Physiotherapy - Research Publications
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ItemHigh-Level Mobility Assessment Tool Normative Values for Children(OXFORD UNIV PRESS INC, 2020-02)BACKGROUND: Physical therapists need to be able to evaluate high-level gross motor skills of children to determine their capacity to engage in activities such as running, jumping, hopping, and stair climbing. The High-Level Mobility Assessment Tool (HiMAT) has excellent interrater and retest reliability and is less susceptible to a ceiling effect than existing mobility scales in children who are 6 to 17 years old and have traumatic brain injury. OBJECTIVE: The purposes of this study were to develop normative HiMAT score ranges for Australian children and to investigate the relationship between children's HiMAT scores and their age, height, weight, and body mass index (BMI). DESIGN: This study used a cross-sectional design. METHODS: Children included in this study were 5 to 12 years old, had no condition affecting their mobility, could follow 2-stage instructions, and had written informed consent from their parent or guardian. A total 1091 children were assessed at their local school, where their height, weight, and HiMAT score were recorded. The relationships between children's age, height, weight, and BMI were summarized using Spearman rank correlations. Truncated regression models were used to determine the most appropriate predictor variable for developing sex-specific normative ranges. RESULTS: There was a positive correlation between children's HiMAT scores and their age, height, weight, and BMI. Age explained the most variability in HiMAT scores for both boys and girls. LIMITATIONS: The reliability, validity, and responsiveness of the HiMAT have not been tested across a broad range of children with mobility limitations. Normative data reported in this study are for Australian children only. CONCLUSIONS: HiMAT scores for children in this study increased with age, height, weight, and BMI. Age was the most appropriate variable for developing a normative dataset of HiMAT scores for children of primary school age.
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ItemReanimating hand function after spinal cord injury using nerve transfer surgery(Whitehouse Publishing, 2020-03)Loss of arm and hand function is a devastating consequence of cervical spinal cord injury. Tendon transfer surgery has traditionally been used to restore key functions including elbow extension, wrist extension and grasp and pinch. The more recent development of nerve transfer surgery enables direct restoration of voluntary control of these functions. While both types of surgery are safe and effective, nerve transfer surgery results in a more open, flexible and natural hand, with more subtle control for a range of activities of daily living.
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ItemHome-based or remote exercise testing in chronic respiratory disease, during the COVID-19 pandemic and beyond: A rapid review(SAGE PUBLICATIONS LTD, 2020-08-24)OBJECTIVES: To identify exercise tests that are suitable for home-based or remote administration in people with chronic lung disease. METHODS: Rapid review of studies that reported home-based or remote administration of an exercise test in people with chronic lung disease, and studies reporting their clinimetric (measurement) properties. RESULTS: 84 studies were included. Tests used at home were the 6-minute walk test (6MWT, two studies), sit-to-stand tests (STS, five studies), Timed Up and Go (TUG, 4 studies) and step tests (two studies). Exercise tests administered remotely were the 6MWT (two studies) and step test (one study). Compared to centre-based testing the 6MWT distance was similar when performed outdoors but shorter when performed at home (two studies). The STS, TUG and step tests were feasible, reliable (intra-class correlation coefficients >0.80), valid (concurrent and known groups validity) and moderately responsive to pulmonary rehabilitation (medium effect sizes). These tests elicited less desaturation than the 6MWT, and validated methods to prescribe exercise were not reported. DISCUSSION: The STS, step and TUG tests can be performed at home, but do not accurately document desaturation with walking or allow exercise prescription. Patients at risk of desaturation should be prioritised for centre-based exercise testing when this is available.
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ItemRehabilitation interventions need more than methodological standardisation: an individualised approach.(BMJ, 2020)OBJECTIVES: The main aim in the current study was to use a single-subject analysis to profile the physical performance characteristics of individuals within an injured group and a between-group approach to profile the group as a whole. These profiles were then used to inform single-subject and between-group rehabilitation interventions. METHODS: Fifty-three (28 with athletic groin pain and 25 non-injured) Gaelic football players (24.8 years±7.1 years; 179 cm±5.5 cm; 79.7 kg±9.2 kg) underwent 3D biomechanical analysis, which was used to measure a series of physical performance characteristics. The non-injured group was used to create a 'performance database' to compare the injured individuals, and a between-group analysis was also conducted. The scores from each analysis were used to inform the targets of interventions. RESULTS: The analysis highlighted the variety of profiles that existed across the tested individuals and that these profiles differed from that of the between-group analysis. By analysing individuals in a single-subject approach, detail can be seen that is lost with between-group analysis.
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ItemDifferences in Strength, Patient-Reported Outcomes, and Return-to-Play Rates Between Athletes With Primary Versus Revision ACL Reconstruction at 9 Months After Surgery(SAGE PUBLICATIONS INC, 2020-09)BACKGROUND: Patient-reported outcomes and return-to-play (RTP) rates are inferior after revision anterior cruciate ligament reconstruction (ACLR) compared with primary ACLR. Physical properties such as maximal, explosive, and reactive strength influence reinjury and RTP rates after ACLR. No study has compared these outcomes between revision and primary ACLR. PURPOSE: To compare maximal, explosive, and reactive strength of the ACLR limb, as well as patient-reported outcomes and RTP rates between primary and revision ACLR at 9 months after surgery. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A comparative study was performed at 9 months after surgery for 344 male athletes who had undergone ACLR (298 primary, 46 revision). Maximal strength of the ACLR limb was measured by means of isokinetic dynamometry. Explosive strength was measured by use of single-leg countermovement jump height, and reactive strength was measured by single-leg drop jump. Patient-reported outcomes and responses to RTP questionnaires were recorded for both groups. RESULTS: The primary ACLR group had higher scores than the revision ACLR group for single-leg countermovement jump height (P = .02) and single-leg drop jump reactive strength index (P = .01) on the ACLR limb. No significant difference was observed between groups on maximal strength of the quadriceps or hamstring, and no significant difference in limb symmetry index was observed between groups on any strength or jump test. The primary ACLR group demonstrated higher scores on the Marx Activity Rating Scale (P = .03) and the Anterior Cruciate Ligament-Return to Sport after Injury scale (P < .001). Athletes in the primary ACLR group were more likely to have returned to sport (P < .001). CONCLUSION: At 9 months after surgery, athletes who had undergone revision ACLR achieved maximal strength similar to that of athletes who had undergone primary ACLR. However, athletes who had revision ACLR demonstrated lower scores on explosive and reactive strength tests. Athletes who underwent revision ACLR had lower RTP rates at 9 months after surgery, potentially due to explosive and reactive strength deficits and lower perceived readiness for RTP.
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ItemAgreement between Inertia and Optical Based Motion Capture during the VU-Return-to-Play- Field-Test(MDPI, 2020-02)The validity of an inertial sensor-based motion capture system (IMC) has not been examined within the demands of a sports-specific field movement test. This study examined the validity of an IMC during a field test (VU®) by comparing it to an optical marker-based motion capture system (MMC). Expected accuracy and precision benchmarks were computed by comparing the outcomes of a linear and functional joint fitting model within the MMC. The kinematics from the IMC in sagittal plane demonstrated correlations (r2) between 0.76 and 0.98 with root mean square differences (RMSD) < 5, only the knee bias was within the benchmark. In the frontal plane, r2 ranged between 0.13 and 0.80 with RMSD < 10, while the knee and hip bias was within the benchmark. For the transversal plane, r2 ranged 0.11 to 0.93 with RMSD < 7, while the ankle, knee and hip bias remained within the benchmark. The findings indicate that ankle kinematics are not interchangeable with MMC, that hip flexion and pelvis tilt higher in IMC than MMC, while other measures are comparable to MMC. Higher pelvis tilt/hip flexion in the IMC can be explained by a one sensor tilt estimation, while ankle kinematics demonstrated a considerable level of disagreement, which is likely due to four reasons: A one sensor estimation, sensor/marker attachment, movement artefacts of shoe sole and the ankle model used.
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ItemNo Preview AvailableEffect of exercise on knee joint contact forces in people following medial partial meniscectomy: A secondary analysis of a randomised controlled trial(ELSEVIER IRELAND LTD, 2020-06)BACKGROUND: Arthroscopic partial meniscectomy may cause knee osteoarthritis, which may be related to altered joint loading. Previous research has failed to demonstrate that exercise can reduce medial compartment knee loads following meniscectomy but has not considered muscular loading in their estimates. RESEARCH QUESTION: What is the effect of exercise compared to no intervention on peak medial tibiofemoral joint contact force during walking using an electromyogram-driven neuromusculoskeletal model, following medial arthroscopic partial meniscectomy? METHODS: This is a secondary analysis of a randomized controlled trial (RCT). 41 participants aged between 30-50 years with medial arthroscopic partial meniscectomy within the past 3-12 months, were randomly allocated to either a 12-week, home-based, physiotherapist-guided exercise program or to no exercise (control group). Three-dimensional lower-body motion, ground reaction forces, and surface electromyograms from eight lower-limb muscles were acquired during self-selected normal- and fast-paced walking at baseline and follow-up. An electromyogram-driven neuromusculoskeletal model estimated medial compartment contact forces (body weight). Linear regression models evaluated between-group differences (mean difference (95% CI)). RESULTS: There were no significant between-group differences in the change (follow-up minus baseline) in first peak medial contact force during self-selected normal- or fast-paced walking (0.07 (-0.08 to 0.23), P = 0.34 and 0.01 (-0.19 to 0.22), P = 0.89 respectively). No significant between-group difference was found for change in second peak medial contact force during normal- or fast-paced walking (0.09 (-0.09 to 0.28), P = 0.31 and 0.02 (-0.17 to 0.22), P = 0.81 respectively). At the individual level, variability was observed for changes in first (range -26.2% to +31.7%) and second (range -46.5% to +59.9%) peak tibiofemoral contact force. SIGNIFICANCE: This is the first study to apply electromyogram-driven neuromusculoskeletal modelling to an exercise intervention in a RCT. While our results suggest that a 12-week exercise program does not alter peak medial knee loads after meniscectomy, within-participant variability suggests individual-specific muscle activation patterns that warrant further investigation.
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ItemNo Preview AvailableDesign, Delivery, Maintenance, and Outcomes of Peer-to-Peer Online Support Groups for People With Chronic Musculoskeletal Disorders: Systematic Review(JMIR PUBLICATIONS, INC, 2020-04-24)BACKGROUND: Online support groups (OSGs) are one way for people with chronic diseases, their family or friends, and health professionals to communicate, gain information, and provide social support. As the number of peer-to-peer OSGs for chronic musculoskeletal conditions grows, it is important to gain insight into the different designs of groups available, who is accessing them, if and how they may be effective, and what strategies are being used to implement or increase consumer engagement. OBJECTIVE: The objectives of this systematic review of people with musculoskeletal conditions were to (1) describe the design features (functions, usage options, moderation, and expert input) of peer-to-peer OSGs, (2) describe the characteristics of the individuals using peer-to-peer OSGs, (3) synthesize the evidence on outcomes of participation, and (4) identify strategies used in the delivery and maintenance of OSGs. METHODS: A search comprising terms related to the population (people with musculoskeletal disorders) and the intervention (peer-to-peer OSGs) was conducted in 6 databases. Results were filtered from 1990 (internet inception) to February 2019. Studies identified in the search were screened according to predefined eligibility criteria using a 2-step process. Quantitative studies were appraised by 2 reviewers using the Risk Of Bias In Non-Randomized Studies of Interventions tool. Qualitative studies were appraised by 2 different reviewers using the Critical Appraisal Skills Programme checklist. Extracted data were synthesized narratively. RESULTS: We examined 21 studies with low to moderate risk of bias. Of these studies, 13 studies included OSGs hosted on public platforms, 11 studies examined OSGs that were conducted in English, and 6 studies used moderators or peer leaders to facilitate engagement. Studies either reported the number of OSG members (n=1985 across all studies) or the number of posts (range: 223-200,000). The majority of OSG members were females who were not full-time employees and with varied levels of education. There were no randomized controlled trials measuring the efficacy of OSGs. Qualitative and quantitative studies identified empowerment, social support, self-management behavior, and health literacy as primary constructs to measure OSG efficacy. Neutral or marginal improvement was reported in these constructs. Sharing experiences and a greater level of engagement appeared to have an important influence on OSGs efficacy. The extent to which members posted on the website influenced engagement. CONCLUSIONS: Across a diverse range of designs, languages, included features, and delivery platforms, peer-to-peer OSGs for chronic musculoskeletal conditions attract predominantly female participants of all ages and education levels. The level of participation of a member appears to be related to their perceived benefit, health literacy, and empowerment. Future studies are needed to identify which design and maintenance strategies have superior efficacy and whether there are concomitant improvements in health outcomes for people with chronic musculoskeletal conditions resulting from participation in OSGs. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42018090326; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018090326.
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ItemNo Preview AvailableThe Efficacy of Higher Versus Lower Dose Exercise in Rotator Cuff Tendinopathy: A Systematic Review of Randomized Controlled Trials(W B SAUNDERS CO-ELSEVIER INC, 2020-10)OBJECTIVES: To compare the effectiveness and harms of higher exercise dose, including higher exercise load or higher volume, with lower exercise dose (lower load or lower volume) in individuals with rotator cuff tendinopathy. DESIGN: Systematic review. DATA SOURCES: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CINAHL from inception to March 2019. STUDY SELECTION: Randomized controlled trials comparing higher versus lower dose exercise that investigated function and pain (overall, activity, night) and adverse event outcomes were independently determined by 2 reviewers. DATA EXTRACTION: Two authors independently extracted data and assessed risk of bias using the Cochrane tool. The primary endpoint was at least 6 weeks to 3 months (other endpoints included up to 6 weeks and beyond 3 months) and the Grades of Recommendation, Assessment, Development and Evaluation was used to assess evidence certainty. DATA SYNTHESIS: Three trials (N=283), none at low risk of bias for all domains, were included. Low-certainty evidence (1 trial, N=102) indicated improved function (20 points [95% confidence interval, 12-28] on a 0-100 point scale) with higher load and volume exercise at 3 months, but little or no clinically important between-group difference in activity or night pain (overall pain not reported). Very low-certainty evidence (1 trial, N=120) indicated higher load exercise conferred no function benefits over lower load exercise at 6 weeks. Very low-certainty evidence (1 trial, N=61) indicated benefit of uncertain clinical importance in function with higher versus lower volume exercise at 3 months and clinically important benefit at more than 3 months (pain outcomes not reported). The risk of adverse events was uncertain. CONCLUSIONS: There are few studies that have investigated higher dose exercise for rotator cuff tendinopathy. There was low to very low certainty and conflicting evidence regarding the value of higher exercise dose in individuals with rotator cuff tendinopathy.
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ItemEffect of Ankle Plantar Flexor Spasticity Level on Balance in Patients With Stroke: Protocol for a Cross-Sectional Study.(JMIR Publications Inc., 2020-08-21)BACKGROUND: The lower limb spasticity after stroke can affect the balance and gait of patients with stroke. OBJECTIVE: The aim of this study is to assess the effects of ankle plantar flexor spasticity level on balance in patients with stroke. METHODS: Patients with stroke were recruited from neurology and physiotherapy clinics in Tehran, Iran. Based on the level of ankle plantar flexor spasticity according to the Modified Modified Ashworth Scale (MMAS), the eligible patients with stroke were divided into 2 groups: high spasticity (MMAS score≥2) and low spasticity (MMAS score<2). The primary outcome measures were the MMAS scores, Activities-Specific Balance Confidence questionnaire scores, eyes-open and eyes-closed posturography measures, and Timed Up and Go test results. The secondary outcome measures were the ankle passive range of motion and ankle joint proprioception. The t test, mixed model univariate analysis of variance, and Spearman rank correlation were used for statistical analysis. RESULTS: Data collection and statistical analysis are complete. The interpretation of results is underway. We expect the results to be published in winter 2020. CONCLUSIONS: We believe that patients with high ankle plantar flexor spasticity after stroke will demonstrate greater balance dysfunction, which will worsen with impaired proprioception, passive range of motion, and eyes closed. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/16045.