Physiotherapy - Research Publications
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ItemExpanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: a prospective case series(ELSEVIER SCIENCE INC, 2019-08-17)BACKGROUND: Loss of upper extremity function after cervical spinal cord injury greatly affects independence, including social, vocational, and community engagement. Nerve transfer surgery offers an exciting new option for the reanimation of upper limb function in tetraplegia. The aim of this study was to evaluate the outcomes of nerve transfer surgery used for the reanimation of upper limb function in tetraplegia. METHODS: In this prospective case series, we consecutively recruited people of any age with early (<18 months post-injury) cervical spinal cord injury of motor level C5 and below, who had been referred to a single centre for upper extremity reanimation and were deemed suitable for nerve transfer. All participants underwent single or multiple nerve transfers in one or both upper limbs, sometimes combined with tendon transfers, for restoration of elbow extension, grasp, pinch, and hand opening. Participants were assessed at 12 months and 24 months post-surgery. Primary outcome measures were the action research arm test (ARAT), grasp release test (GRT), and spinal cord independence measure (SCIM). FINDINGS: Between April 14, 2014, and Nov 22, 2018, we recruited 16 participants (27 limbs) with traumatic spinal cord injury, among whom 59 nerve transfers were done. In ten participants (12 limbs), nerve transfers were combined with tendon transfers. 24-month follow-up data were unavailable for three patients (five limbs). At 24 months, significant improvements from baseline in median ARAT total score (34·0 [IQR 24·0-38·3] at 24 months vs 16·5 [12·0-22·0] at baseline, p<0·0001) and GRT total score (125·2 [65·1-154·4] vs 35·0 [21·0-52·3], p<0·0001) were observed. Mean total SCIM score and mobility in the room and toilet SCIM score improved by more than the minimal detectable change and the minimal clinically important difference, and the mean self-care SCIM score improved by more than the minimal detectable change between baseline and 24 months. Median Medical Research Council strength grades were 3 (IQR 2-3) for triceps and 4 (IQR 4-4) for digital extensor muscles after 24 months. Mean grasp strength at 24 months was 3·2 kg (SD 1·5) in participants who underwent distal nerve transfers (n=5), 2·8 kg (3·2) in those who had proximal nerve transfers (n=9), and 3·9 kg (2·4) in those who had tendon transfers (n=8). There were six adverse events related to the surgery, none of which had any ongoing functional consequences. INTERPRETATION: Early nerve transfer surgery is a safe and effective addition to surgical techniques for upper limb reanimation in tetraplegia. Nerve transfers can lead to significant functional improvement and can be successfully combined with tendon transfers to maximise functional benefits. FUNDING: Institute for Safety, Compensation, and Recovery Research (Australia).
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ItemEffectiveness of an online self-management tool, OPERAS (an On-demand Program to EmpoweR Active Self-management), for people with rheumatoid arthritis: a research protocol(BMC, 2019-12-11)BACKGROUND: Active self-management is a process where patients are fully engaged in managing their health in daily life by having access to contextualized health data and tailored guidance to support a healthy lifestyle. This study aims to determine whether an e-health intervention that incorporates symptom/disease activity monitoring and physical activity counselling can improve self-management ability in patients with rheumatoid arthritis (RA). METHODS: The 'Empowering active self-management of arthritis: Raising the bar with OPERAS (an On-demand Program to EmpoweR Active Self-management)' project is a randomized controlled trial that uses a delayed control design. One hundred thirty-four participants with RA will be randomly assigned to start the intervention either immediately (immediate group) or 6 months later (delayed group). The intervention involves (1) use of a Fitbit-compatible web app to record and monitor their RA disease activity, symptoms, and time spent on physical activity and a Fitbit; (2) group education and individual counselling by a physiotherapist (PT); and (3) six phone calls with a PT. The primary outcome measure is self-management ability measured by the Patient Activation Measure. Secondary outcome measures include disease status, fatigue, pain, depressive symptoms, and characteristics of habitual behavior and also time spent in physical activity and sedentary activity with a wearable multi-sensor device (SenseWear Mini). After the 6-month intervention, we will interview a sample of participants to examine their experiences with the intervention. DISCUSSION: The results of this study will help to determine whether this technology-enhanced self-management intervention improves self-management ability and health outcomes for people living with RA. A limitation of this study is that participants will need to self-report their symptoms, disease status, and treatment use through questionnaires on the OPERAS web app. The user-friendly interface, reminder emails from the research staff, and tailored guidance from PTs will encourage participants to actively engage with the app. TRIAL REGISTRATION: Date of last update in ClinicalTrials.gov: January 2, 2019. ClinicalTrials.gov Identifier: NCT03404245.
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ItemObjective classification and scoring of movement deficiencies in patients with anterior cruciate ligament reconstruction(PUBLIC LIBRARY SCIENCE, 2019-07-23)Motion analysis systems are widely employed to identify movement deficiencies-e.g. patterns that potentially increase the risk of injury or inhibit performance. However, findings across studies are often conflicting in respect to what a movement deficiency is or the magnitude of association to a specific injury. This study tests the information content within movement data using a data driven framework that was taught to classify movement data into the classes: NORM, ACLOP and ACLNO OP, without the input of expert knowledge. The NORM class was presented by 62 subjects (124 NORM limbs), while 156 subjects with ACL reconstruction represented the ACLOP and ACLNO OP class (156 limbs each class). Movement data from jumping, hopping and change of direction exercises were examined, using a variety of machine learning techniques. A stratified shuffle split cross-validation was used to obtain a measure of expected accuracy for each step within the analysis. Classification accuracies (from best performing classifiers) ranged from 52 to 81%, using up to 5 features. The exercise with the highest classification accuracy was the double leg drop jump (DLDJ; 81%), the highest classification accuracy when considering only the NORM class was observed in the single leg hop (81%), while the DLDJ demonstrated the highest classification accuracy when considering only for the ACLOP and ACLNO OP class (84%). These classification accuracies demonstrate that biomechanical data contains valuable information and that it is possible to differentiate normal from rehabilitating movement patterns. Further, findings highlight that a few features contain most of the information, that it is important to seek to understand what a classification model has learned, that symmetry measures are important, that exercises capture different qualities and that not all subjects within a normative cohort utilise 'true' normative movement patterns (only 27 to 71%).
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ItemNo Preview AvailableExploring the Characteristics and Preferences for Online Support Groups: Mixed Method Study(JMIR PUBLICATIONS, INC, 2019-12-03)BACKGROUND: Osteoarthritis (OA) is a chronic, disabling, and prevalent disorder. As there is no cure for OA, long-term self-management is paramount. Support groups (SGs) can facilitate self-management among people living with OA. Understanding preferences in design and features of SGs, including online SGs (OSGs), among people with OA can inform future development of SG interventions for this condition. OBJECTIVE: The objective of this study was to investigate health care- and health information-seeking behavior, digital literacy, and preferences for the design of SGs in people with OA. The study also explored the perceived barriers and enablers to being involved in OSGs. METHODS: An online survey study was conducted with a mixed method design (quantitative and qualitative). Individuals aged ≥45 years with knee, hip, or back pain for ≥3 months were recruited from an extant patient database of the Institute of Bone and Joint Research via email invitations. Quantitative elements of the survey included questions about sociodemographic background; health care- and health information-seeking behavior; digital literacy; and previous participation in, and preferences for, SGs and OSGs. Respondents were classified into 2 groups (Yes-SG and No-SG) based on previous participation or interest in an SG. Group differences were assessed with Chi-square tests (significance level set at 5%). Responses to free-text questions relating to preferences regarding OSG engagement were analyzed qualitatively using an inductive thematic analysis. RESULTS: A total of 415 people with OA completed the survey (300/415, 72.3% females; 252/415, 61.0% lived in a major city). The Yes-SG group included 307 (307/415, 73.9%) participants. Between the Yes-SG and No-SG groups, there were no differences in sociodemographic characteristics, health care- and health information-seeking behavior, and digital literacy. An online format was preferred by 126/259 (48.7%) of the Yes-SG group. Trained peer facilitators were preferred, and trustworthiness of advice and information were highly prioritized by the respondents. Qualitative analysis for OSG participation revealed 5 main themes. Lack of time and motivation were the main barriers identified. The main enablers were related to accessibility, enjoyment of the experience, and the content of the discussed information. CONCLUSIONS: These findings highlight the preferences in design features and content of SGs and OSGs and may assist in the further development of such groups.
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ItemA Short Message Service Intervention to Support Adherence to Home-Based Strengthening Exercise for People With Knee Osteoarthritis: Intervention Design Applying the Behavior Change Wheel(JMIR PUBLICATIONS, INC, 2019-10-18)BACKGROUND: Knee osteoarthritis is a chronic condition with no known cure. Treatment focuses on symptom management, with exercise recommended as a core component by all clinical practice guidelines. However, long-term adherence to exercise is poor among many people with knee osteoarthritis, which limits its capacity to provide sustained symptom relief. To improve exercise outcomes, scalable interventions that facilitate exercise adherence are needed. SMS (short message service) interventions show promise in health behavior change. The Behavior Change Wheel (BCW) is a widely used framework that provides a structured approach to designing behavior change interventions and has been used extensively in health behavior change intervention design. OBJECTIVE: The study aimed to describe the development of, and rationale for, an SMS program to support exercise adherence in people with knee osteoarthritis using the BCW framework. METHODS: The intervention was developed in two phases. Phase 1 involved using the BCW to select the target behavior and associated barriers, facilitators, and behavior change techniques (BCTs). Phase 2 involved design of the program functionality and message library. Messages arranged into a 24-week schedule were provided to an external company to be developed into an automated SMS program. RESULTS: The target behavior was identified as participation in self-directed home-based strengthening exercise 3 times a week for 24 weeks. A total of 13 barriers and 9 facilitators of the behavior and 20 BCTs were selected to use in the intervention. In addition, 198 SMS text messages were developed and organized into a 24-week automated program that functions by prompting users to self-report the number of home exercise sessions completed each week. Users who reported ≥3 exercise sessions/week (adherent) received positive reinforcement messages. Users who reported <3 exercise sessions/week (nonadherent) were asked to select a barrier (from a list of standardized response options) that best explains why they found performing the exercises challenging in the previous week. This automatically triggers an SMS containing a BCT suggestion relevant to overcoming the selected barrier. Users also received BCT messages to facilitate exercise adherence, irrespective of self-reported adherence. CONCLUSIONS: This study demonstrates application of the BCW to guide development of an automated SMS intervention to support exercise adherence in knee osteoarthritis. Future research is needed to assess whether the intervention improves adherence to the prescribed home-based strengthening exercise.
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ItemBehaviour change techniques to optimise participation in physical activity or exercise in adolescents and young adults with chronic cardiorespiratory conditions: a systematic review(WILEY, 2019-10)Participation in regular physical activity decreases the risk of developing cardiometabolic disease. However, the proportion of people who participate in the recommended amount of physical activity is low, with common barriers including competing interests and inclement weather. In people with chronic cardiorespiratory conditions, participation in physical activity is reduced further by disease-specific barriers, time burden of treatment and unpleasant symptoms during physical activity. Addressing these barriers during adolescence and early adulthood may promote greater physical activity participation into older age. The aim of this review was to classify interventions aimed at optimising participation in physical activity as 'promising' or 'not promising' in people aged 15-45 years with chronic cardiorespiratory conditions and categorise the behaviour change techniques (BCT) within these interventions. Nine databases and registries were searched (October 2017) for studies that reported objective measures of physical activity before and after an intervention period. Interventions were classified as 'promising' if a between-group difference in physical activity was demonstrated. Michie et al.'s (2013) v1 Taxonomy was used to unpack the BCT within interventions. Across the six included studies (n = 396 participants), 19 (20%) of 93 BCT were described. The interventions of three studies were classified as 'promising'. The most commonly used BCT comprised goal setting, action planning and social support. Five BCT were solely used in 'promising' interventions. Our review demonstrated that only 20% of BCT have been utilised, and those BCT that were used only in 'promising' physical activity interventions in adolescents and adults with chronic cardiorespiratory conditions were isolated.
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ItemThe effects of behavioural counselling on the determinants of health behaviour change in adults with chronic musculoskeletal conditions making lifestyle changes: A systematic review and meta-analysis(WILEY, 2019-09)OBJECTIVE: A systematic review and meta-analysis of controlled trials was carried out to examine the effect of behavioural counselling on determinants of behaviour change in adults with chronic, painful musculoskeletal conditions. METHODS: Seven databases were searched up to January 2019. Two reviewers independently screened title/abstracts and full texts. Eligible trials included those including participants over 18 years of age with a chronic, painful musculoskeletal condition, a measurement of at least one behavioural determinant and lifestyle behaviour, and where behavioural counselling was the distinguishing intervention. Two reviewers independently extracted data and assessed for risk of bias using the Cochrane Risk of Bias Tool. Meta-analyses were conducted, using standardized mean differences and 95% confidence intervals (CIs) when at least two trials examined the same outcome. The quality of the evidence was evaluated using the Grades of Recommendation, Assessment, Development and Evaluation approach. RESULTS: Fourteen unique trials, reported in 16 publications, were included. Low-quality evidence showed that behavioural counselling has a small effect on increasing self-reported physical activity (standardized mean difference 0.26; 95% CI 0.00, 0.53). Very-low-quality evidence showed that behavioural counselling has a moderate effect on self-efficacy related to physical activity (standardized mean difference 0.69; 95% CI 0.19, 1.18). Low-quality evidence suggested that behavioural counselling has no effect on symptoms of depression and anxiety. CONCLUSIONS: Behavioural counselling may help to increase self-reported physical activity levels in adults with chronic painful musculoskeletal conditions. Self-efficacy may be a behavioural determinant in an underlying causal pathway explaining positive lifestyle change.
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ItemMuscle and Joint Function After Anatomic and Reverse Total Shoulder Arthroplasty Using a Modular Shoulder Prosthesis(John Wiley & Sons, Inc., 2019-09-01)Changes in joint architecture and muscle loading resulting from total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA) are known to influence joint stability and prosthesis survivorship. This study aimed to measure changes in muscle moment arms, muscle lines of action, as well as muscle and joint loading following TSA and RSA using a metal‐backed uncemented modular shoulder prosthesis. Eight cadaveric upper extremities were assessed using a customized testing rig. Abduction, flexion, and axial rotation muscle moment arms were quantified using the tendon‐excursion method, and muscle line‐of‐force directions evaluated radiographically pre‐operatively, and after TSA and revision RSA. Specimen‐specific musculoskeletal models were used to estimate muscle and joint loading pre‐ and post‐operatively. TSA lateralized the glenohumeral joint center by 4.3 ± 3.2 mm, resulting in small but significant increases in middle deltoid force (2.0%BW) and joint compression during flexion (2.1%BW) (p < 0.05). Revision RSA significantly increased the moment arms of the major abductors, flexors, adductors, and extensors, and reduced their peak forces (p < 0.05). The superior inclination of the deltoid significantly increased while the inferior inclination of the rotator cuff muscles decreased (p < 0.05). TSA using an uncemented metal‐backed modular shoulder prosthesis effectively restores native joint function; however, lateralization of the glenoid component should be minimized intra‐operatively to mitigate increased glenohumeral joint loading and polyethylene liner contact stresses. Revision RSA reduces muscle forces required during shoulder function but produces greater superior joint shear force and less joint compression. The findings may help to guide component selection and placement to mitigate joint instability after arthroplasty.
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ItemNocturnal voiding frequency does not describe nocturia-related bother(WILEY, 2019-08)AIM: Nocturia frequency has been used as a measure of treatment efficacy for nocturia even though fluctuation of the symptom over time has been well described in the literature. Additionally, given the multifactorial causal pathway and clinically relevant comorbidities, frequency alone may be an insufficient marker of treatment direction. The aim of this study was to investigate factors associated with nocturia-related bother to identify additional variables that may capture the impact of nocturia, direct clinical care and have potential to quantify treatment outcome. METHODS: Prospective data from tertiary hospital Urology and Continence cohorts were matched for identical variables to generate a sample of 204 datasets. Descriptive statistics were obtained to describe the two cohorts. Characteristics of patients were evaluated across levels of nocturia frequency and nocturia-related bother using nonparametric methods; statistically significant differences between groups in each cohort were established. RESULTS: Nocturia frequency alone does not comprehensively reflect attributable bother. Five sleep variables (poor quality sleep, short time to first awakening to void, less than 7 hours of total sleep, primary sleep latency, and daytime sleepiness) and daily urinary urgency were significantly associated with high nocturia-related bother. Attributable bother, despite high-frequency nocturia, was minimized by male gender, lack of daily urinary urgency and good sleep quality. Poor health status, urinary urgency and sleep latency were associated with nocturia frequency. CONCLUSIONS: Items of importance to individuals with nocturia have been identified from patient data. These variables have the potential to sit alongside change in nocturia frequency as potential markers of treatment response.
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ItemAn accelerometry and observational study to quantify upper limb use after stroke during inpatient rehabilitation(WILEY, 2019-10)OBJECTIVES: The objectives of the study are to characterize paretic upper limb (UL) use in people with different levels of impairment 4 weeks poststroke and to compare accelerometry and direct observational approaches. METHODS: Twelve stroke inpatients (five mild, three moderate, and four severe UL impairment) were recruited from a rehabilitation hospital. UL use was measured using accelerometry (24 hr) and direct observation (12 hr of behavioural mapping). Accelerometry variables included duration of use, use ratio, magnitude ratio, bilateral magnitude, and variation ratio. Direct observation recorded the duration of use and type of UL movement (e.g., functional vs. non-functional). RESULTS: From accelerometry data, people with mild, moderate, and severe UL impairments used their paretic UL 59%, 45%, and 22% of a 24 hr-day, respectively. People with severe UL impairment had the lowest paretic UL use duration (median 1.49 hr/day), magnitude ratio, and variation ratio compared with people with mild and moderate UL impairment. From 12 hr of observational data, people with mild impairment were using their UL for 37.8% of the observed time, whereas the people with moderate and severe impairment were using their UL 15.8% and 4.9%, respectively. UL movements for the mild cohort were mainly functional, whereas UL movements of the moderate and severe cohorts were mainly non-functional. UL movements were predominantly active for the mild and moderate cohorts but passive for the severe cohort. Duration of paretic UL use from accelerometry and observation data were highly correlated (ICC > 0.8), but the absolute percentage error between methods ranged from 34.2% to 42.7%. CONCLUSIONS: Paretic UL use within the first 4 weeks poststroke differs across levels of impairment in this exploratory study. Accelerometry and observation findings of paretic UL use were correlated and may be needed in different situations as they capture different information.