and PurposeStep training on a treadmill is a common intervention for adult and pediatric patients with spinal cord injuries (SCI). Treadmill training has not been used as an intervention for infants and toddlers presenting with SCI before walking onset. Here we describe the intervention and stepping behavior on a treadmill and overground of a toddler after surgical removal of a rare spinal tumor resulting in SCI.Case DescriptionFollowing spinal tumor excision at 5.5 weeks of age, step training on a treadmill and overground occurred once per week from 15 to 35 months of age in addition to traditional physical therapy (PT). The toddler presented with an inability to step on the left, rare stepping on the right, and apparent lack of sensation in the lower extremities.OutcomesIndependent symmetrical stepping emerged both on and off the treadmill over 20 months. Improvements in the number and pattern of steps occurred with training. Walking velocity and milestones important to over ground walking developed.DiscussionIndependent steps developed during this intervention with little motor development of the lower extremities during the first year of life. Furthermore, improvements in stepping alternation, standing, and walking occurred despite no evidence of sensation in the lower extremities.
- Indications, Benefits, and Risks of Pilates Exercise for People With Chronic Low Back Pain: A Delphi Survey of Pilates-Trained Physical Therapists. [JOURNAL ARTICLE]
- Phys Ther 2014 Apr 3.
BackgroundThe effectiveness of Pilates exercise for treating people with chronic low back pain (CLBP) is yet to be established. Understanding how to identify people with CLBP who may benefit, or not benefit from Pilates exercise, and the benefits and risks of Pilates exercise will assist trial design.ObjectivesTo establish a consensus regarding the indications, contraindications, and precautions of Pilates exercise, and the potential benefits and risks of Pilates exercise for people with CLBP.MethodsA panel of 30 Australian physical therapists experienced in the use of Pilates exercise were surveyed using the Delphi technique. Three electronic questionnaires were used to collect participant opinions. Answers to open-ended questions were analyzed thematically, combined with research findings, and translated into statements about Pilates exercise. Participants then rated their level of agreement with statements using a 6 point Likert scale. Consensus was achieved when 70% of panel members agreed or disagreed with an item.ResultsThirty physical therapists completed the 3 questionnaires. Consensus was reached on 100% of items related to the benefits, indications, and precautions of Pilates exercise, 50% of risks, and 56% of contraindications. Participants agreed that people who have poor body awareness and maladaptive movement patterns may benefit from Pilates exercise, while those with pre-eclampsia, unstable spondylolisthesis, or a fracture may not. Participants also agreed that Pilates exercise may improve functional ability, movement confidence, body awareness, posture, and movement control.ConclusionsThese findings contribute to a better understanding of the indications, contraindications, and precautions of Pilates exercise, and the benefits and risks of Pilates exercise for people with CLBP. This can assist in future trial design examining the effectiveness of Pilates exercise.
- Reduced Moderate-to-Vigorous Physical Activity and Increased Sedentary Behavior Is Associated With Elevated Blood Pressure Values in Children With Cerebral Palsy. [JOURNAL ARTICLE]
- Phys Ther 2014 Apr 3.
BackgroundChildren with cerebral palsy (CP) participate in reduced levels of physical activity and spend increased time in sedentary behavior. The effect of this on their cardiometabolic health has not been investigated.ObjectivesThe purpose of this study was to investigate the prevalence of overweight/obesity and elevated blood pressure (BP) among a cohort of ambulatory children with CP. Secondly, the aim was to investigate the association between physical activity, sedentary behavior, overweight/obesity and BP in children with CP.Study designThis was a cross-sectional study of 90 ambulatory children, age 6 to 17 years, with CP.MethodsBody mass index (BMI), waist circumference, waist-height ratio and BP were measured on one occasion. Habitual physical activity was measured by accelerometry over 7 days.ResultsThe prevalence of overweight/obesity in the cohort was 18.9%. Twenty-two percent of children had BP values within the hypertensive or pre-hypertensive range. Systolic BP was positively associated with waist circumference (β = 0.324, p <0.05) and BMI (β = 0.249, p<0.05). Elevated BP values were associated with reduced time in moderate-to-vigorous activity, vigorous activity and total activity, and increased time in sedentary behavior. The strongest association was observed between elevated BP and vigorous activity alone (odds ratio, 0.61; 95% confidence interval, 0.37-0.99; p <0.05).LimitationsA convenience sample was recruited for this study and it is possible that this resulted in selection bias.ConclusionsDespite the relatively low prevalence of overweight/obesity, a relatively high proportion of children with CP had elevated BP values. Reducing sedentary behavior and increasing habitual physical activity, particularly vigorous activity, should be a primary aim of rehabilitation in order to reduce cardiometabolic disease risk in this population.
- Effectiveness of Trigger Point Dry Needling for Plantar Heel Pain: A Randomized Controlled Trial. [JOURNAL ARTICLE]
- Phys Ther 2014 Apr 3.
BackgroundPlantar heel pain can be managed with dry needling of myofascial trigger points, however there is only poor quality evidence supporting its use.ObjectiveTo evaluate the effectiveness of dry needling for plantar heel pain.DesignParallel group, participant blinded, randomized controlled trial.SettingA university health sciences clinic.PatientsStudy participants were 84 patients with plantar heel pain of at least one month's duration.InterventionParticipants were randomised to real or sham trigger point dry needling. The intervention consisted of one treatment per week for six weeks. Participants were followed for 12 weeks.MeasurementsPrimary outcome measures included 'first-step pain' measured with a Visual Analogue Scale and foot pain measured with the pain subscale of the Foot Health Status Questionnaire. The primary end-point for predicting the effectiveness of dry needling for plantar heel pain was six weeks.ResultsAt the primary end-point, significant effects favored real dry needling over sham dry needling for pain (adjusted mean difference: VAS first-step pain -14.4 mm, 95% CI -23.5 to - 5.2, p=0.002; FHSQ foot pain 10.0 points, 95% CI 1.0 to 19.1, p=0.029), although the between-group difference was lower than the minimal important difference. The number needed to treat at six weeks was 4 (95% CI 2 to 12). The frequency of minor transitory adverse events was significantly greater in the real dry needling group (70 real dry needling appointments [32%] compared with only 1 sham dry needling appointment [<1%]).LimitationsIt was not possible to blind the therapist.ConclusionDry needling provided statistically significant improvements in plantar heel pain, but the magnitude of this effect should considered against the frequency of minor transitory adverse events.
- Consensus on a Multidisciplinary Treatment Guideline for De Quervain Disease: Results From the European HANDGUIDE Study. [JOURNAL ARTICLE]
- Phys Ther 2014 Apr 3.
ObjectiveTo achieve consensus on a multidisciplinary treatment guideline for De Quervain's disease.MethodsA European Delphi consensus strategy was initiated. A systematic review reporting on the effectiveness of surgical and non-surgical interventions was conducted and published, and used as an evidence-based starting point for this study. In total, 35 experts (hand therapists/hand surgeons selected by the national member associations of their European federations, and Physical Medicine & Rehabilitation physicians) participated in the Delphi consensus strategy. Each Delphi round consisted of a questionnaire, an analysis and a feedback report.ResultsConsensus was achieved on the description, symptoms and diagnosis of De Quervain's disease. The experts agreed that patients with this disorder should always receive instructions and that these instructions should be combined with another form of treatment and should not be used as a sole treatment. Instructions combined with NSAIDs, splinting, NSAIDs plus splinting, corticosteroid injection, corticosteroid injections plus splinting, or surgery were considered suitable treatment options. Details on the use of instructions, NSAIDs, splinting, corticosteroid injections, and surgery were described. Main factors for selecting one of the above-mentioned treatment options were identified: severity and duration of the disorder, and previous treatments given. A relation between the severity and duration, and choice of therapy was indicated by the experts and reported in the guideline.ConclusionsThis multidisciplinary treatment guideline may help in the treatment of and research on De Quervain's disease.
- Elevating the quality of disability and rehabilitation research: mandatory use of the reporting guidelines. [Journal Article]
- Phys Ther 2014 Apr; 94(4):446-8.
- Validity of Maximal Exercise Testing in Patients With Low to Moderate Multiple Sclerosis. [JOURNAL ARTICLE]
- Phys Ther 2014 Mar 27.
BackgroundCardiopulmonary exercise testing (CPET) can be considered the gold standard for the assessment of cardiorespiratory fitness. Little is known about the criteria for maximal exercise testing in patients with Multiple Sclerosis (MS) and how these criteria behave across different levels of neurological disability.ObjectiveThe objective of the present study was twofold: (a) to determine the criteria for maximal exercise testing across various levels of disability and (b) to assess concomitant subgroup differences in measures related to the patient, disease and function.DesignCross-sectional study.MethodsCPET was conducted in a convenience sample of 56 patients with MS. Analysis of variance was used to assess the different criteria in patients with low, mild and moderate MS.ResultsThe mean peak oxygen uptake (VO2) was 21.4 ± 7.1 mL·kg·min(-1). A VO2 plateau was seen in 37.5% of patients. A respiratory exchange ratio≥1.10 was achieved by 69.6% of the patients; a maximal heart rate within 10% of their age-predicted heart rate was achieved by 48.2% of the patients; 23.2% of the patients perceived their exertion as ≥18 on the BORG scale (6-20). Of these four criteria, the achieved heart rate and incidence of a VO2 plateau significantly decreased in patients from mild to moderate disability.LimitationsThe primary limitations of this study were its cross-sectional nature and relatively small sample of patients with moderate disability.ConclusionThe present findings suggest that the outcome of CPET in patients with MS with low to mild disability (Expanded Disability Status Scale (EDSS) ≤4.0) is a valid measure of cardiorespiratory fitness, whereas the outcome in patients with moderate disability (EDSS >4.0) is most likely symptom-limited.
- Are Hierarchical Properties of the Fugl-Meyer Assessment Scale (FM Motor Scale) the Same in Acute and Chronic Stroke? [JOURNAL ARTICLE]
- Phys Ther 2014 Mar 27.
The Fugl-Meyer assessment scale (FM motor scale) is recognized as a robust scale of motor ability for patients after stroke, with a high predictive validity for outcome, but, if not used as a hierarchical scale, is time consuming. The hierarchical properties of the upper extremity (UE) and lower extremity (LE) sections of the FM motor scale have been established in patients with chronic stroke, supporting a shortened administration and confirming scores can be legitimately summed. The present study aims to establish that similar hierarchies exist, in patients within 72 hours after stroke onset.A sub-cohort of 75 eligible patients from a nationwide prospective study entitled 'Early Prediction of Functional Outcome after Stroke' (EPOS) were identified as appropriate to provide data. The full version of both motor function sections of the FM motor scale were administered within 72 hours after stroke onset. Hierarchy of item difficulty was investigated by applying Guttman scaling procedures within each stage and each subsection of the UE and LE sections of the scale. The scaling procedure then considered item difficulty between stages and subsections and finally across all of the scale items (stage divisions ignored) of the FM motor scale.For all of the analyses the results exceeded the acceptable levels for the coefficient of reproducibility and the coefficient of scalability.The sample was an stroke population of moderate severity.The uni-dimensional hierarchy of the UE and LE sections of the FM motor scale, as already established for chronic stroke, is in this study confirmed within 72 hours of stroke onset. Legitimate total summed scores can indicate a patient's level of motor ability.
- Clinical Identifiers for Early-Stage Primary/Idiopathic Adhesive Capsulitis: Are We Seeing the Real Picture? [JOURNAL ARTICLE]
- Phys Ther 2014 Mar 20.
Adhesive capsulitis is often difficult to diagnose in its early stage and differentiate from other common shoulder disorders.The aim of this study was to validate any or all of the eight clinical identifiers of early stage primary/idiopathic adhesive capsulitis established in an earlier Delphi study.Cross-sectional study.Sixty-four patients diagnosed with early stage adhesive capsulitis by a physical therapist or medical practitioner were included in the study. Eight active and eight passive shoulder movements and visual analogue scale pain scores for each movement were recorded, prior to and immediately following an intraarticular injection of corticosteroid and local anaesthetic. Using the local anaesthetic as the reference standard, pain relief of ≥70% for passive external rotation was deemed a positive anaesthetic response (PAR).Sixteen (25%) participants demonstrated a PAR. Univariate logistic regression identified that of the proposed identifiers, global loss of passive range of movement (OR 0.26; p = 0.03), pain at the end of range of all measured active movements (OR 0.06; p = 0.02) and global loss of passive glenohumeral movements (OR 0.23; p = 0.02) were associated with a PAR. Following stepwise removal of the variables, pain at the end of range of all measured active movements remained the only identifier but was associated with reduced odds of a PAR.The lack of a recognised reference standard for diagnosing early stage adhesive capsulitis remains problematic in all related research.None of the clinical identifiers for early stage adhesive capsulitis previously proposed by expert consensus have been validated in this study. Clinicians should be aware that commonly used clinical identifiers may not be applicable to this stage.