Wednesday, August 27, 2008
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Decreased quadriceps activation measured hours prior to a noncontact anterior cruciate ligament tear
Terry L. Grindstaff, Kate R. Jackson, J. Craig Garrison, David R. Diduch, Christopher D. IngersollSTUDY DESIGN: Case report. BACKGROUND: Decreased quadriceps activation has been shown to be present following anterior cruciate ligament (ACL) injury, but its presence prior to ACL injury is unknown. The purpose of this case report was to describe the level of quadriceps activation measured hours before a noncontact ACL injury in an individual who previously demonstrated known biomechanical risk factors for ACL injury. CASE DESCRIPTION: A 23-year-old female (height, 176.9 cm; mass, 72.4 kg), sustained a left noncontact ACL injury while landing from a jump stop during a recreational basketball game. This case was unique because data regarding landing biomechanics and quadriceps force and activation were gathered in 2 separate, unrelated studies prior to injury. OUTCOMES: Peak external knee abduction moment (-65.3 Nm) during a drop jump landing 8 months prior to injury indicated elevated risk for ACL injury. Involved quadriceps central activation ratios (CAR) were obtained 1 week (CAR, 0.81) and 4 hours (CAR, 0.77) prior to injury. Strength and CAR (0.76) measurements changed very little within 36 hours of injury and both strength, and activation (CAR, 0.90) improved following surgical reconstruction and formal rehabilitation. DISCUSSION: An individual with known biomechanical risk factors for ACL injury may compound risk for noncontact ACL injury if decreased quadriceps activation is also present. LEVEL OF EVIDENCE: Prognosis, level 4.J Orthop Sports Phys Ther. 2008;38(8):502-507, published online 25 April 2008. doi:10.2519/jospt.2008.2761KEY WORDS: ACL, biomechanics, knee, muscle inhibition (Source: The Journal of Orthopaedic and Sports Physical Therapy)... MORE...
POSTED 08/23/2008 at 03:55 PM --

A primer on selected aspects of evidence-based practice to questions of treatment, part 2: interpreting results, application to clinical practice, and self-evaluation
J. Timothy Noteboom, Stephen C. Allison, Joshua A. Cleland, Julie M. WhitmanSYNOPSIS: The process of evidence-based practice (EBP) guides clinicians in the integration of individual clinical expertise, patient values and expectations, and the best available evidence. Becoming proficient with this process takes time and consistent practice, but should ultimately lead to improved patient outcomes. The EBP process entails 5 steps: (1) formulating an appropriate question, (2) performing an efficient literature search, (3) critically appraising the best available evidence, (4) applying the best evidence to clinical practice, and (5) assessing outcomes of care. This second commentary in a 2-part series will review principles relating to steps 3 through 5 of this 5-step model. The purpose of this commentary is to provide a perspective to assist clinicians in interpreting results, applying the evidence to patient care, and evaluating proficiency with EBP skills in studies of interventions for orthopaedic and sports physical therapy.  J Orthop Sports Phys Ther. 2008;38(8):485-501, published online 27 June 2008. doi:10.2519/jospt.2008.2725KEY WORDS: critical appraisal, physical therapy, treatment effectiveness (Source: The Journal of Orthopaedic and Sports Physical Therapy)... MORE...
POSTED 08/23/2008 at 03:55 PM --

A primer on selected aspects of evidence-based practice relating to questions of treatment, part 1: asking questions, finding evidence, and determining validity
Joshua A. Cleland, J. Timothy Noteboom, Julie M. Whitman, Stephen C. AllisonSYNOPSIS: The process of evidence-based practice (EBP) guides clinicians in the integration of individual clinical expertise, patient values and expectations, and the best available evidence. Becoming proficient with this process takes time and consistent practice, but should ultimately lead to improved patient outcomes. The EBP process entails 5 steps: (1) formulating an appropriate question, (2) performing an efficient literature search, (3) critically appraising the best available evidence, (4) applying the best evidence to clinical practice, and (5) assessing outcomes of care. This first commentary in a 2-part series will review principles relating to steps 1, 2, and 3 of this 5-step model. The purpose of this commentary is to provide a perspective to assist clinicians in formulating foreground questions, searching for the best available evidence, and determining validity of results in studies of interventions for orthopaedic and sports physical therapy.J Orthop Sports Phys Ther. 2008;38(8):476-484, published online 27 June 2008. doi:10.2519/jospt.2008.2722KEY WORDS: critical appraisal, physical therapy, treatment effectiveness (Source: The Journal of Orthopaedic and Sports Physical Therapy)... MORE...
POSTED 08/23/2008 at 03:55 PM --

Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run
Tracy A. Dierks, Kurt T. Manal, Joseph Hamill, Irene S. DavisSTUDY DESIGN: Cross-sectional experimental laboratory study. OBJECTIVES: To investigate the relationships between hip strength and hip kinematics, and between arch structure and knee kinematics during prolonged treadmill running in runners with and without patellofemoral pain syndrome (PFPS). BACKGROUND: Hip weakness can lead to excessive femoral motions that adversely affect patellofemoral joint mechanics. Similarly, foot mechanics, which are influenced by foot structure, are also known to influence patellofemoral joint mechanics. Thus, proximal and distal factors should be considered when studying individuals with PFPS. METHODS AND MEASURES: Twenty recreational runners with PFPS (5 male, 15 female) and 20 matched uninjured runners participated in the study. Hip abduction and hip external rotation isometric strength measurements were collected before and after a prolonged run, while the arch height index was recorded on all runners before the run. Lower extremity kinematic data were collected at the beginning and end of the run. Two-way repeated-measures analyses of variance (ANOVAs) were used for analysis. RESULTS: Both groups displayed decreases in hip abductor and external rotator strengths at the end of the run. The PFPS group displayed significantly lower hip abduction strength [(kg x cm)/body mass] compared to controls (PFPS group: begin 15.3, end 13.5; uninjured group: begin 17.3, end 15.4). At the end of the run, the level of association between hip abduction strength and the peak hip adduction angle for the PFPS group was statistically significant, indicating a strong relationship (r = -0.74). No other associations with hip strength were observed in either group. Arch height did not differ between groups and no significant association was observed between arch height and peak knee adduction angle during running. CONCLUSIONS: Runners with PFPS displayed weaker hip abductor muscles that were associated with an increase in hip adduction during running. This relationship became more pronounced at the end of the run. LEVEL OF EVIDENCE: Therapy, level 5.J Orthop Sports Phys Ther. 2008;38(8):448-456, published online 15 April 2008. doi:10.2519/jospt.2008.2490KEY WORDS: arch height index, hip abductor muscle strength, hip external rotator muscle strength, knee valgus (Source: The Journal of Orthopaedic and Sports Physical Therapy)... MORE...
POSTED 08/23/2008 at 03:55 PM --

The role of pulse duration and stimulation duration in maximizing the normalized torque during neuromuscular electrical stimulation
Ashraf S. Gorgey, Gary A. DudleySTUDY DESIGN: Controlled laboratory study OBJECTIVES: To determine the effects of pulse duration and stimulation duration on the evoked torque after controlling for the activated area by using magnetic resonance imaging (MRI). BACKGROUND: Neuromuscular electrical stimulation (NMES) is commonly used in the clinic without considering the physiological implications of its parameters. METHODS AND MEASURES: Seven able-bodied, college students (mean ± SD age, 28 ± 4 years) participated in this study. Two NMES protocols were applied to the knee extensor muscle group in a random order. Protocol A applied 100-Hz, 450-microsecond pulses for 5 minutes in a 3-seconds-on 3-seconds-off duty cycle. Protocol B applied 60-Hz, 250-microsecond pulses for 5 minutes in a 10-seconds-on 20-seconds-off duty cycle. The amplitude of the current was similar in both protocols. Torque, torque time integral, and normalized torque for the knee extensors were measured for both protocols. MRI scans were taken prior to, and immediately after, each protocol to measure the cross-sectional area of the stimulated muscle. RESULTS: The skeletal muscle cross-sectional areas activated after both protocols were similar. The longer pulse duration in protocol A elicited 22% greater torque output than that of protocol B (P<.05). After considering the activated area in both protocols, the normalized torque with protocol A was 38% greater than that with protocol B (P<.05). Torque time integral was 21% greater with protocol A (P = .029). Protocol B failed to maintain torque at the start and the end of the 10-second activation. CONCLUSIONS: Longer pulse duration, but not stimulation duration, resulted in a greater evoked and normalized torque compared to the shorter pulse duration, even after controlling for the activated muscular cross-sectional areas with both protocols. LEVEL OF EVIDENCE: Therapy, level 5.J Orthop Sports Phys Ther. 2008;38(8):508-516, published online 25 April 2008. doi:10.2519/jospt.2008.2734   KEY WORDS: electrotherapy, MRI, NMES, quadriceps (Source: The Journal of Orthopaedic and Sports Physical Therapy)... MORE...
POSTED 08/23/2008 at 03:55 PM --

Upper cervical ligament testing in a patient with os odontoideum presenting with headaches
Paul E. Mintken, Lisa Metrick, Timothy W. FlynnSTUDY DESIGN: Resident's case problem. BACKGROUND: The role of premanipulative testing of the cervical spine is an area of controversy, and there are very few data to inform and guide practitioners on the use of ligamentous stability tests when assessing the upper cervical spine. DIAGNOSIS: A 23-year-old female was referred to physical therapy by a neurologist for the management of intractable headaches of possible musculoskeletal origin. Her Neck Disability Index score was 54% and she rated her headache pain from 3/10 to 9/10 on a Numerical Pain Rating Scale. She reported a 2-year history of intermittent lower extremity paresthesias without a known mechanism or current symptoms. She was treated in physical therapy for 11 visits with improvements in cervical range of motion, strength, and intensity of her headaches, but noted no change in the frequency of headaches. She was subsequently referred to the primary author for a second opinion and potential manual therapy interventions. Initial neurological screening examination for upper and lower motor neuron lesions was unremarkable. Assessment of the transverse ligament, using the anterior shear test in supine, brought on paresthesias in both feet and her toes. The paresthesias continued after the cessation of the test. The Sharp-Purser test performed in sitting, immediately after the transverse ligament test, abolished the paresthesias. She was then referred back to her primary care physician for further evaluation. Subsequent radiographs and magnetic resonance imaging revealed that the patient had a C2-C3 Klippel-Feil congenital fusion and os odontoideum. The patient was examined by a neurosurgeon who concluded that she was not a surgical candidate. Her neurological symptoms completely resolved, but she continued to have headaches. DISCUSSION: Os odontoideum is a clinically important condition, given that the mobile dens may render the transverse ligament incompetent, leading to atlantoaxial instability. Both the role and sequencing of upper cervical ligamentous testing is controversial. The results of this case report suggest that physical therapists should be cognizant of this condition and consider screening the upper cervical ligaments prior to manual or mechanical interventions to this region. LEVEL OF EVIDENCE:  Differential diagnosis, level 4. J Orthop Sports Phys Ther. 2008;38(8):465-475, published online 27 June 2008. doi:10.2519/jospt.2008.2747KEY WORDS: Klippel-Feil syndrome, manual therapy, neck, transverse ligament, upper cervical instability (Source: The Journal of Orthopaedic and Sports Physical Therapy)... MORE...
POSTED 08/23/2008 at 03:55 PM --

Strength deficits identified with concentric action of the hip extensors and eccentric action of the hamstrings predispose to hamstring injury in elite sprinters
Yusaku Sugiura, Tomoyuki Saito, Keishoku Sakuraba, Kazuhiko Sakuma, Eiichi SuzukiSTUDY DESIGN: Prospective cohort study. OBJECTIVES: In this prospective cohort study of elite sprinters, muscle strength of the hip extensors, as well as of the knee extensors and flexors, was measured to determine a possible relationship between strength deficits and subsequent hamstring injury within 12 months of testing. The method used for testing muscle strength simulated the specific muscle action during late swing and early contact phases when sprinting. BACKGROUND: There have been no prospective studies in elite sprinters that examine the concentric and eccentric isokinetic strength of the hip extensors and the quadriceps and hamstring muscles in a manner that reflects their actions in late swing or early contact phases of sprinting. Consequently, the causal relationship between hip and thigh muscle strength and hamstring injury in elite sprinters may not be fully understood. METHODS AND MEASURES: Isokinetic testing was performed on 30 male elite sprinters to assess hip extensors, quadriceps, and hamstring muscle strength. The occurrence of hamstring injury among the subjects was determined during the year following the muscle strength measurements. The strength of the hip extensors, quadriceps, and hamstring muscles, as well as the hamstrings-quadriceps and hip extensors- quadriceps ratios were compared. RESULTS: Hamstring injury occurred in 6 subjects during the 1-year period. Isokinetic testing at a speed of 60°/s revealed weakness of the injured limb with eccentric action of the hamstring muscles and during concentric action of the hip extensors. When performing a side-to-side comparison for the injured sprinters, the hamstring injury always occurred on the weaker side. Differences in the hamstrings-quadriceps and hip extensors-quadriceps strength ratios were also evident between uninjured and injured limbs, and this was attributable to deficits in hamstring strength. CONCLUSION: Hamstring injury in elite sprinters was associated with weakness during eccentric action of the hamstrings and weakness during concentric action of the hip extensors, but only when tested at the slower speed of 60°/s.J Orthop Sports Phys Ther. 2008;38(8):457-464, published online 15 April 2008. doi:10.2519/jospt.2008.2575KEY WORDS: isokinetics, quadriceps, running, sprinting (Source: The Journal of Orthopaedic and Sports Physical Therapy)... MORE...
POSTED 08/23/2008 at 03:55 PM --

Masterclass editorial.
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Masterclass editorial.

Man Ther. 2008 Oct;13(5):373-374

Authors: Beeton K

PMID: 18708021 [PubMed - as supplied by publisher]

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POSTED 08/20/2008 at 08:25 AM --

Energy conservation for people with ms-related fatigue: a pilot randomized controlled trial
Background. Fatigue is one of the most common symptoms of multiple sclerosis (MS) (Mathiowetz et al., 2005). Although education about energy conservation is widely used in the clinical setting, research to ensure evidence-based practice is still limited (MSC, 1998; Brañas et al., 2000; The National Collaborating Centre for Chronic Conditions, 2004). Aim. To test the methodology for a further randomized controlled trial. To evaluate the impact of an energy conservation programme (ECP). Design. Pilot randomized controlled trial. Method. A convenience sample of 13 people with MS was randomly allocated to two groups. The experimental intervention was an ECP and the control intervention a peer support group which received information about MS and its treatment. Both interventions were delivered in group format once a week for six weeks in two-hour sessions. Outcome Measures. The Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), MS Impact Scale-29 (MSIS-29) and MS Self-efficacy Scale (MSSS). Statistics. Repeated-measures analysis of variance (ANOVA). Statistical analysis was conducted on an intention to treat (ITT) and compliers only basis. Results. There were significant reductions over time in the FIS for both groups (p = 0.004). Although the experimental group showed larger reductions in the FIS, the difference between groups was not significant (p = 0.12). Similarly, both groups showed a strong trend towards significant differences over time for the FSS and MSSS (p = 0.05), but differences between the groups were not significant (p = 0.58). Differences for the MSIS-29 were neither significant over time (p = 0.58) nor between the groups (p = 0.66). Conclusion. This pilot study shows that an ECP may be beneficial and supports further evaluation of the effect of an ECP in the management of MS-related fatigue. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)... MORE...
POSTED 08/13/2008 at 11:00 PM --

Rheumatoid arthritis, alcohol, leflunomide and methotrexate. can changes to the bsr guidelines for leflunomide and methotrexate on alcohol consumption be justified?
Introduction: The summary of product characteristics for leflunomide and methotrexate recommend avoiding alcohol. By contrast, the latest British Society for Rheumatology (BSR) guidelines suggest that alcohol should be 'well within national limits'. A postal survey was performed of rheumatoid arthritis (RA) patients to address their alcohol consumption, and assess whether this influenced any rise in alanine transaminase (ALT) levels while on leflunomide or methotrexate.Methods: RA patients commenced on methotrexate or leflunomide within the preceding two years were identified using the departmental database. A total of 200 patients on methotrexate or leflunomide were sent questionnaires covering demographics, disease details, duration of disease-modifying anti-rheumatic drug (DMARD) use, previous medical and drug history, alcohol advice recalled, and alcohol consumption while on the drug. ALT levels at drug commencement and the highest level on the drug were recorded.Results: Replies were received from 69.5% of methotrexate and 57.5% of leflunomide patients. 68.6% of patients recalled receiving alcohol advice. 55.8% of leflunomide patients did not drink alcohol prior to taking the DMARD, compared with 39.4% of methotrexate patients. 27.7% of leflunomide patients continued to drink alcohol compared with 64.3% on methotrexate. For both drugs, no patterns emerged to suggest that baseline or highest ALT levels were influenced by higher levels of alcohol consumption.Discussion: No differences were found with either methotrexate or leflunomide for self-reported alcohol consumption influencing ALT levels. It is appropriate to give similar alcohol advice to patients beginning therapy with either methotrexate or leflunomide. This research has not found any evidence to contradict the relaxation of advice on alcohol consumption with methotrexate and leflunomide in the updated BSR guidelines. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)... MORE...
POSTED 08/13/2008 at 11:00 PM --

Reliability of performance-based measures in people awaiting joint replacement surgery of the hip or knee
Background and Purpose. Understanding the reliability of selected measurement tools is a prerequisite to understanding the effects of clinical interventions. The aim of this investigation was to determine the reliability of the 50-Foot Timed Walk (50 FTW) and 30-second Chair Stand Test (30 CST) in subjects awaiting joint replacement surgery of the hip or knee. Methods. Eighty-two subjects participating in a 6-week exercise programme were assessed at baseline, 7 weeks and 15 weeks. Four trials of the 50 FTW and two trials of the 30 CST were completed at each assessment. Eleven trained assessors completed the assessments. Results. Intra-class correlations were consistently high for the 50 FTW and 30 CST at all assessments. At the baseline assessment, trial 1 was found to be significantly different from subsequent trials for both the 50 FTW and 30 CST. This effect was not evident at the 7-week and 15-week assessments. At the baseline assessment, scores for the 50 FTW became stable after the first trial. Estimates of minimum detectable change indicated that participants needed to change by more than 3.08 seconds and 1.64 stands to be 90% confident that a real change had occurred for the 50 FTW and 30 CST, respectively. Conclusion. The 50 FTW and 30 CST can be reliable measures of physical performance. However, because we found a practice effect at the baseline assessment, a practice trial should be allowed before data collection begins. Because only two trials of the 30 CST were completed, further research is required to confirm whether scores at the initial assessment become stable on repeated testing. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)... MORE...
POSTED 08/12/2008 at 11:00 PM --

Welfare benefit promotion within a district general hospital rheumatology centre: a joint project with the local citizens advice bureau
Objectives: The Health Assessment Questionnaire (HAQ), used in arthritis provides an overall disability index and has been used previously to indicate those patients with arthritis who may be eligible for welfare benefits such as Attendance Allowance (AA) or Disability Living Allowance (DLA) (Langley et al., 2004, Memel et al., 2002, Powell et al., 2004). The aim of this study was to assess the effectiveness of the HAQ in this local population as a tool for identifying patients who may be eligible for benefits, and to assist those identified in claiming benefits with the help of a Citizens Advice Bureau benefits advisor.Method: HAQ forms were sent to patients attending the Rheumatology Centre, all those patients with a HAQ score of [le]1.5, indicating moderate to severe disability were contacted initially by telephone by the CAB advisor. Those whom were considered eligible were invited to attend the Rheumatology Centre to determine their suitability to apply for benefit. Suitable patients were invited to complete a department of Work and Pensions claim pack either with the advisor in the Rheumatology Centre, with a CAB form completion volunteer within the patient's home or fill the forms in themselves.Results: Of the 86 patients contacted by the CAB advisor, 48 were already on benefits, 8 of these patients were advised to have their benefits reviewed. 38 were not in receipt of any benefits. 29 (63%) were awarded benefits.Conclusions: The HAQ was found to be a useful tool in this local population for identifying patients with arthritis who may be entitled to AA or DLA. The CAB advisor was central to the identification and application process for eligible patients for AA and DLA, which in some cases led to the award of other entitlements. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)... MORE...
POSTED 08/12/2008 at 11:00 PM --

Rheumatoid arthritis patients' knowledge of the disease and its treatments: a descriptive study
Objective: The purpose of rheumatoid arthritis (RA) patient education is to increase patients' knowledge levels. However, there are only a limited number of studies available concerning these patients' knowledge of their disease and its various treatments. The purpose of this study was to describe RA patients' understanding of their disease and its treatments.Methods: A total of 252 RA patients participated in this survey in August 2004 (response rate 53.2%). The knowledge levels of the patients and their physical functioning were measured using self-reported questionnaires. The data were analysed using descriptive and non-parametric statistical methods.Results: RA patients' knowledge of the disease and its treatments was, on average, good. However, the total scores of the Patient Knowledge Questionnaire ranged from 2 to 29 (maximum score 30). The patients knew well the aetiology and symptoms of RA, the blood tests and the physical exercise; they knew moderately well the facts relating to joint protection, energy conservation and how to use anti-rheumatic drugs and non-steroidal anti-inflammatory drugs. Young patients, women and patients with a long disease duration knew the most. There was a weak correlation between patient knowledge and physical functioning: the weaker the patient's functioning, the higher the knowledge level.Conclusions: RA patients' knowledge of their disease and its treatments varied from poor to good in this group. These results can be used for advancing RA patient education. However, more research is needed to evaluate RA patients' knowledge levels. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)... MORE...
POSTED 08/10/2008 at 11:00 PM --

Clinical measurement of craniovertebral angle by electronic head posture instrument: a test of reliability and validity.
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Clinical measurement of craniovertebral angle by electronic head posture instrument: A test of reliability and validity.

Man Ther. 2008 Aug 9;

Authors: Cheung Lau HM, Wing Chiu TT, Lam TH

The study was a cross-sectional reliability study with the objective of assessing the reliability and validity of the Electronic Head Posture Instrument (EHPI) in measuring the craniovertebral (CV) angle for subjects with or without neck pain. Twenty-six subjects (mean age=36.88, SD+/-9.95) with chronic neck pain and 27 subjects (mean age=31.85, SD+/-7.63) without neck pain were recruited. The CV angle was measured by the EHPI which consists of an electronic angle finder, a transparent plastic base and a camera stand. Two therapists were recruited to assess the intra- and inter-rater reliability of the EHPI in two separate sessions of measurement. The difference in CV angle between the two groups was determined. The CV angle of the patient group (mean 43.94, SD+/-3.61) was significantly smaller (p<0.001) than that of the normal group (mean 50.58, SD+/-2.09). Intra-rater (intra-class correlation coefficient (ICC) ranged from 0.86 to 0.94) and inter-rater (ICC ranged from 0.85 to 0.91) reliability of the EHPI in measuring CV angle for both groups of subjects were high. In conclusion the EHPI was found to be reliable and valid in measuring the CV angle for subjects with or without neck pain.

PMID: 18694655 [PubMed - as supplied by publisher]

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POSTED 08/08/2008 at 11:00 PM --

Piloting education days for patients with early rheumatoid arthritis and their partners: a multidisciplinary approach
Objectives: To develop, pilot, refine and reassess an education day presented by a rheumatology multidisciplinary team (MDT) for recently diagnosed (less than six months) rheumatoid arthritis (RA) patients and their partners/carers.Methods: A patient education day was developed drawing on an assessment of local patient educational needs and preferences and input from a rheumatology MDT. Feedback from the first education day (2004) (Day 1; 12 patients; age range 19-63 years (median 46); 10 of whom were accompanied by a partner) informed the development of a second education day (2005) (Day 2; 19 patients; age range 36-75 years (median 57.5); 13 of whom were accompanied by a partner). Participants completed evaluation forms on both days and at follow-up between six and seven weeks later, rating each session on a 5-point scale on dimensions of 'informative', 'useful', 'interesting' and 'enjoyable'. A global rating of the day's 'usefulness' was completed at the end of each day on a 10-point scale. Participants were asked to write comments on each session and on aspects of the entire day. RA knowledge, and general and RA-specific self-efficacy were also measured on day 2 (and at follow-up) using the 12-item Patient Knowledge Questionnaire, the 10-item generalized self-efficacy scale and a four-item RA-specific self-efficacy scale. Both qualitative and quantitative methodologies were used in the analysis.Results: Ratings for individual sessions were all high, with no session being rated below 4 out of 5 (1 = 'totally disagree' to 5 = 'totally agree') on both days. The majority of patients (84%) and their partners (57%) responded to the follow-up. Many had used the information package distributed on the day. Some patients and their partners reported positive changes in RA management. Although patient knowledge did not increase significantly (medians 11 at both time points, p = 0.054) (Day 2), RA self-efficacy improved (baseline 11 and 14, respectively), suggesting that patients were more confident in managing their condition (p = 0.010).Conclusions: The development of this 'local' education and information intervention was carried out in line with Medical Research Council guidelines, and the lessons learned from Day 1 informed further development for Day 2. A one-day format for education of early RA involving the rheumatology MDT was rated highly by participants and warrants further examination. Although this study was a small 'local' intervention, its strengths are that it informs the possibility of wider developments of this kind using a MDT. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)... MORE...
POSTED 08/07/2008 at 11:00 PM --

Inclusion of thoracic spine thrust manipulation into an electro-therapy/thermal program for the management of patients with acute mechanical neck pain: a randomized clinical trial.
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Inclusion of thoracic spine thrust manipulation into an electro-therapy/thermal program for the management of patients with acute mechanical neck pain: A randomized clinical trial.

Man Ther. 2008 Aug 7;

Authors: González-Iglesias J, Fernández-de-Las-Peñas C, Cleland JA, Alburquerque-Sendín F, Palomeque-Del-Cerro L, Méndez-Sánchez R

Our aim was to examine the effects of a seated thoracic spine distraction thrust manipulation included in an electrotherapy/thermal program on pain, disability, and cervical range of motion in patients with acute neck pain. This randomized controlled trial included 45 patients (20 males, 25 females) between 23 and 44years of age presenting with acute neck pain. Patients were randomly divided into 2 groups: an experimental group which received a thoracic manipulation, and a control group which did not receive the manipulative procedure. Both groups received an electrotherapy program consisting of 6 sessions of TENS (frequency 100Hz; 20min), superficial thermo-therapy (15min) and soft tissue massage. The experimental group also received a thoracic manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain (numerical pain rate scale; NPRS), level of disability (Northwick Park Neck Pain Questionnaire; NPQ) and neck mobility. These outcomes were assessed at baseline and 1week after discharge. A 2-way repeated-measures ANOVA with group as between-subject variable and time as within-subject variable was used. Patients receiving thoracic manipulation experienced greater reductions in both neck pain, with between-group difference of 2.3 (95% CI 2-2.7) points on a 11-NPRS, and perceived disability with between-group differences 8.5 (95% CI 7.2-9.8) points. Further, patients receiving thoracic manipulation experienced greater increases in all cervical motions with between-group differences of 10.6 degrees (95% CI 8.8-12.5 degrees ) for flexion; 9.9 degrees (95% CI 8.1-11.7 degrees ) for extension; 9.5 degrees (95% CI 7.6-11.4 degrees ) for right lateral-flexion; 8 degrees (95% CI 6.2-9.8 degrees ) for left lateral-flexion; 9.6 degrees (95% CI 7.7-11.6 degrees ) for right rotation; and 8.4 degrees (95% CI 6.5-10.3 degrees ) for left rotation. We found that the inclusion of a thoracic manipulation into an electrotherapy/thermal program was effective in reducing neck pain and disability, and in increasing active cervical mobility in patients with acute neck pain.

PMID: 18692428 [PubMed - as supplied by publisher]

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POSTED 08/06/2008 at 11:00 PM --

Factors with independent influence on the 'timed up and go' test in patients with hip fracture
Background and Purpose. Data on performance times for the 'timed up and go' (TUG) test with analyses of factors, that eventually could affect the result in patients with hip fracture, have not been published to date. The aims of the present study, therefore, were to assess normative reference values of TUG performances and determine the influence of individual and clinical factors on TUG-test scores in patients with hip fracture. Method. In this prospective, descriptive study, a total of 196 consecutive patients over the age of 60, and able to perform the TUG when discharged directly to their own homes from a specialized orthopaedic hip fracture unit, were evaluated. The association between TUG scores and categorical variables were examined, and linear regression was used to investigate the factors influencing performance times. Results. Univariate analysis showed significant differences between all categorical variables, except gender, but multivariate linear regression analyses showed that only a high pre-fracture function level, evaluated by the New Mobility Score (B = -11), was independently associated with having a good TUG score, while older age (B = 0.49), having an intertrochanteric fracture (B = 7), performing TUG with a walker (B = 15), and performing TUG in the later postoperative period (B = 0.39) were independently associated with having a poorer TUG score. Conclusions. These preliminary normative reference values of TUG performances in patients with hip fracture can be used as references, to which individuals can expect to perform. Multivariate testing suggests that clinicians should use age, pre-fracture function, fracture type and walking-aid specific data when interpreting the TUG test results. Physiotherapists should be aware of this if TUG scores are to be used predictively or as an outcome measure in patients with hip fracture, especially in research. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)... MORE...
POSTED 07/23/2008 at 11:00 PM --

'it's quite hard to grasp the enormity of it': perceived needs of people upon diagnosis of rheumatoid arthritis
Objectives: The diagnosis of rheumatoid arthritis (RA) brings rapid pharmacological and multidisciplinary team interventions to address inflammatory processes and symptom management. However, people may also need support on the journey to self-management. The aim of this study was to explore what professional support patients feel they receive upon diagnosis, and what support they feel would be most helpful.Methods: Two focus groups comprised patients with at least five years'; disease duration (n = 7), and patients more recently diagnosed (5-18 months, n = 5). The latter had attended at least two appointments in a rheumatology nurse specialist clinic during the previous year, aimed at providing support upon diagnosis. Transcripts were subjected to thematic analysis to identify common issues regarding support needs, which were then grouped into themes. Interviewing and analysis was performed by researchers not involved in clinical care.Results: Four overarching themes emerged. 'Information' was needed about the symptoms of RA, its management and personal outcome, while 'Support' related to emotional needs ('It's quite hard to grasp the enormity of it'). Information and Support overlapped, in that patients wanted someone to talk to, and to be listened to. These two themes were underpinned by issues of service delivery: 'Choice' (patient or professional to talk to, groups, one-to-one) and 'Involvement' (holistic care, partnership), which overlapped in terms of the opportunity to decide when and which interventions to access.Conclusions: People with RA report not only informational, but also emotional support needs at diagnosis. The potential for delivering emotional support to patients around the time of diagnosis warrants further exploration. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)... MORE...
POSTED 07/21/2008 at 11:00 PM --

Knowledge, attitude and willingness of nigerian physiotherapists to provide care for patients living with acquired immunodeficiency syndrome
Background and Purpose. Adequate knowledge, positive attitude, and willingness to provide services are important factors in rendering competent and compassionate care to patients living with Acquired Immunodeficiency Syndrome (AIDS). Inadequate knowledge and poor attitude could exclude the application of the principles of logic and scientific methods to the practice of physiotherapy, and could result in fragmented care, with a potentially negative impact on treatment outcome and patient satisfaction. The purpose of this study was (1) to investigate the Nigerian physiotherapists' global knowledge, attitude and willingness to provide care for patients living with AIDS (PLWA), and to (2) determine the relationship between socio-demographic variables and previous encounter with PLWA, and physiotherapists' knowledge, attitude and willingness to care for AIDS survivors. Methods. Using a 90-item two-part questionnaire that elicited sociodemographic and previous AIDS encounter information, and also assessed knowledge, attitude and willingness to provide care to PLWA, physiotherapists (N = 131) practicing in Nigeria were surveyed. Results. Overall, the physiotherapists showed unsatisfactory knowledge about AIDS, harbored negative attitude towards PLWA, and some were unwilling to provide care for PLWA. Previous experience caring for PLWA influenced their attitude, and modest but positive relationships were found between knowledge and attitude and between attitude and willingness. Conclusion. The study underscores the need to address Nigerian physiotherapists' working knowledge deficits and negative attitudes to PLWA. A comprehensive AIDS education that would assist clinicians in exploring their attitude, stereotype and bias against PLWA is warranted. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Physiotherapy Research International)... MORE...
POSTED 07/10/2008 at 11:00 PM --

The de quervain's screening tool: validity and reliability of a measure to support clinical diagnosis and management
Background: Studies into the effectiveness of interventions for upper limb soft tissue disorders have been hampered by a lack of consistently used diagnostic criteria, meaning that comparison of research results is a problem. To aid homogeneous recruitment into a study of de Quervain's disease, a de Quervain's screening tool (DQST) was developed. This could also be used to facilitate clinical diagnosis and management in practice.Aims: To provide evidence for the content and construct validity and test-retest and inter-rater reliability of the DQST.Method: The study was conducted in an acute care, outpatient hand unit in a district general hospital. Three convenience samples of: 59 people with de Quervain's disease; 18 with carpal tunnel syndrome (CTS) and 16 with osteoarthritis (OA) of the carpometacarpal (CMC) joint were recruited. The DQST diagnostic criteria were initially generated from a literature review. Content validity was then established by expert doctors with an interest in upper limb musculoskeletal disorders (n = 7) rating the relevance of the seven items included. The DQST was then tested in people either already diagnosed with, or reported as having some of the symptoms of, de Quervain's disease. Construct validity was tested with people with CTS or OA of the CMC joint.Results: The median DQST score was 5 (Interquartile range IQR = 4-6) out of a possible seven diagnostic criteria. Inter-rater reliability was excellent (Intra-class coefficient [ICC] = 0.85; 95% confidence interval [CI] = 0.75, 0.91). Test retest reliability was good (ICC = 0.64; 95% CI = 0.20, 0.87). Sensitivity (Se) and specificity (Sp) testing (Se = 1.00; Sp = 1.00) demonstrated that the DQST discriminated between people with de Quervain's disease, CTS or OA of the CMC joint.Conclusions: The DQST is a valid, reliable tool which could be of assistance in aiding correct diagnosis for recruitment to clinical trials and in clinical practice. Future research is recommended to further examine retest reliability with a larger sample size and to identify the commonest diagnostic criteria required for inclusion. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Musculoskeletal Care)... MORE...
POSTED 07/10/2008 at 11:00 PM --

 

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